559 results on '"Li Wei Lo"'
Search Results
102. Long-Term Outcome of Non-Sustained Ventricular Tachycardia in Structurally Normal Hearts.
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Chin-Yu Lin, Shih-Lin Chang, Fa-Po Chung, Yun-Yu Chen, Yenn-Jiang Lin, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Tze-Fan Chao, Jo-Nan Liao, Yao-Ting Chang, Chung-Hsing Lin, Suresh Allamsetty, Rohit Walia, Abigail Louise D Te, Shinya Yamada, Shuo-Ju Chiang, Hsuan-Ming Tsao, and Shih-Ann Chen
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Medicine ,Science - Abstract
The impact of non-sustained ventricular tachycardia (NSVT) on the risk of thromboembolic event and clinical outcomes in patients without structural heart disease remains undetermined. This study aimed to evaluate the association between NSVT and clinical outcomes.The study population of 5903 patients was culled from the "Registry of 24-hour ECG monitoring at Taipei Veterans General Hospital" (REMOTE database) between January 1, 2002 and December 31, 2004. Of that total, we enrolled 3767 patients without sustained ventricular tachycardia, structural heart disease, and permanent pacemaker. For purposes of this study, NSVT was defined as 3 or more consecutive beats arising below the atrioventricular node with an RR interval of 100 beats/min) and lasting < 30 seconds.There were 776 deaths, 2042 hospitalizations for any reason, 638 cardiovascular (CV)-related hospitalizations, 350 ischemic strokes, 409 transient ischemic accident (TIA), 368 new-onset heart failure (HF), and 260 new-onset atrial fibrillation (AF) with a mean follow-up duration of 10 ± 1 years. In multivariate analysis, the presence of NSVT was independently associated with death (hazard ratio [HR]: 1.362, 95% confidence interval [CI]: 1.071-1.731), CV hospitalization (HR: 1.527, 95% CI: 1.171-1.992), ischemic stroke (HR: 1.436, 95% CI: 1.014-2.032), TIA (HR 1.483, 95% CI: 1.069-2.057), and new-onset HF (HR: 1.716, 95% CI: 1.243-2.368). There was no significant association between the presence of NSVT and all-cause hospitalization or new-onset AF.In patients without structural heart disease, presence of NSVT on 24-hour monitoring was independently associated with death, CV hospitalization, ischemic stroke, TIA, and new onset heart failure.
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- 2016
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103. Rhodiola crenulata reduces ventricular arrhythmia through mitigating the activation of IL-17 and inhibiting the MAPK signaling pathway
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Ya Wen Hsiao, Shuen Hsin Liu, Yenn Jiang Lin, Fa Po Chung, Shih Lin Chang, Shih Ann Chen, Yu Feng Hu, Satoshi Higa, Yung Nan Tsai, Yu Ting Huang, Li Wei Lo, and Shien-Fong Lin
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0301 basic medicine ,MAPK/ERK pathway ,MAP Kinase Signaling System ,p38 mitogen-activated protein kinases ,Anti-Inflammatory Agents ,Stimulation ,030204 cardiovascular system & hematology ,Pharmacology ,Electrocardiography ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Glucosides ,Phenols ,Fibrosis ,NLR Family, Pyrin Domain-Containing 3 Protein ,Rhodiola ,Animals ,Medicine ,Pharmacology (medical) ,RNA, Messenger ,Chemokine CCL20 ,Dose-Response Relationship, Drug ,biology ,business.industry ,Interleukin-17 ,Salidroside ,Arrhythmias, Cardiac ,General Medicine ,medicine.disease ,biology.organism_classification ,CD4 Lymphocyte Count ,Disease Models, Animal ,Drug Combinations ,030104 developmental biology ,chemistry ,Apoptosis ,Rabbits ,Interleukin 17 ,Inflammation Mediators ,Cardiology and Cardiovascular Medicine ,business ,Signal Transduction - Abstract
Ventricular arrhythmia (VA) is related to inflammatory activity. Rhodiola crenulate (RC) and its main active component, salidroside, have been reported as anti-inflammatory agents. The aim of this study was to demonstrate the effect of RC and salidroside in preventing VA via the inhibition of IL-17 in an ischemic heart failure (HF) model. Rabbit HF models were established by coronary artery ligation for 4 weeks. These rabbits were treated with RC (125, 250, 500 mg/kg) and salidroside (9.5 mg/kg) once every 2 days for 4 weeks. WBC, serum biochemistry, ECG, and the expression of CD4+ T cells were measured every 2 weeks. The mRNA and protein expressions of IL-17 were measured by real time-PCR, ELISA, and Western blotting after RC and salidroside treatment for 4 weeks. Open-chest epicardial catheter stimulation was performed for VA provocation. After RC and salidroside treatment in HF left ventricle, (1) the levels of WBC and CD4+ T cells decreased, (2) the expression of IL-17 and its downstream target genes, IL-6, TNF-α, IL-1β, IL-8, and CCL20, reduced, (3) the level of NLRP3 inflammasome was decreased, (4) fibrosis and collagen production were significantly downregulated, (5) p38 MAPK and ERK1/2 phosphorylation were attenuated, (6) the inducibility of VA was decreased, and (7) the levels of Kir2.1, Nav1.5, NCX, PLB, SERCA2a and RyR were up-regulated. RC inhibited the expression of IL-17 and its downstream target genes that were mediated by activation of several MAPKs, which decreased the levels of fibrosis and apoptosis and suppressed VA.
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- 2020
104. Left Ventricular Electromechanical Remodeling Detected by Acoustic Cardiography in Paroxysmal Atrial Fibrillation
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Chin Yu Lin, Yao Ting Chang, Li Wei Lo, Jo Nan Liao, Kuo Li Pan, Shih Ann Chen, Yenn Jiang Lin, Chung Hsing Lin, Shinya Yamada, Shih Lin Chang, Abigail Louise D. Te, Fa Po Chung, Yu Feng Hu, and Tze Fan Chao
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0301 basic medicine ,medicine.medical_specialty ,Ejection fraction ,Paroxysmal atrial fibrillation ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Pharmaceutical Science ,Systolic function ,030204 cardiovascular system & hematology ,Ablation ,law.invention ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,law ,Internal medicine ,Genetics ,medicine ,Cardiology ,Molecular Medicine ,Cardiology and Cardiovascular Medicine ,business ,Genetics (clinical) ,Paroxysmal AF - Abstract
This study aimed to investigate the electromechanical function detected by acoustic cardiography before and after radiofrequency ablation therapy (RFA) in paroxysmal AF (PAF) patients with preserved left ventricular ejection fraction (LVEF). Seventy-five symptomatic PAF patients and 69 patients without arrhythmia were enrolled. Thirty-seven PAF patients received RFA therapy. Acoustic cardiographic exam was performed to check S3 and S4 heart sound, electromechanical activation time (EMAT), LV systolic time percentage (LVST), and systolic dysfunction index (SDI) in all participants. Furthermore, 37 PAF patients also received follow-up acoustic cardiography postRFA. PAF had impaired electromechanical systolic function compared with health participants (%EMAT 14.69 ± 3.62 vs. 10.84 ± 2.62; %LVST 40.83 ± 5.14 vs. 36.70 ± 3.87; SDI 4.75 ± 1.61 vs. 3.26 ± 0.96 all p
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- 2020
105. Resistin as a Biomarker for the Prediction of Left Atrial Substrate and Recurrence in Patients with Drug-Refractory Atrial Fibrillation Undergoing Catheter Ablation
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Shih Lin Chang, Ya Wen Hsiao, Jo Nan Liao, Ting Yung Chang, Yenn Jiang Lin, Tze Fan Chao, Shu Mei Guo, Fa Po Chung, Yu Feng Hu, Li Wei Lo, Ta Chuan Tuan, Chin Yu Lin, Shih Ann Chen, and Satoshi Higa
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Inflammation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Resistin ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,Catheter ,Catheter Ablation ,Cardiology ,Biomarker (medicine) ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,hormones, hormone substitutes, and hormone antagonists - Abstract
Resistin is an adipocytokine that is abundantly secreted from lipid cells and is related to the inflammatory process and cardiometabolic diseases. This study aimed to examine the role of resistin on inflammation and its effect on the clinical outcome of patients with atrial fibrillation (AF) following catheter ablation.A total of 108 patients (56.9 ± 12.0 years, 76.8% male) with symptomatic and drug-refractory AF undergoing catheter ablation were enrolled. Inflammatory biomarkers and epicardial fat volume by contrast computed tomography (CT) images were assessed in all patients before the procedure. Baseline resistin correlated with epicardial fat volume, tumor necrosis factor-α (TNF-α), and left atrial (LA) scar area. After the index procedure, the univariate analysis revealed that hypertension, persistent AF, LA diameter, and plasma resistin level were related to recurrent atrial arrhythmia. Multivariate regression analysis revealed that persistent AF, LA diameter, and plasma resistin level all independently predicted recurrent atrial arrhythmia after ablation. Plasma resistin with a level higher than 777 (pg/mL) could predict recurrence following catheter ablation of AF.High plasma resistin level is associated with poor left atrial substrate, high epicardial fat volume, and elevated TNF-α level in patients with AF. Plasma resistin may predict the recurrence of atrial arrhythmia after ablation.
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- 2020
106. Identification of critical isthmus using coherent mapping in patients with scar‐related atrial tachycardia
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Cheng I. Wu, Shin Huei Liu, Isaiah C. Lugtu, Li Wei Lo, Chye Gen Chin, Chun Chao Chen, Yu Feng Hu, Ching Han Liu, Fa Po Chung, Chung Hsing Lin, Sung Hao Huang, Jennifer Jeanne B. Vicera, Wen Han Cheng, Po Tseng Lee, Shih Lin Chang, Ching Yao Chou, Tze Fan Chao, Ting Yung Chang, Shih Ann Chen, Jo Nan Liao, Le Phat Tai, Chin Yu Lin, Yenn Jiang Lin, Ta Chuan Tuan, Chih Min Liu, and Chieh Mao Chuang
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Male ,Tachycardia ,Electroanatomic mapping ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Action Potentials ,Pilot Projects ,030204 cardiovascular system & hematology ,Focal origin ,Nerve conduction velocity ,Cicatrix ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Tachycardia, Supraventricular ,medicine ,Humans ,In patient ,Prospective Studies ,030212 general & internal medicine ,Atrial tachycardia ,Aged ,Observer Variation ,business.industry ,Reproducibility of Results ,Signal Processing, Computer-Assisted ,Middle Aged ,Ablation ,Treatment Outcome ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
INTRODUCTION Accurate identification of slow conducting regions in patients with scar-related atrial tachycardia (AT) is difficult using conventional electrogram annotation for cardiac electroanatomic mapping (EAM). Estimating delays between neighboring mapping sites is a potential option for activation map computation. We describe our initial experience with CARTO 3 Coherent Mapping (Biosense Webster Inc,) in the ablation of complex ATs. METHODS Twenty patients (58 ± 10 y/o, 15 males) with complex ATs were included. We created three-dimensional EAMs using CARTO 3 system with CONFIDENSE and a high-resolution mapping catheter (Biosense Webster Inc). Local activation time and coherent maps were used to aid in the identification of conduction isthmus (CI) and focal origin sites. System-defined slow or nonconducting zones and CI, defined by concealed entrainment (postpacing interval
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- 2020
107. 2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS
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EB Saad, Li Wei Lo, Younghoon Kim, Roderick Tung, Shih Ann Chen, Yun Gi Kim, Akihiko Nogami, Martin K. Stiles, Christian Sticherling, Zbigniew Kalarus, Seongwook Han, Carlos E. Guzman, Carlos Labadet, Roland Tilz, Sabine Ernst, Yenn Jian Lin, and John L. Sapp
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Tachycardia ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Clinical Review ,Statement (logic) ,business.industry ,MEDLINE ,Expert consensus ,medicine.disease ,lcsh:RC666-701 ,medicine ,Medical emergency ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
108. The clinical and electroanatomical characteristics of paroxysmal lone atrial fibrillation
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Ta-Chuan Tuan, Shih-Lin Chang, Yenn-Jiang Lin, Yu-Feng Hu, Li-Wei Lo, Tze-Fan Chao, Fa-Po Chung, Ching-Tai Tai, and Shih-Ann Chen
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Voltage ,Lone atrial fibrillation ,Pulmonary vein isolation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: Lone atrial fibrillation (AF) is defined as AF occurring in the absence of any other cardiovascular disease. The prognosis of patients with lone AF varies in previous studies, and the clinical and electroanatomical characteristics of lone AF are unclear. The purpose of this study was to investigate the clinical characteristics of lone AF. Methods: This study included 203 patients (52±13 years old, 144 males) that underwent circumferential pulmonary vein isolation (CPVI) for paroxysmal AF. The mean voltage and total activation time of the individual atria were obtained by using a NavX mapping system and were compared for patients with lone and non-lone AF. Several parameters, including the age, gender, AF duration, and left atrial (LA) diameter were analyzed. Results: Compared with non-lone AF patients, lone AF patients were significantly younger (49±13 years old vs. 58±11 years old, p
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- 2012
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109. Application of dynamic display technology to identify gaps after pulmonary vein isolation in catheter ablation of atrial fibrillation
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Wei-Tso Chen, Li-Wei Lo, Wen-Chin Tsai, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, Jo-Nan Liao, Ta-Chuan Tuan, Tze-Fan Chao, Chin-Yu Lin, Ting-Yung Chang, Ling Kuo, Chih-Min Liu, Shin-Huei Liu, Wen-Han Cheng, Linda Lin, An Nu-Khanh Ton, Chu-Yu Hsu, Chhay Chheng, Ahmed Elimam, Hui-Sheng Wang, Ming-Ren Kuo, Pei-Heng Kao, and Shih-Ann Chen
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Technology ,Treatment Outcome ,Pulmonary Veins ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Cardiology and Cardiovascular Medicine - Abstract
The identification of post pulmonary vein isolation (PVI) gaps by activation and voltage maps is time-consuming. This study aimed to investigate the characteristics, efficiency and accuracy of LiveView dynamic display module (EnSite™ Dynamic Display; Abbott, Abbott Park, IL, USA) in unmasking post PVI gaps and conduction block line.Twenty four patients with paroxysmal atrial fibrillation (PAF) who failed to achieve first-pass PVI or with recurrent PAF were enrolled. Ninety-six pulmonary veins (PVs) were evaluated, and gaps were identified in 25 (26.0%) PVs. The gap location was confirmed by activation and propagation maps; 110 frames on gaps and 118 frames on block lines were analyzed by using LiveView module. We defined isochronal crowding in the local activation time (LAT) mode as three colors between two adjacent electrodes. Each frame was classified as with or without isochronal crowding in LAT mode and one/continuous color or isochronal discontinuity in reentrant mode. The gray color inside the PVs was considered to represent conduction block.The isochronal crowding could be found on both gap and block line in LAT mode, whereas isochronal discontinuity only presented on the block line in reentrant mode. The sensitivity and specificity of isochronal discontinuity or gray color in reentrant mode to identify block line were 61.0% and 100%, respectively. The sensitivity and specificity of isochronal crowding or gray color in LAT mode to identify block line were 71.2% and 71.8%, respectively.Reentrant mode in LiveView module is very specific in identifying block lines. We proposed an efficient, practical algorithm to differentiate the block line from PV gaps.
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- 2021
110. Risks of Ventricular Tachyarrhythmia and Mortality in Patients with Amyloidosis - A Long-Term Cohort Study
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Yun-Yu, Chen, Ming-Jen, Kuo, Fa-Po, Chung, Yenn-Jiang, Lin, Kuo-Liong, Chien, Yu-Cheng, Hsieh, Shih-Lin, Chang, Li-Wei, Lo, Yu-Feng, Hu, Tze-Fan, Chao, Jo-Nan, Liao, Ting-Yung, Chang, Chin-Yu, Lin, Ling, Kuo, Ta-Chuan, Tuan, Cheng-I, Wu, Chih-Min, Liu, Shin-Huei, Liu, Cheng-Hung, Li, and Shih-Ann, Chen
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Original Article - Abstract
BACKGROUND: The presence of ventricular tachycardia (VT) is associated with higher mortality. The annual incidence of VT after a diagnosis of amyloidosis and the associated cardiovascular (CV) outcomes have not been well assessed in a large cohort. METHODS: A total of 12,139 amyloidosis patients were identified from the Taiwan National Health Insurance Research Database. Non-amyloidosis group was matched 1:1 for age, gender, hypertension, and diabetes mellitus (DM) to the amyloidosis group using a propensity score. Analysis of the risk of CV outcomes was conducted. We also analyzed the incidence of cardiac amyloidosis (CA). RESULTS: The incidence rates of amyloidosis and CA were 6.54 and 0.61 per 100,000 person-years, respectively. Multivariable analysis revealed that the risk of VT was higher in both the amyloidosis [hazard ratio (HR): 7.90; 95% confidence interval (CI): 4.49-13.9] and CA (HR: 153.3, 95% CI: 54.3-432.7) groups. In the amyloidosis group, the risk of heart failure (HF)-related hospitalization, CV death, and all-cause death was also higher. Amyloidosis was associated with a higher CV mortality rate following VT (HR: 1.50; 95% CI: 1.07-2.12). The onset of a new VT event in patients with amyloidosis was associated with HF, DM, chronic liver disease, and anti-arrhythmic drug use. CONCLUSIONS: In this nationwide cohort study, the incidence rates of amyloidosis and CA were 6.54 and 0.61 per 100,000 person-years, respectively. The long-term risks of VT and CV mortality were higher in the patients with amyloidosis and CA. The patients with amyloidosis had a poorer prognosis following VT events, highlighting the importance of continuous monitoring in these patients.
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- 2021
111. BS-526-03 RENAL SYMPATHETIC DENERVATION PREVENTS LIFE-THREATENING ARRHYTHMIAS THROUGH AUTONOMIC REVERSE REMODELING IN CHRONIC SLEEP DISORDERED BREATHING
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Li-Wei Lo, Yu-Hui Chou, Shin-Huei Liu, Wen-Han Cheng, Wei-Lun Lin, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
112. PO-660-02 EFFECTS OF ESTROGEN SUPPLEMENT ON VENTRICULAR ELECTRICAL REMODELING IN A RABBIT MODEL OF ESTROGEN DEFICIENCY
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Shin-Huei Liu, Li-Wei Lo, Yu-Hui Chou, Wei-Lun Lin, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
113. PO-664-03 A NOVEL PREDICTOR OF EPICARDIAL BREAKTHROUGH DURING CATHETER ABLATION OF PERIMITRAL ATRIAL FLUTTER
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Chheng Chhay, Chu-Yu Hsu, Shih-Lin Chang, Yenn-Jiang Lin, Li-Wei Lo, Tze-Fan Chao, Fa-Po Chung, Jo-Nan Liao, Ting-Yung Chang, Chin-Yu Lin, TA-CHUAN TUAN, Ling Kuo, Chih-Min Liu, Shin-Huei Liu, Pei Heng Kao, Wei Tso Chen, Ming-Jen Kuo, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
114. PO-638-05 NONLINEAR HEART RATE DYNAMICS IN PAROXYSMAL AF PATIENTS WITH AND WITHOUT RECURRENCE AFTER PULMONARY VEIN ISOLATION
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Ting-Wei Ernie Liao, Li-Wei Lo, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Tze-Fan Chao, Jo-Nan Liao, Hui-Wen Yang, Men-Tzung Lo, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
115. PO-706-06 A DEEP LEARNING-ENABLED ELECTROCARDIOGRAM MODEL FOR THE IDENTIFICATION OF PRESENCE OF ATRIAL FIBRILLATION DURING SINUS RHYTHM
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Chih-Min Liu, Wei-Wen Chen, Wei Shiang Chen, Yu-Feng Hu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Fa-Po Chung, Tze-Fan Chao, Ta-chuan TUAN, Jo-Nan Liao, Chin-Yu Lin, Ting-Yung Chang, Ling Kuo, Cheng-I Wu, Shin-Huei Liu, Henry Horng-Shing Lu, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
116. Multimodal Artificial Neurological Sensory-Memory System Based on Flexible Carbon Nanotube Synaptic Transistor
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Li-Wei Lo, Junyi Zhao, Nelson Sepúlveda, Yunqi Cao, Chuan Wang, and Haochuan Wan
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Signal processing ,Transistors, Electronic ,Human intelligence ,Computer science ,Nanotubes, Carbon ,Sensory memory ,Models, Neurological ,General Engineering ,General Physics and Astronomy ,Classical conditioning ,Transduction (psychology) ,Memorization ,Associative learning ,Human–computer interaction ,Artificial Intelligence ,Biomimetics ,Synaptic plasticity ,Synapses ,General Materials Science ,Neural Networks, Computer - Abstract
As the initial stage in the formation of human intelligence, the sensory-memory system plays a critical role for human being to perceive, interact, and evolve with the environment. Electronic implementation of such biological sensory-memory system empowers the development of environment-interactive artificial intelligence (AI) that can learn and evolve with diversified external information, which could potentially broaden the application of the AI technology in the field of human-computer interaction. Here, we report a multimodal artificial sensory-memory system consisting of sensors for generating biomimetic visual, auditory, tactile inputs, and flexible carbon nanotube synaptic transistor that possesses synapse-like signal processing and memorizing behaviors. The transduction of physical signals into information-containing, presynaptic action potentials and the synaptic plasticity of the transistor in response to single and long-term action potential excitations have been systematically characterized. The bioreceptor-like sensing and synapse-like memorizing behaviors have also been demonstrated. On the basis of the memory and learning characteristics of the sensory-memory system, the well-known psychological model describing human memory, the "multistore memory" model, and the classical conditioning experiment that demonstrates the associative learning of brain, "Pavlov's dog's experiment", have both been implemented electronically using actual physical input signals as the sources of the stimuli. The biomimetic intelligence demonstrated in this neurological sensory-memory system shows its potential in promoting the advancement in multimodal, user-environment interactive AI.
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- 2021
117. Arrhythmogenic right ventricular cardiomyopathy: diverse substrate characteristics and ablation outcome
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Shih-Ann Chen, Shin-Huei Liu, Chih-Min Liu, Cheng-I Wu, Ling Kuo, Ting-Yung Chang, Chin-Yu Lin, Jo-Nan Liao, Tze-Fan Chao, Ta-Chuan Tuan, Yu-Feng Hu, Shih-Lin Chang, Li-Wei Lo, Yenn-Jiang Lin, Fa-Po Chung, and Wen-Han Cheng
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arrhythmogenic right ventricular cardiomyopathy ,General Medicine ,epicardial approach ,Death, Sudden, Cardiac ,Treatment Outcome ,RC666-701 ,Ventricular Fibrillation ,Catheter Ablation ,Tachycardia, Ventricular ,Diseases of the circulatory (Cardiovascular) system ,Humans ,ventricular tachycardia ,Cardiology and Cardiovascular Medicine ,substrates ,Arrhythmogenic Right Ventricular Dysplasia - Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy caused by defective desmosomal proteins. The typical histopathological finding of ARVC is characterized by progressive fibrofatty infiltration of the right ventricle due to the dysfunction of cellular adhesion molecules, thus, developing arrhythmogenic substrates responsible for the clinical manifestation of ventricular tachycardia/fibrillation (VT/VF). Current guidelines recommend implantable cardiac defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in ARVC, especially for those experiencing VT/VF or aborted SCD, while antiarrhythmic drugs, despite their modest effectiveness and several undesirable adverse effects, are frequently used for those experiencing episodes of ICD interventions. Given the advances in mapping and ablation technologies, catheter ablation has been implemented to eliminate drug-refractory VT in ARVC. A better understanding of the pathogenesis, underlying arrhythmogenic substrates, and putative VT isthmus in ARVC contributes to a significant improvement in ablation outcomes through comprehensive endocardial and epicardial approaches. Regardless of ablation strategies, there is a diversity of arrhythmogenic substrates in ARVC, which could partly explain the nonuniform ablation outcome and long-term recurrences and reflect the role of potential factors in the modification of disease progression and triggering of arrhythmic events.
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- 2021
118. Comparison of lesion characteristics between conventional and high-power short-duration ablation using contact force-sensing catheter in patients with paroxysmal atrial fibrillation
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Chieh Mao Chuang, Ting Chun Huang, Ankit Jain, Chun Chao Chen, Cheng I. Wu, Vu Van Ba, Po Tseng Lee, Ting Yung Chang, Fa Po Chung, Jennifer Jeanne B. Vicera, Chin Yu Lin, Shih Ann Chen, Li Wei Lo, Isaiah C. Lugtu, Chih Min Liu, Yenn Jiang Lin, Yu Feng Hu, and Shih Lin Chang
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Male ,medicine.medical_specialty ,Time Factors ,Contact force-guided ablation ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Operative Time ,Force time integral ,Pulmonary vein isolation ,Lesion ,Sex Factors ,Recurrence ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,In patient ,Angiology ,business.industry ,Research ,Age Factors ,Voltage ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,Cardiac surgery ,Catheter ,Smart Materials ,Treatment Outcome ,Pulmonary Veins ,Case-Control Studies ,RC666-701 ,Catheter Ablation ,Female ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Anti-Arrhythmia Agents ,High-power short-duration ablation - Abstract
Background Transmural lesion creation is essential for effective atrial fibrillation (AF) ablation. Lesion characteristics between conventional energy and high-power short-duration (HPSD) setting in contact force-guided (CF) ablation for AF remained unclear. Methods Eighty consecutive AF patients who received CF with conventional energy setting (power control: 25–30 W, force–time integral = 400 g s, n = 40) or with HPSD (power control: 40–50 W, 10 s, n = 40) ablation were analyzed. Of them, 15 patients in each conventional and HPSD group were matched by age and gender respectively for ablation lesions analysis. Type A and B lesions were defined as a lesion with and without significant voltage reduction after ablation, respectively. The anatomical distribution of these lesions and ablation outcomes among the 2 groups were analyzed. Results 1615 and 1724 ablation lesions were analyzed in the conventional and HPSD groups, respectively. HPSD group had a higher proportion of type A lesion compared to conventional group (P P = 0.04). The procedure time and ablation time were significantly shorter in the HPSD group than that in the conventional group (91.0 ± 12.1 vs. 124 ± 14.2 min, P = 0.03; 30.7 ± 19.2 vs. 57.8 ± 21 min, P = 0.02, respectively). At a mean follow-up period of 11 ± 1.4 months, there were 13 and 7 patients with recurrence in conventional and HPSD group respectively (P = 0.03). Conclusion Optimal ablation lesion characteristics and distribution after conventional and HPSD ablation differed significantly. HPSD ablation had shorter ablation time and lower recurrence rate than did conventional ablation.
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- 2021
119. Deep Sedation with Intravenous Anesthesia Is Associated with Outcome in Patients Undergoing Cryoablation for Paroxysmal Atrial Fibrillation
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Ankit Jain, Cheng I. Wu, Shih Ann Chen, Satoshi Higa, Chih-Min Liu, Li Wei Lo, Ting Yung Chang, Sugako Ishigaki, Yenn Jiang Lin, Isaiah C. Lugtu, Fa Po Chung, Shih Lin Chang, Yu Feng Hu, Akira Maesato, Ta Chuan Tuan, Abigail Louise D. Te, Jo Nan Liao, Chin Yu Lin, Tze Fan Chao, and Ling Kuo
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Male ,Sedation ,medicine.medical_treatment ,Cryosurgery ,Pulmonary vein ,Atrial Fibrillation ,medicine ,Humans ,Local anesthesia ,Aged ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Cryoablation ,General Medicine ,Middle Aged ,Ablation ,Intravenous anesthesia ,Anesthesia ,Anesthesia, Intravenous ,Female ,medicine.symptom ,Deep Sedation ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Whether deep sedation with intravenous anesthesia will affect the recurrence after cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (AF) is yet to be examined. Thus, in this study, we hypothesize that there is difference in terms of the recurrence between local anesthesia and deep sedation with intravenous anesthesia after an index ablation procedure.In total, 109 patients were enrolled and received CBA, of which 68 (58.2 years) patients underwent pulmonary vein (PV) isolation with a local anesthesia (group 1) and 41 patients (63.2 years) underwent PV isolation with deep sedation using intravenous anesthesia (group 2).During the index procedure, isolation of all major PVs was achieved in 66 patients in group 1 and in 41 patients in group 2. There was no difference in non-PV triggers between the two groups. The periprocedural complication was found to be similar between the two groups (2.9% in group 1 and 4.9% in group 2). Further, 17 patients in group 1 and 4 patients in group 2 experienced recurrences after a follow-up of 19.3 months (P = 0.019). Repeat procedures revealed similar PV reconnection rates between the two groups. It has also been noted that the number of reconnected PV and incidence of atypical flutter seem to increase in group 1.Deep sedation with intravenous anesthesia during CBA for paroxysmal AF is safe and had a better long-term outcome than those with local anesthesia.
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- 2021
120. Percutaneous Left Atrial Appendage Closure Using an Occluder Device: A Single Center Experience
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Isaiah C, Lugtu, Wen-Han, Cheng, Shih-Lin, Chang, Shin-Huei, Liu, Li-Wei, Lo, and Shih-Ann, Chen
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Original Article ,cardiovascular diseases - Abstract
BACKGROUND: Left atrial appendage (LAA) is the main source of thrombus formation, and occlusion of this structure decreases the risk of stroke in patients with atrial fibrillation. OBJECTIVES: We aimed to describe the feasibility, safety and outcomes of percutaneous LAA closure using an occluder device, and to evaluate residual LAA contrast leak detected on computed tomography (CT) imaging in patients who underwent implantation in our institution. METHODS: Consecutive patients of Taipei Veterans General Hospital who underwent percutaneous implantation of an LAA occluder (LAAO) were retrospectively collected and analyzed. RESULTS: A total of 23 patients were included with a median age of 67 years (42-87) and median CHA(2)DS(2)-VASc score of 4 (1-7). The most frequent indication for intervention was bleeding while on oral anticoagulation treatment. After a mean follow-up of 31.17 ± 25.10 months, successful device implantation was achieved in 95.7% of the patients. There was no occurrence of death, stroke, device embolization, acute ST elevation myocardial infarction, major bleeding requiring invasive treatment or blood transfusion, inguinal hematoma or major bleeding related to antiplatelet therapy. One patient had cardiac tamponade, 1 had intra-procedural thrombus formation, 1 had impingement of mitral valve leaflet, and 1 had device-related thrombosis. Of 12 patients who underwent CT post- implantation, 6 had residual contrast leak into the LAA, one third of those who had peri-device leak. CONCLUSIONS: Percutaneous implantation of an LAAO appeared to be feasible with a low risk of major complications.
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- 2021
121. Generation of IBMS-iPSC-015, -016, -017 human induced pluripotent stem cells (IBMSi013-A, IBMSi014-A, and IBMSi015-A) derived from patients with atrial fibrillation
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Ming Heng Tsai, Chi Ying F. Huang, Li Wei Lo, Yueh Ting Chiu, Huai En Lu, Shih Lin Chang, Patrick C.H. Hsieh, Yu Feng Hu, Ching-Ying Huang, Yenn Jiang Lin, Hui Wen Ko, Darien Zhing Herr Chan, and Shih Ann Chen
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0301 basic medicine ,Pluripotent Stem Cells ,Heart disease ,QH301-705.5 ,Induced Pluripotent Stem Cells ,Germ layer ,Biology ,Peripheral blood mononuclear cell ,Cell Line ,03 medical and health sciences ,0302 clinical medicine ,Atrial Fibrillation ,medicine ,Humans ,Human Induced Pluripotent Stem Cells ,Biology (General) ,Induced pluripotent stem cell ,Atrial fibrillation ,Cell Differentiation ,Cell Biology ,General Medicine ,medicine.disease ,030104 developmental biology ,Cell culture ,Cancer research ,Leukocytes, Mononuclear ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
Atrial fibrillation is the most common heart disease in the world, with around 35 million patients in 2020. Here we reported the generation of IBMS-iPSC-015-06, IBMS-iPSC-016-06, and IBMS-iPSC-017-02 as human induced pluripotent stem cell (iPSC) lines from patients' peripheral blood mononuclear cells (PBMCs) with atrial fibrillation. The cell lines expressed properties of pluripotent stem cells, including pluripotent markers and the ability to differentiate into three germ layers. These cell lines served as suitable models for studying alternative therapies of atrial fibrillation.
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- 2021
122. Generation of IBMS-iPSC-021, -022, -023 human induced pluripotent stem cells (IBMSi016-A, IBMSi017-A, and IBMSi018-A) derived from patients with the ALDH2 rs671 polymorphism
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Huai En Lu, Cheng Hao Wen, Yu Feng Hu, Shih Lin Chang, Shih Ann Chen, Shih Han Syu, Yueh Ting Chiu, Yenn Jiang Lin, Patrick C.H. Hsieh, Darien Zhing Herr Chan, Ching-Ying Huang, Ming Heng Tsai, Chi Ying F. Huang, and Li Wei Lo
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0301 basic medicine ,QH301-705.5 ,Induced Pluripotent Stem Cells ,Aldehyde dehydrogenase ,medicine.disease_cause ,Polymorphism, Single Nucleotide ,Cell Line ,03 medical and health sciences ,Exon ,0302 clinical medicine ,Polymorphism (computer science) ,medicine ,Humans ,Biology (General) ,Induced pluripotent stem cell ,ALDH2 ,Mutation ,Polymorphism, Genetic ,biology ,Aldehyde Dehydrogenase, Mitochondrial ,Point mutation ,Cell Differentiation ,Cell Biology ,General Medicine ,Molecular biology ,030104 developmental biology ,Cell culture ,biology.protein ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
ALDH2 gene is coded for the aldehyde dehydrogenase (ALDH), which is an enzyme involved in alcohol metabolism. Compared to normal aldehyde dehydrogenases, a homozygous point mutation on exon 12 from G to A significantly reduces its efficiency. In this study, we have reported the generation of IBMS-iPSC-021-04, IBMS-iPSC-022-01, and IBMS-iPSC-023-03 as induced pluripotent stem cell (iPSC) lines carrying the homozygous form of ALDH2 with the rs671 genetic polymorphism (E487K mutation). These cell lines were characterized in terms of pluripotency and differentiation potential. They serve as useful platforms to study alcohol metabolism and other chronic diseases associated with alcohol consumption.
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- 2021
123. Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation
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Shih-Ann Chen, Shin-Huei Liu, Chih-Min Liu, Cheng-I Wu, Ling Kuo, Ting-Yung Chang, Chin-Yu Lin, Jo-Nan Liao, Tze-Fan Chao, Ta-Chuan Tuan, Yu-Feng Hu, Shih-Lin Chang, Li-Wei Lo, Yenn-Jiang Lin, Fa-Po Chung, and Wen-Han Cheng
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
124. Using QRS loop descriptors to characterize the risk of sudden cardiac death in patients with structurally normal hearts
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Cheng-I Wu, Yenn-Jiang Lin, I-Hsin Lee, Men-Tzung Lo, Yu-Cheng Hsieh, Amelia Yun-Yu Chen, Wei-Kai Wang, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Ta-Chuan Tuan, Tze-Fan Chao, Jo-Nan Liao, Wan-Hsin Hsieh, Ting-Yung Chang, Chin-Yu Lin, An-Ning Feng, Chorng-Kuang How, and Shih-Ann Chen
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Male ,Multidisciplinary ,Science ,Vectorcardiography ,Heart ,Middle Aged ,Risk Assessment ,Electrocardiography ,Death, Sudden, Cardiac ,Predictive Value of Tests ,Risk Factors ,Case-Control Studies ,Medicine ,Humans ,Female ,cardiovascular diseases - Abstract
The predictive value of non-invasive electrocardiographic examination findings for the risk of sudden cardiac death (SCD) in populations with structurally normal hearts remains unclear. This study aimed to investigate the characteristics of the QRS vectorcardiography of surface electrocardiography in patients with structurally normal hearts who experienced SCD. We consecutively enrolled patients who underwent vectorcardiography between March 2017 and December 2018 in a tertiary referral medical center. These patients didn’t have structural heart diseases, histories of congestive heart failure, or reduced ejection fraction, and they were classified into SCD (with aborted SCD history and cerebral performance category score of 1) and control groups (with an intervention for atrioventricular node reentrant tachycardia and without SCD history). A total of 162 patients (mean age, 54.3±18.1 years; men, 75.9%), including 59 in the SCD group and 103 in the control group, underwent propensity analysis. The baseline demographic variables, underlying diseases, QRS loop descriptors (the percentage of the loop area, loop dispersion, and inter-lead QRS dispersion), and other electrocardiographic parameters were compared between the two groups. In the univariate and multivariate analyses, a smaller percentage of the loop area (odds ratio, 0.0003; 95% confidence interval, 0.00–0.02; p4-5 dispersion (odds ratio, 1.04; 95% confidence interval, 1.02–1.07; p = 0.002), and longer QRS duration (odds ratio, 1.05; 95% confidence interval, 1.00–1.10; p = 0.04) were associated with SCD. In conclusion, the QRS loop descriptors of surface electrocardiography could be used as non-invasive markers to identify patients experiencing aborted SCD from a healthy population. A decreased percentage of loop area and elevated V4-5 QRS dispersion values assessed using vectorcardiography were associated with an increased risk of SCD in patients with structurally normal hearts.
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- 2021
125. Effects of renal denervation on sleep apnea and arrhythmia in rats with myocardial infarction
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Wei-Lun Lin, Chun-Ting Lai, Shinya Yamada, Shin-Huei Liu, Wen-Han Cheng, Yu-Hui Chou, Cheryl C.H. Yang, Terry B.J. Kuo, Shih-Ann Chen, and Li-Wei Lo
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Male ,Sleep Apnea Syndromes ,Heart Rate ,Myocardial Infarction ,Animals ,Humans ,Arrhythmias, Cardiac ,General Medicine ,Kidney ,Denervation ,Rats - Abstract
Sympathetic hyperactivity and poor sleep quality have been reported in patients with myocardial infarction (MI). Sleep is an important modulator of cardiovascular function. We aimed to evaluate the effects of renal denervation (RDN) on cardiac autonomic activity and disordered sleep patterns in rats with MI.Wireless transmission of polysomnographic recordings was performed in sham and left coronary artery (LCA) ligation male rats during normal daytime sleep before and after RDN. Spectral analyses of electroencephalogram and electromyogram (EMG) recordings were performed to define active waking, quiet sleep, and paradoxical sleep. Cardiac autonomic activity was measured by analyzing the power spectrum of heart rate variability. Central sleep apnea events were measured by analyzing the EMG recordings of the diaphragm.In the LCA ligation group, there was a higher low-frequency (LF)/high-frequency (HF) power ratio during sleep; the LF/HF ratio decreased significantly in the rats that underwent RDN in all sleep stages when compared with that in the rats that did not. The frequency of sleep interruptions increased without RDN in the LCA ligation group when compared with that in the sham group. This change was ameliorated and prevented with RDN in the LCA ligation group.Our results demonstrate significant sleep fragmentation with sympathetic hyperactivity after MI and that RDN prevents autonomic dysfunction and disordered sleep. RDN may then reduce sleep apnea and sleep-related sudden cardiac death after MI by restoring autonomic homeostasis.
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- 2021
126. The impact of height on recurrence after index catheter ablation of paroxysmal atrial fibrillation
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Ching-Han, Liu, Li-Wei, Lo, Fa-Po, Chung, Shih-Lin, Chang, Yu-Feng, Hu, Yenn-Jiang, Lin, Shih-Chung, Huang, Su-Ting, Gan, Chin-Yu, Lin, Tze-Fan, Chao, Jo-Nan, Liao, Ta-Chuan, Tuan, Chih-Min, Liu, Yang-Che, Shiu, Cheng-I, Wu, Ling, Kuo, Jennifer Jeanne B, Vicera, Isaiah, Lugtu, Cheng-Hung, Li, Yu-Cheng, Hsieh, Yi-Jen, Chen, and Shih-Ann, Chen
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Adult ,Male ,Treatment Outcome ,Recurrence ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Female ,Middle Aged ,Body Height - Abstract
The relationship between height and incident atrial fibrillation (AF) has recently been demonstrated. We aimed to evaluate the impact of height on outcomes of ablation in patients with drug-refractory symptomatic paroxysmal AF (PAF).A total of 689 patients (470 males; age, 53.0 ± 11.7 years) with symptomatic paroxysmal AF receiving index catheter ablation (CA) between 2003 and 2013 were enrolled in this study. The baseline characteristics, ablation, and follow-up results were evaluated. The patients were categorized according to the quartiles of height for each sex.Patients in the lower quartiles of height had a lower incidence of AF recurrence (log-rank p = 0.022). Height in female patients was strongly associated with AF recurrence (p = 0.027) after an index ablation in the 6.33 ± 4.32 years of follow-up. Female patients 159 cm in height had a higher likelihood of AF recurrence after index CA (HR = 2.01, 95% CI: 1.24-3.25, p = 0.005) than that in those below this height. In computed tomography (CT) scan, the superoinferior diameter of the left atrium (LA) correlated with body height in females, but not in male patients.Height is associated with AF recurrence after the index CA of PAF in female patients. In Asian populations, women above height 159 cm are twice as likely to have AF recurrence post-ablation as shorter women.
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- 2021
127. Efficacy of Patient-Specific Strategy: Catheter Ablation Strategy of Persistent Atrial Fibrillation Based on Morphological Repetitiveness by Periodicity and Similarity
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Yun Yu Chen, Fa Po Chung, Ta Chuan Tuan, Jo Nan Liao, Chih Min Liu, Ting Yung Chang, Wen Han Cheng, Ling Kuo, Shin Huei Liu, Yu Feng Hu, Yenn Jiang Lin, An Nu Khanh Ton, Chin Yu Lin, Tze Fan Chao, Isaiah C. Lugtu, Shih Ann Chen, Chen Lin, Ankit Jain, Men Tzung Lo, Dony Yugo Hermanto, Li Wei Lo, Chia Hsin Chiang, Cheng I. Wu, and Shih Lin Chang
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Patient-Specific Modeling ,Periodicity ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Clinical Decision-Making ,Action Potentials ,Catheter ablation ,Pattern Recognition, Automated ,Similarity (network science) ,Heart Rate ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Prospective Studies ,business.industry ,Models, Cardiovascular ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Patient specific ,Ablation ,medicine.disease ,Treatment Outcome ,Persistent atrial fibrillation ,Catheter Ablation ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
128. The isthmus characteristics of scar‐related macroreentrant atrial tachycardia in patients with and without cardiac surgery
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Ting Yung Chang, Cheng I. Wu, Po Tseng Lee, Jennifer Jeanne B. Vicera, Wen Han Cheng, Li Wei Lo, Shih Lin Chang, Yenn Jiang Lin, Fa Po Chung, Shih Ann Chen, Ta Chuan Tuan, Yu Feng Hu, Chih Min Liu, Jo Nan Liao, Tze Fan Chao, Chin Yu Lin, and Shin Huei Liu
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Nerve conduction velocity ,Cicatrix ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Tachycardia, Supraventricular ,medicine ,Humans ,Sinus rhythm ,In patient ,Prospective Studies ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Prospective cohort study ,Atrial tachycardia ,Aged ,business.industry ,Mean age ,Middle Aged ,Ablation ,Cardiac surgery ,Treatment Outcome ,Catheter Ablation ,Cardiology ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Abstract
INTRODUCTION Identifying the critical isthmus (CI) in scar-related macroreentrant atrial tachycardia (AT) is challenging, especially for patients with cardiac surgery. We aimed to investigate the electrophysiological characteristics of scar-related macroreentrant ATs in patients with and without cardiac surgery. METHODS A prospective study of 31 patients (mean age 59.4 ± 9.81 years old) with scar-related macroreentrant ATs were enrolled for investigation of substrate properties. Patients were categorized into the nonsurgery (n = 18) and surgery group (n = 13). The CIs were defined by concealed entrainment, conduction velocity less than 0.3 m/s, and the presence of local fractionated electrograms. RESULTS Among the 31 patients, a total of 65 reentrant circuits and 76 CIs were identified on the coherent map. The scar in the surgical group is larger than the nonsurgical group (18.81 ± 9.22 vs. 10.23 ± 5.34%, p = .016). The CIs in surgical group have longer CI length (15.27 ± 4.89 vs. 11.20 ± 2.96 mm, p = .004), slower conduction velocity (0.46 ± 0.19 vs. 0.69 ± 0.14 m/s, p
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- 2021
129. Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia
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Tiew-Hwa K. Teng, Wan Ting Tay, Arthur Mark Richards, Timothy Shi Ming Chew, Inder Anand, Wouter Ouwerkerk, Chanchal Chandramouli, Weiting Huang, Claire A. Lawson, Umesh T. Kadam, Jonathan Yap, Shirlynn Lim, Chung-Lieh Hung, Michael Ross MacDonald, Seet Yoong Loh, Wataru Shimizu, Jasper Tromp, Carolyn Su Ping Lam, Lieng Hsi Ling, Houng Bang Liew, Calambur Narasimhan, Tachapong Ngarmukos, Sang Weon Park, Eugenio Reyes, Bambang B. Siswanto, Shu Zhang, Xiaohan Fan, Keping Chen, Liqun Wu, Yucai Xie, Qi Jin, Tianyou Ling, Xinli Li, Fang Zhou, Yanli Zhou, Dongjie Xu, Haifeng Zhang, Yangang Su, Xueying Chen, Shengmei Qin, Jingfeng Wang, Xue Gong, Zhaodi Wu, Cheuk Man Yu, B K S Sastry, Arun Gopi, K Raghu, C Sridevi, Daljeet Kaur, Ajay Naik, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Gurpreet Singh Wander, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Sanjay Mittal, Jitendra Sawhney, Manish Kr. Sharma, Mohanan Padinhare Purayil, Bambang Budi Siswanto, RS Dr Hasan Sadikin, Pintoko Tedjokusumo, Erwan Martanto, Muhammad Munawar, Jimmy Agung Pambudi, RS Siloam Karawaci, Antonia Lukito, Ingrid Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Takashi Noda, Ikutaro Nakajima, Mitsuru Wada, Kohei Ishibashi, Takashi Kurita, Ryoubun Yasuoka, Kuniya Asai, Kohji Murai, Yoshiaki Kubota, Yuki Izumi, Takanori Ikeda, Shinji Hisatake, Takayuki Kabuki, Shunsuke Kiuchi, Nobuhisa Hagiwara, Atsushi Suzuki, Dr Tsuyoshi Suzuki, Sang-Weon Park, Suk Keun Hong, SookJin Lee, Lim Dal Soo, Dong-Hyeok Kim, Jaemin Shim, Seong-Mi Park, Seung-Young Roh, Young Hoon Kim, Mina Kim, Jong-Il Choi, Jin Oh Na, Seung Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae-Sun Uhm, Moon Hyoung Lee, In-Jeong Cho, Hui-Nam Park, Hyung-Wook Park, Jeong-Gwan Cho, Namsik Yoon, KiHong Lee, Kye Hun Kim, Seong Hwan Kim, Sahrin Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, Amie-Anne Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Razali Omar, Azmee Mohd Ghazi, Surinder Kaur Khelae, David S.P. Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Mohd. Ghazi Azmee, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Yee Ling Cham, Ning Zan Khiew, Asri Bin Said, Alan Yean Yip Fong, Nor Hanim Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Jones Santos, Allan Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis L.Y. Teo, Laura L.H. Chan, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M. Lee, Min Er Ching, Deanna Z.L. Khoo, Min Sen Yew, Wenjie Huang, Kui Toh Gerard Leong, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Rehman Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Kar Nee Soon, Hung-I Yeh, Jen-Yuan Kuo, Chih-Hsuan Yen, Juey-Jen Hwang, Kuo-Liong Chien, Ta-Chen Su, Lian-Yu Lin, Jyh-Ming Juang, Yen-Hung Lin, Fu-Tien Chiang, Jiunn-Lee Lin, Yi-Lwun Ho, Chii-Ming Lee, Po-Chih Lin, Chi-Sheng Hung, Sheng-Nan Chang, Jou-Wei Lin, Chih-Neng Hsu, Wen-Chung Yu, Tze-Fan Chao, Shih-Hsien Sung, Kang-Ling Wang, Hsin-Bang Leu, Yenn-Jiang Lin, Shih-Lin Chang, Po-Hsun Huang, Li-Wei Lo, Cheng-Hsueh Wu, Hsin-Yueh Liang, Shih-Sheng Chang, Lien-Cheng Hsiao, Yu-Chen Wang, Chiung-Ray Lu, Hung-Pin Wu, Yen-Nien Lin, Ke-Wei Chen, Ping-Han Lo, Chung-Ho Hsu, Li-Chuan Hsieh, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Waraporn Tiyanon, Wanwarang Wongcharoen, Arintaya Phrommintikul, Cardiovascular Centre (CVC), and Epidemiology and Data Science
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Male ,Asia ,heart failure ,socioeconomic factors ,Social class ,Sudden cardiac death ,Economic inequality ,Quality of life ,medicine ,Humans ,In patient ,Prospective Studies ,Socioeconomic status ,Ejection fraction ,business.industry ,INCOME INEQUALITY ,Stroke Volume ,Middle Aged ,medicine.disease ,health status disparities ,quality of life ,CARDIOVASCULAR-DISEASE ,Heart failure ,PURE ,Female ,HEALTH ,social class ,Cardiology and Cardiovascular Medicine ,business ,SUDDEN CARDIAC DEATH ,Demography - Abstract
Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (P interaction Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.
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- 2021
130. Low-Dose Rivaroxaban and Risks of Adverse Events in Patients With Atrial Fibrillation
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Li Wei Lo, Jo Nan Liao, Ta Chuan Tuan, Wen Han Cheng, Fa Po Chung, Shih Ann Chen, Yenn Jiang Lin, Shih Lin Chang, Gregory Y.H. Lip, Yu Feng Hu, and Tze Fan Chao
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Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,Risk Factors ,Internal medicine ,Daily practice ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Adverse effect ,Aged ,Aged, 80 and over ,Advanced and Specialized Nursing ,business.industry ,Low dose ,Antagonist ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Stroke ,Cardiology ,Female ,Warfarin ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,Factor Xa Inhibitors ,medicine.drug - Abstract
Background and Purpose— In the daily practice, low-dose nonvitamin K antagonist oral anticoagulants are commonly used among Asian patients with atrial fibrillation (AF). The aim of the present study was to compare the risks of ischemic stroke, intracranial hemorrhage, and net clinical benefit of Asian patients with AF treated with off-label low-dose and on-label dosing rivaroxaban. Methods— A total of 2214 patients with AF aged ≥20 years treated with rivaroxaban at a tertiary medical center in Taiwan were studied. Patients were categorized into 2 groups: (1) on-label dose (n=1630): ROCKET-AF or J-ROCKET dosage criteria; and (2) off-label low-dose (10 mg/d for patients with an estimated glomerulus filtration rate >50 mL/min, n=584). The risks of ischemic stroke and intracranial hemorrhage were compared between 2 groups. Results— Compared with the on-label dose group, off-label low-dose rivaroxaban was associated with an increased risk of ischemic stroke with an adjusted hazard ratio of 2.75; 95% CI =1.62–4.69; P P =0.213). Compared with off-label low-dose group, on-label dosing rivaroxaban was associated with a positive net clinical benefit in different weighted models. The results were consistent among the propensity-matched cohort. Conclusions— Off-label low-dosing rivaroxaban should be avoided for Asian patients with AF giving the higher risk of ischemic stroke without risk reduction in intracranial hemorrhage compared with on-label dosing.
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- 2019
131. Role of catheter ablation in patients with ischemic ventricular tachycardia
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Li Wei Lo, Ting Yung Chang, Chin Yu Lin, Yenn Jiang Lin, Shih Ann Chen, Shih Lin Chang, Yu Feng Hu, and Fa Po Chung
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Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Ischemia ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,business.industry ,General Medicine ,Ablation ,medicine.disease ,Clinical Practice ,030220 oncology & carcinogenesis ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,medicine.symptom ,business ,Complication - Abstract
Catheter ablation provides a therapeutic option for decreasing episodes of ventricular tachycardia in patients with coronary artery disease. Clinical studies show improvement with catheter ablation in reducing arrhythmia recurrence and therapy from implantable defibrillators, but not in decreasing mortality. Ablation can be an important tool for patients with electrical storm. Overall, complication rates of catheter ablation are acceptable, but recurrence rates are still significant. Advances in mapping and ablation technologies could be expected to improve the success rates and reduce the mortality.
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- 2019
132. Long‐term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation
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Cheng I. Wu, Jo Nan Liao, Yun Yu Chen, Li Wei Lo, Shih Lin Chang, Ting Yung Chang, Yu Feng Hu, Fa Po Chung, Ting Chung Huang, Yenn Jiang Lin, Tze Fan Chao, Simon Salim, Ta Chuan Tuan, Chih Min Liu, Chin Yu Lin, Quang Minh Hoang, Ling Kuo, Jennifer Jeanne B. Vicera, Shih Ann Chen, and Chieh Mao Chuang
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Ablation Techniques ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Action Potentials ,Catheter ablation ,030204 cardiovascular system & hematology ,Risk Assessment ,Disease-Free Survival ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Heart Rate ,Recurrence ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Vein ,Aged ,Retrospective Studies ,Ethanol ,business.industry ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,Coronary Vessels ,Confidence interval ,medicine.anatomical_structure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction We aimed to clarify the effect of vein of Marshall (VOM) ethanol infusion for treating VOM triggers and/or mitral flutter after first-attempt endocardial ablation in patients with nonparoxysmal atrial fibrillation (AF). Methods and results Of the 254 consecutive patients (age, 56 ± 10 years; 221 male) undergoing catheter ablation for drug-refractory nonparoxysmal AF, 32 (12.6%) received VOM ethanol infusion. The patients were stratified into group 1 (pulmonary vein isolation [PVI], substrate modification, VOM ethanol infusion), group 2 (PVI, substrate modification), and group 3 (PVI alone). Propensity-matched analysis (N = 128) of long-term outcomes (3.9 ± 0.5 years) revealed a higher AF recurrence risk in group 2 (hazard ratio [HR], 4.17; 95% confidence interval [95% CI], 1.63-10.69; P = .003) and group 3 (HR, 1.82; 95% CI, 1.09-3.04; P = .021) than in group 1, as well as a higher atrial arrhythmia recurrence risk in group 2 than in group 1 (HR, 2.42; 95% CI, 1.16-5.03; P = .018). A higher procedural termination rate was observed in group 1 than groups 2 and 3 (41.7% vs 17.2% vs 18.8%; P = .042). On multivariate analysis, VOM ethanol injection was an independent predictor of freedom from recurrence of AF (HR, 0.20; 95% CI, 0.08-0.52; P = .001) and atrial arrhythmia (HR, 0.35; 95% CI, 0.17-0.74; P = .005), whereas a left atrial diameter >45 mm and hypertension were independent risk factors for recurrence. Periprocedural complications rates were comparable among the groups. Conclusion Adjunctive VOM ethanol infusion is effective and safe for treating nonparoxysmal AF in patients with VOM triggers and/or refractory mitral flutter, providing good long-term freedom from AF and atrial arrhythmia.
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- 2019
133. Ultra‐rapid high‐density mapping system with the phase singularity technique is feasible in identifying rotors and focal sources and predicting AF termination
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Shih Ann Chen, Jennifer Jeanne B. Vicera, Wen Han Cheng, Yamada Shinya, Wei Lun Lin, Yenn Jiang Lin, Men Tzung Lo, Shin Huei Liu, Yu Hui Chou, Tsung Ying Tsai, and Li Wei Lo
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Time Factors ,medicine.medical_treatment ,Sus scrofa ,Action Potentials ,High density ,Phase singularity ,030204 cardiovascular system & hematology ,Right atrial ,Cardiac Catheters ,Article ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Predictive Value of Tests ,Physiology (medical) ,Mapping algorithm ,Atrial Fibrillation ,Animals ,Medicine ,030212 general & internal medicine ,business.industry ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,medicine.disease ,Ablation ,Disease Models, Animal ,Mapping system ,Catheter Ablation ,Feasibility Studies ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Mean acquisition ,Algorithms ,Biomedical engineering - Abstract
Introduction Phase singularity (PS) mapping provides additional insight into the AF mechanism and is accurate in identifying rotors. The study aimed to evaluate the feasibility of PS mapping in identifying AF rotors using data obtained from an automatic ultra-rapid high-resolution mapping system with a high-density mini-basket catheter. Methods Twenty-three pigs underwent rapid right atrial (RA) pacing (RAP 480 bpm) for 5 weeks before the experiment. During AF, RA endocardial automatic continuous mappings with a mini-basket catheter were generated using an automatic ultra-rapid mapping system. Both fractionation mapping and waveform similarity measurements using a PS mapping algorithm were applied on the same recording signals to localize substrates maintaining AF. Results Seventeen (74%) pigs developed sustained AF after RAP. Three were excluded because of periprocedural ventricular arrhythmia and corrupted digital data. RA fractionation maps were acquired with 6.17 ± 4.29 minutes mean acquisition time, 13768 ± 12698 acquisition points mapped during AF from 581 ± 387 beats. Fractionation mapping identified extensively distributed (66.7%) RA complex fractionated atrial electrogram (CFAE), whereas the nonlinear analysis identified high similarity index (SI > 0.7) parts in limited areas (23.7%). There was an average of 1.67 ± 0.87 SI sites with 0.43 ± 0.76 rotor/focal source/chamber. AF termination occurred in 11/16 (68.75%) AF events in 14 pigs during ablation targeting max CFAE. There was a higher incidence of rotor/focal source at AF termination sites compared with non-AF termination sites (54.5% vs 0%, P = 0.011). Conclusions The data obtained from ultra-rapid high-density automatic mapping is feasible and effective in identifying AF rotors/focal sources using PS technique, and those critical substrates were closely related to AF procedural termination.
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- 2019
134. Early detection of electromechanical dysfunction in patients with idiopathic premature ventricular contractions
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Chin Yu Lin, Abigail Louise D. Te, Hsuan Ming Tsao, Yenn Jiang Lin, Tze Fan Chao, Shih Lin Chang, Fa Po Chung, Yao Ting Chang, Li Wei Lo, Yu Feng Hu, Chung Hsing Lin, Rohit Walia, Jo Nan Liao, Shih Ann Chen, and Shinya Yamada
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Adult ,Male ,medicine.medical_specialty ,Fourth heart sound ,Adolescent ,Radiofrequency ablation ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,medicine ,Humans ,Sinus rhythm ,030212 general & internal medicine ,Electromagnetic acoustic transducer ,Aged ,Aged, 80 and over ,Ejection fraction ,business.industry ,General Medicine ,Middle Aged ,Ablation ,medicine.disease ,Ventricular Premature Complexes ,Early Diagnosis ,Heart failure ,Catheter Ablation ,Electrocardiography, Ambulatory ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Premature ventricular contractions (PVCs) induced by subtle cardiac dysfunction are missed by echocardiography. We evaluated acoustic cardiography for detection of early electromechanical dysfunction in patients with idiopathic PVCs and normal left ventricular ejection fraction (LVEF), and investigated the impact of radiofrequency ablation (RFA) in reversing this adverse effect. Methods Eighty-six patients with PVCs and 33 normal controls having normal LVEF were studied. Fifty PVC patients were in the ablation group and 36 in the nonablation group. %Electromechanical activation time (%EMAT), %left ventricular systolic time (%LVST), third (S3) and fourth heart sound (S4), and systolic dysfunction index (SDI) during sinus rhythm (SR) were measured by acoustic cardiography (Audicor, Inovise Medical, Inc., Beaverton, OR, USA) pre- and postablation. In 28 patients, acoustic parameters were compared during SR without PVCs, and SR with single PVC, ≥ 2 PVCs, or ventricular tachycardia over 10-second Audicor recording in a single patient at different times. Twenty-four-hour acoustic cardiographic and acoustic cardiographic Holter recording were used to assess the impact of PVC burden on electromechanical function in 41 patients. Results %EMAT, S3, S4, and SDI showed significant worsening in the PVC versus control group. %EMAT and SDI were worsened with increasing PVC number in a 10-second strip. %EMAT showed significant linear increment with increasing PVC burden. There was a significant improvement in %EMAT, %LVST, S3, S4, and SDI postablation in patients with PVCs. Conclusion Acoustic cardiography can detect PVC-induced minor electromechanical dysfunction in patients with normal LVEF. RFA can reverse this adverse effect.
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- 2019
135. Incident Co-Morbidities in Patients with Atrial Fibrillation Initially with a CHA2DS2-VASc Score of 0 (Males) or 1 (Females): Implications for Reassessment of Stroke Risk in Initially ‘Low-Risk’ Patients
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Fa Po Chung, Yu Feng Hu, Tzeng Ji Chen, Tze Fan Chao, Jo Nan Liao, Gregory Y.H. Lip, Shih Ann Chen, Li Wei Lo, Shih Lin Chang, Yenn Jiang Lin, and Ta Chuan Tuan
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Adult ,Male ,Risk ,0301 basic medicine ,medicine.medical_specialty ,reassessment ,Taiwan ,Administration, Oral ,Comorbidity ,030204 cardiovascular system & hematology ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,atrial fibrillation ,Stroke ,ischaemic stroke ,business.industry ,Incidence ,Hazard ratio ,Age Factors ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Hematology ,Middle Aged ,medicine.disease ,Confidence interval ,CHA DS -VASc score ,030104 developmental biology ,Research Design ,CHA2DS2–VASc score ,Female ,business ,Follow-Up Studies ,medicine.drug - Abstract
Background Oral anticoagulants (OACs) are not recommended for ‘low-risk’ patients with atrial fibrillation (AF). We investigated the incidences of new risk factors developing, and the temporal trends in the CHA2DS2-VASc score in initially ‘low-risk’ AF patients. Second, we propose a reasonable timing interval at which stroke risk should be reassessed for such AF patients. Methods We studied 14,606 AF patients who did not receive anti-platelet agents or OACs with a baseline CHA2DS2-VASc score of 0 (males) or 1 (females). The CHA2DS2-VASc scores of patients were followed up and updated until the occurrence of ischaemic stroke or mortality or 31 December 2011. The associations between the prescription of warfarin and risk of adverse events once patients' scores changed were analysed. Decile values of durations to incident co-morbidities and from the acquirement of new co-morbidities to ischaemic stroke were studied. Results During a mean follow-up of 4 years, 7,079 (48.5%) patients acquired at least one new stroke risk factor component(s) with annual risks of 6.35% for hypertension, 3.68% for age ≥ 65 years, 2.77% for heart failure, 1.99% for diabetes mellitus and 0.33% for vascular diseases. The incidence for CHA2DS2-VASc score increments was 12.1%/year. Initiation of warfarin was associated with a lower risk of adverse events (adjusted hazard ratio, 0.530; 95% confidence interval, 0.371–0.755). Among 6,188 patients who acquired new risk factors, 80% would acquire these co-morbidities after 4.2 months of AF diagnosis. The duration from the acquirement of incident co-morbidities to the occurrence of ischaemic stroke was longer than 4.4 months for 90% of the patients. Conclusion The CHA2DS2-VASc score increases in approximately 12% of initially ‘low-risk’ AF patients each year, and the initiation of warfarin once the score changed was associated with a better prognosis. Three to four months may be a reasonable timing interval at which stroke risk should be reassessed so that OACs could be prescribed in a timely manner for stroke prevention.
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- 2019
136. A link between bilirubin levels and atrial fibrillation recurrence after catheter ablation
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Su Chan Chen, Fa Po Chung, Chin Yu Lin, Shih Ann Chen, Atul Prabhu, Tze Fan Chao, Shinya Yamada, Li Wei Lo, Yenn Jiang Lin, Ta Chuan Tuan, Abigail Louise D. Te, Shih Lin Chang, Yu Feng Hu, and Ting Yung Chang
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Adult ,Male ,medicine.medical_specialty ,Bilirubin ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Recurrence ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Catheter ,Liver ,chemistry ,030220 oncology & carcinogenesis ,Catheter Ablation ,Cardiology ,Female ,Bilirubin levels ,business - Abstract
Bilirubin is associated with different cardiovascular diseases. The relationship between bilirubin and atrial fibrillation (AF) remains unclear. The aim of this study is to determine the association between bilirubin and AF recurrence after catheter ablation.A total of 212 patients who received AF ablation were retrospectively studied. The total bilirubin level, clinical characteristics, and echocardiographic findings were analyzed to predict the outcome of AF ablations.During a mean follow-up period of 12.2 ± 5.8 months, 61 (28.8%) patients had AF recurrence after catheter ablation. The patients with AF recurrence had a larger left atrial (LA) diameter (39.8 ± 6.3 versus 36.7 ± 5.8 mm; p = 0.001) and higher total bilirubin levels (0.82 ± 0.37 versus 0.63 ± 0.29 mg/dL; p0.001) than those without recurrence. The patients with recurrence had higher direct and indirect bilirubin levels than patients without recurrence. The total bilirubin level remained an independent predictor of AF recurrence after multivariate analysis (odds ratio, 4.95; 95% CI, 1.65-14.83; p = 0.004). We identified a cut point of the total bilirubin level for predicting AF recurrence by receiver operator characteristic curve (cut point, 0.7 mg/dL; area under the curve, 0.65; p0.001). The total bilirubin levels were positively correlated with the neutrophil counts. However, there were no associations among the total bilirubin level, left atrial (LA) diameter, and voltage.Higher serum bilirubin levels were associated with AF recurrence in paroxysmal AF patients following catheter ablation.
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- 2019
137. Bleeding and New-Onset Cancers in Patients With Atrial Fibrillation Receiving Nonvitamin K Antagonist Oral Anticoagulants
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Simon Salim, Jennifer Jeanne B. Vicera, Chih Min Liu, Ting Yung Chang, Tze Fan Chao, Shih Lin Chang, Cheng I. Wu, Li Wei Lo, Yenn Jiang Lin, Yu Feng Hu, Jo Nan Liao, Ting Chun Huang, Fa Po Chung, Chang-Ming Chern, Cheng Hsueh Wu, Shih Ann Chen, and Le Phat Tai
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Male ,medicine.medical_specialty ,Time Factors ,Vitamin K ,Taiwan ,Administration, Oral ,030204 cardiovascular system & hematology ,Risk Assessment ,Gastroenterology ,New onset ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Incidence ,Incidence (epidemiology) ,Antagonist ,Follow up studies ,Anticoagulants ,Cancer ,Atrial fibrillation ,medicine.disease ,Stroke ,Cardiology ,Female ,Gastrointestinal Hemorrhage ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Whether bleeding should be considered a sufficient sign to justify thorough cancer surveillance in atrial fibrillation (AF) patients receiving nonvitamin K antagonist oral anticoagulants (NOACs) remains unclear. We investigated the relationships between bleeding events and new-onset cancers in AF patients receiving NOACs in a prospective cohort (n = 395, mean follow-up duration of 2.8 years). There were 18 patients who were diagnosed with new-onset cancers 584 ± 372 days after the initiation of NOACs. The patients with new-onset cancers had higher HAS-BLED scores (no, preexisting and new-onset cancer: 1.51 ± 0.81, 1.69 ± 0.87, and 2.11 ± 0.96, respectively; p = 0.006) and a higher incidence of bleeding events (22%, 33%, 67%, respectively; p0.001) than did patients without new-onset cancers. Bleeding events that preceded the diagnosis of new-onset cancers were independently correlated with new-onset cancers (odds ratio: 7.89, p = 0.001) in the multivariate logistic regression. More than half of the patients (61%) with new-onset cancers had either a significant period of drug interruption for at least 2 months or discontinued NOACs. In conclusions, bleeding in AF patients receiving NOACs could be an alerting sign of new-onset cancers and should prompt the initiation of thorough surveillance to detect early cancers.
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- 2019
138. Dynamic unipolar voltage criteria of right ventricular septum for identifying left ventricular septal scar
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Yu Feng Hu, Li Wei Lo, Chin Yu Lin, Cheng I. Wu, Shih Lin Chang, Ting Chung Huang, Yun Yu Chen, Shinya Yamada, Jo Nan Liao, Jennifer Jeanne B. Vicera, Fa Po Chung, Tze Fan Chao, Ting Yung Chang, Simon Salim, Abigail Louise D. Te, Ta Chuan Tuan, Chih Min Liu, Yenn Jiang Lin, Shih Ann Chen, and Ling Kuo
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Epicardial Mapping ,Male ,medicine.medical_specialty ,Scars ,Ventricular Septum ,030204 cardiovascular system & hematology ,Cicatrix ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Interventricular septum ,Retrospective Studies ,business.industry ,Mean age ,Middle Aged ,Magnetic Resonance Imaging ,Net reclassification improvement ,medicine.anatomical_structure ,Cardiology ,Female ,medicine.symptom ,Cardiomyopathies ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Wall thickness ,business - Abstract
The right ventricular (RV) septal unipolar voltage (UV) for predicting left ventricular (LV) septal scar wall thickness (WT) remains to be elucidated. From 2013 to 2015, data obtained from RV and LV electroanatomic maps of 28 patients (mean age, 53 ± 16 years; 19 men [67.9%]) with/without identified LV septal scars were reviewed. Patients with an RV septal scar were excluded (n = 90). Direct measurement of septal WT was conducted (mean distance, 10.4 ± 3.3 mm). Patients in group 1 had a normal LV substrate, while those in group 2 had an LV septal scar. Fisher’s linear discriminant formula was used to determine the dynamic UV criteria. A total of 552 points were collected: 323 in 12 patients from group 1 and 229 in 16 patients from group 2. The UV of the RV septum is capable of identifying the opposite LV endocardial bipolar scar and is proportional to the WT of the interventricular septum. In the absence of an RV endocardial scar, the formula of “RV septal cut-off value = 0.736 × WT − 0.117 mV” has better sensitivity and specificity for predicting the LV septal scar (0.96 vs. 0.68 and 0.91 vs. 0.80, respectively) than the predefined fixed criteria of 8.3 mV with a net reclassification improvement of 25.7% (P
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- 2019
139. Ambient fine particulate matter (PM2.5) exposure is associated with idiopathic ventricular premature complexes burden: A cohort study with consecutive Holter recordings
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Fa Po Chung, Shih Lin Chang, Yu Feng Hu, Ta Chuan Tuan, Tsung Ying Tsai, Yamada Shinya, Yenn Jiang Lin, Jo Nan Liao, Yu Hui Chou, Shih Ann Chen, Wen Han Cheng, Tze Fan Chao, Li Wei Lo, Wei Lun Lin, and Shin Huei Liu
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Ventricular Premature Complexes ,Heart disease ,Fine particulate ,Taiwan ,Action Potentials ,030204 cardiovascular system & hematology ,complex mixtures ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,Epidemiology ,Humans ,Medicine ,030212 general & internal medicine ,Particle Size ,Normal heart ,Aged ,Inhalation Exposure ,business.industry ,Healthy population ,Middle Aged ,medicine.disease ,Electrocardiography, Ambulatory ,Cardiology ,Female ,Particulate Matter ,Cardiology and Cardiovascular Medicine ,business ,Cohort study ,Holter ecg - Abstract
Background Epidemiological evidence has shown an association between ambient fine particulate matter (PM2.5) exposure and cardiovascular mortality. Increased ventricular premature complex (VPC) burden can cause left ventricular dilatation and dysfunction. We aimed to investigate the relationship between acute PM2.5 exposure and VPC burden in patients without structural heart disease. Methods We reviewed 26 820 patients who underwent 24-hour Holter electrocardiogram (ECG) recordings between 1 Jan 2013 and 1 Dec 2016. We enrolled patients with significant idiopathic (structurally normal heart) VPC burden defined as ≥30 VPCs/h (Lown grade 2) who had at least two Holter ECG recordings. The VPC burden between the studies on high and low PM2.5 exposure dates was compared in 24 and 12 hours time periods. Result Sixty-seven patients (31 men, 56.49 ± 18.35 years) were enrolled. Patients were exposed to 25.63 ± 11.47 and 14.66 ± 7.51 μg/m 3 of PM2.5 during the high and low study dates, respectively. The overall VPC counts (10,490.69 ± 10,681.63/day) and burden (10.22% ± 10.17%) were significantly higher on the days with higher PM2.5 exposure compared with low PM2.5 exposure dates (8293.31 ± 9009.09; P = 0.014% and 9.14% ± 12.73%, P = 0.012, respectively). Compared with low PM2.5 exposure dates, the VPC burden on high exposure dates was significantly higher from 9 am to 9 pm (5.85% ± 6.41% vs 4.84% ± 6.97%; P = 0.025) but not at nocturnal periods. Conclusion Our study demonstrated a significantly higher VPC burden on high PM2.5 exposure date. The burden was increased in the daytime but not at nighttime. This result suggests that daytime PM2.5 exposure may be associated with ventricular arrhythmia burden in the healthy population.
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- 2019
140. PO-709-02 COMPARISON OF ABLATION LESIONS ADJACENT TO THE GAPS BETWEEN HIGH-POWER SHORT-DURATION AND LOW-POWER LONG-DURATION DURING PULMONARY VEIN ISOLATION
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Shin-Huei Liu, Fa-Po Chung, Yenn-Jiang Lin, Li-Wei Lo, Shih-Lin Chang, Yu-Feng Hu, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
141. PO-630-03 EFFECTS OF RENAL DENERVATION TO SLEEP APNEA AND CARDIAC ARRHYTHMIA IN RATS WITH MYOCARDIAL INFARCTION
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Wei-Lun Lin, Li-Wei Lo, Chun-Ting Lai, Yu-Hui Chou, Shin-Huei Liu, Wen-Han Cheng, Tsung Ying Tsai, Cheryl C.H. Yang, Terry B.J. Kuo, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
142. BS-512-02 AUTONOMIC NEUROMODULATION FROM RENAL SYMPATHETIC DENERVATION PREVENTS ATRIAL FIBRILLATION VULNERABILITY CAUSED BY CHRONIC OBSTRUCTIVE SLEEP APENA IN A RABBIT MODEL
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Li-Wei Lo, Yu-Hui Chou, Shin-Huei Liu, Wen-Han Cheng, Wei-Lun Lin, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
143. PO-709-06 THREE-DIMENSIONAL MAPPING SYSTEM FACILITATED SUPERIOR APPROACH FOR RADIOFREQUENCY ABLATION OF TACHYARRHYTHMIA IN PATIENTS WITHOUT INFERIOR VENA CAVA ACCESS
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Chu-Yu Hsu, Shih-Lin Chang, Yenn-Jiang Lin, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Chin-Yu Lin, Ting-Yung Chang, Chieh-Mao Chuang, Ming-Jen Kuo, Wei Tso Chen, Chheng Chhay, Pei Heng Kao, Ahliah Esmilla Ibrahim, Wei-Hsiang Lin, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
144. PO-645-06 EPICARDIAL ELECTRICAL HETEROGENEITY AFTER AMIODARONE TREATMENT INCREASES VULNERABILITY TO VENTRICULAR ARRHYTHMIAS IN A SWINE MODEL UNDER THERAPEUTIC HYPOTHERMIA
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Chin-Yu Lin, Ting-Yung Chang, Yu-Feng Hu, Fa-Po Chung, Shih-Lin Chang, Li-Wei Lo, Yenn-Jiang Lin, Hung-I Yeh, Yi-Jen Chen, Yu-Cheng Hsieh, Yu-Xuan Wu, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
145. PO-681-04 THE CLINICAL VALUE AND LONG-TERM OUTCOME OF CATHETER ABLATION BY USING HIGH DENSITY VECTOR FIELD MAPPING FOR PERSISTENT ATRIAL FIBRILLATION
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Ming-Jen Kuo, Yenn-Jiang Lin, Chin-Yu Lin, Men-Tzung Lo, Chia-Hsin Chiang, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Da Chyuan Duan, Tze-Fan Chao, Jo-Nan Liao, Ting-Yung Chang, Ling Kuo, Chih-Min Liu, Wei Tso Chen, Pei Heng Kao, Guan-Yi Li, Chih-Hsien Lin, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
146. CA-529-02 PROSPECTIVE EVALUATION OF THE WAVE DYNAMICS USING HIGH DENSITY VECTOR FIELD MAPPING FOR PERSISTENT ATRIAL FIBRILLATION TO DETECT THE ARRHYTHMOGENIC SOURCES
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Yenn-Jiang Lin, Chia-Hsin Chiang, Ming-Jen Kuo, Fa-Po Chung, Men-Tzung Lo, Li-Wei Lo, Shih-Lin Chang, Yu-Feng Hu, Chin-Yu Lin, Ting-Yung Chang, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
147. PO-630-06 NEURAL MECHANISM FACILITATING PM2.5-RELATED CARDIAC ARRHYTHMIAS THROUGH CARDIOVASCULAR AUTONOMIC AND CALCIUM DYSREGULATION IN A RAT MODEL
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Tsung Ying Tsai, Li-Wei Lo, Wei-Lun Lin, Yu-Hui Chou, Wen-Han Cheng, Shin-Huei Liu, and Shih-Ann Chen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
148. The association between atrium electromechanical interval and pericardial fat.
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Tze-Fan Chao, Yau-Huei Lai, Chun-Ho Yun, Chih-Hsuan Yen, Kang-Ling Wang, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Chung-Lieh Hung, Jen-Yuan Kuo, Hung-I Yeh, and Shih-Ann Chen
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Medicine ,Science - Abstract
OBJECTIVES: Pericardial fat (PCF) may induce local inflammation and subsequent structural remodeling of the left atrium (LA). However, the adverse effects of PCF on LA are difficult to be evaluated and quantified. The atrial electromechanical interval determined by transthoracic echocardiogram was shown to be a convenient parameter which can reflect the process of LA remodeling. The goal of the present study was to investigate the association between the electromechanical interval and PCF. METHODS AND RESULTS: A total of 337 patients with mean age of 51.9 ± 9.0 years were enrolled. The electromechanical interval (PA-PDI) defined as the time interval from the initiation of the P wave deflection to the peak of the mitral inflow A wave on the pulse wave Doppler imaging was measured for every patient. The amount of PCF was determined by multi-detector computed tomography. The PA-PDI interval was significantly correlated with the amount of PCF (r = 0.641, p value
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- 2014
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149. Usefulness of the CHA2DS2-VASc Score to Predict the Risk of Sudden Cardiac Death and Ventricular Arrhythmias in Patients With Atrial Fibrillation
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Su Jung Chen, Yu Feng Hu, Tzeng Ji Chen, Shih Ann Chen, Tze Fan Chao, Shih Lin Chang, Li Wei Lo, Ling Kuo, Yenn Jiang Lin, Gregory Y.H. Lip, Ta Chuan Tuan, Chia Jen Liu, Fa Po Chung, and Jo Nan Liao
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medicine.medical_specialty ,Scoring system ,business.industry ,Hazard ratio ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Confidence interval ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,National health insurance ,Internal medicine ,CHA2DS2–VASc score ,Cardiology ,medicine ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Sudden cardiac death (SCD), the most devastating manifestation of ventricular arrhythmias (VAs), is the leading cause of mortality in patients with atrial fibrillation (AF). We hypothesized that the CHA2DS2-VASc score, consisting of age and several clinical risk factors, could be used to estimate the individual risk of SCD/VAs for AF patients. From year 2000 to 2011, 288,181 newly-diagnosed AF patients without antecedent SCD/VAs were identified from “Taiwan National Health Insurance Research Database.” During the follow-up of 1,065,751 person-years, 11,166 patients experienced SCD/VAs with an annual risk of 1.05% which increased from 0.34% for patients with a CHA2DS2-VASc score of 0% to 2.63% for those with a score of 9. The CHA2DS2-VASc score was a significant predictor of SCD/VAs with an adjusted hazard ratio of 1.21 (95% confidence interval 1.20 to 1.22) per 1 point increment of the score. As the CHA2DS2-VASc score increased from 1 to 9, the hazard ratio of SCD/VAs continuously increased from 1.28 to 4.17 compared with patients with a CHA2DS2-VASc score of 0. In conclusion, CHA2DS2-VASc score was a convenient scoring system which could be used to predict the risk of SCD/VAs in AF patients in addition to its ability for stroke risk stratification.
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- 2018
150. High-resolution mapping of pulmonary vein potentials improved the successful pulmonary vein isolation using small electrodes and inter-electrode spacing catheter
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Abigail Louise D. Te, Shih Lin Chang, Yu Feng Hu, Simon Salim, Ta Chuan Tuan, Jennifer Jeanne B. Vicera, Chih Min Liu, Chin Yu Lin, Li Wei Lo, Shinya Yamada, Jo Nan Liao, Vu Van Ba, Fa Po Chung, Shih Ann Chen, Tze Fan Chao, Ting Chun Huang, Cheng I. Wu, Ting Yung Chang, and Yenn Jiang Lin
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Male ,Substrate mapping ,Computed Tomography Angiography ,030204 cardiovascular system & hematology ,Pulmonary vein ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Superior vena cava ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Prospective Studies ,030212 general & internal medicine ,Aged ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Catheter ,Pulmonary Veins ,Electrode ,Catheter Ablation ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Microelectrodes - Abstract
Background Intracardiac electrogram recording is influenced by the electrode size and inter-electrode spacing. Smaller electrodes with a closer inter-electrode spacing may improve the mapping resolution and outcome. Methods Substrate mapping of the left atrium and residual pulmonary vein (PV) potentials during sinus rhythm was sequentially performed using a 3.5-mm electrode tip catheter and a 1-mm electrode multielectrode catheter in 33 patients (Group 1) that underwent repeat atrial fibrillation (AF) procedures. PV gap identification and electrophysiological characteristics were compared. Arrhythmia freedom was compared with a propensity matched (1:2) control group (66 patients, Group 2) undergoing repeat AF procedures guided by wide inter-electrode spacing catheter. Results In the Group 1 patients, the total area of residual PV potentials measured using the 1-mm catheter was larger than that measured by the 3.5-mm catheter. Overall 1.97 ± 0.59 (1–3) and 1.49 ± 0.62 (1–3) PVs were identified by the 1-mm electrode and 3.5 mm catheters, respectively (P = 0.02). The gaps not identified by the 3.5 mm catheter had a smaller width and lower voltage. Radiofrequency catheter ablation in the areas with residual PV potentials identified by the 1-mm catheter resulted in complete electrical isolation of the PVs. Arrhythmia freedom at one year of follow-up was achieved in 26 of 33 (78.8%) patients in Group 1, which was significantly higher than the matched control group (33/66 [50%], P Conclusion In the patients with a previous PV isolation, mapping with small, closely spaced electrodes can increase the detection rate of residual PV potentials and improve the outcome.
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- 2018
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