| Background:Atrial fibrillation (AF) is one of the most common arrhythmia in clinic, with its prevalence increasing with age to 17% in those aged?80 years. It can cause chest distress, palpitation and short of breath which troubles people's daily life, decrease their quality of life and exercise capacity. What's more, serious complications such as heart failure and systemic embolism (most common stroke) make it highly lethality and disabling. As a result, AF begin to draw more and more attention. Methods to cure AF includes following aspects:reversing and maintaining sinus rhythm, controlling ventricular rhythm and preventing embolism.(1) Rhythm control. Major methods of rhythm control conclude antiarrhythmic drug therapy (AAD) and radiofrequency catheter ablation(RFCA). However, whether RFCA could reverse the remodeling of atrium and improve the cardiac function is controversial. At the same time, the comments of how AAD or RFCA could improve patients' quality of life is undecidable from the various scales. Based on these, this research intend to compare RFCA with AAD in improving cardiac function, quality of life and exercise capacity in AF patients.(2) Thromboembolism prevention. In the past decades, warfarin as a stone of anticoagulation played a great role in decreasing the risk of embolism in AF patients. But it also had some disadvantages, for example, needing long-term supervising the international normalized ratio (INR), having a narrow therapeutic window, liable to interacting with food and other drugs and a relatively low compliance in AF patients. All these inconveniences impose restrictions on the effectiveness of warfarin. Left atrial appendage is a place where thrombus is most likely to form in patients with AF. As a result, excising, ligaturing or closing left atrial appendage maybe effective in preventing thrombus-embolism. Excising or ligaturing left atrial appendage only suits those patients who needed cardiac surgery, not for all. On the other hand, left atrial appendage occlusion is fit for more patients with high risk of thrombus-embolism. Several big randomized clinical trials had improved that left atrial appendage occlusion is non-inferior with warfarin in preventing thrombus embolism in AF patients. But similar reports in China is rare. LAmbreTM left atrial appendage closure device (Lifetech Scientific Corp., Shenzhen, China) is a novel device invented in China. The occlusion system comprises an implant and its delivery system. The implant is a nitinol-based, self-expanding device comprising a hook-embedded umbrella and a cover connected with a short central waist. The safety and effectiveness had been verified by animal experiments and some Asians. Based on these, this research intend to compare the effectiveness of preventing thrombus embolism and the risk of bleeding between left atrial appendage occlusion and warfarin therapy. And analyzing the safety and effectiveness of LAmbreTM in preventing the thrombus embolism in AF patients.1 Comparison of Radiofrequency Catheter Ablation and Antiarrhythmic Drug Therapy for Atrial Fibrillation in improving cardiac function, quality of life and exercise capacityObjective:To compare the effectiveness of radiofrequency catheter ablation (RFCA) and antiarrhymic drugs (AAD) for patients with atrial fibrillation (AF) in improving cardiac function, quality of life and exercise capacity.Methods:Patients with AF in our hospital were enrolled in this research and were distributed into RFCA group and AAD group. Follow-ups were carried out in 3,6, 12months. All the patients went through ultrasonic cardiogram and 7-day remote ECG monitoring every follow-up and finish SF-36 quality-of-life questionnaire and 6-minute-walk-test (6MWT) in 12-month follow-up.Results:One-hundred and seventy-five patients were enrolled in the research.93 patients went through radiofrequency catheter ablation and another 82 received drug therapy. The average left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were no difference before therapy. During the follow-up period, the average LAD in RFCA group tended to be smaller while average LVEF higher. There were significant difference before and after therapy. In AAD group, mean LAD tended to be bigger and mean LVEF lower. There were also significant difference before and after therapy. As for quality of life, RFCA group showed a great improvement in every dimension while AAD group worsen except emotional function. Comparing the 6MWT in both groups, it significantly got higher in RFCA group while had no difference in AAD group.Conclusion:RFCA is superior to AAD in AF patients in reversing the remodeling of atrium, improving LVEF, quality of life and exercise capacity.2 The comparison of effectiveness and safety in left atrial appendage occlusion and warfarin therapy for stroke prevention in atrialfibrillationObjective:To compare the effectiveness and safety of left atrial appendage occlusion (LAAO) and warfarin therapy for stroke prevention in atrial fibrillation (AF) in China.Methods:Enroll patients who went through LAAO in cardiology department in Renmin Hospital of Wuhan University. During the same period, selecting patients who used warfarin for stroke prevention as control group by the ratio of 1:1. Follow-ups were carried out in 1,3,6,12 months in LAAO group, while in control group, international normalized ratio (1NR) was tested every 4 weeks when stable. The dose of warfarin can be adjusted according to the INR results. Collecting the adverse events including stroke, systemic embolism, intracerebral bleeding, gingival bleeding, petechiae in skin, hematuresis or bleeding in other parts of the body.Results:Fifty patients were enrolled, including 22 male (44%) and 28 female, mean age 66.1±8.6 years old.25 patients went through LAAO and another 25 warfarin therapy. In LAAO group and control group, mean CHADS2 score (2.44±1.00 vs 2.28±1.28, P> 0.05), mean CHA2DS2-VASC score (3.96±1.14 vs 3.28±1.34, P>0.05) and mean HAS-BLED score(2.12±0.67 vs 2.16±0.85, P>0.05) had no significant differences. The rate of thrombus embolism were almost the same between both groups. The rate of bleeding in early follow-up period is no difference but LAAO group showed a greater decrease than control group in the late phase.Conclusion:Both LAAO and warfarin have the same effectiveness of stroke prevention as well as the bleeding rate in the early phase. But LAAO decreases the bleeding rate in the late phase.3 Long-term outcome of a novel left atrial appendage occluder (Lifetech LAmbreTM device) for stroke prevention in patients with atrial fibrillationObjective:To evaluate the effectiveness and safety of a new left atrial appendage occluder (Lifetech LAmbreTM device) for stroke prevention in atrial fibrillation (AF) in China.Methods:Enroll patients with atrial fibrillation according to inclusion and exclusion criteria. All patients went through left atrial appendage occlusion by LAmbreTM device. Follow-up were carried out in 1,3,6,12 months. Collecting the adverse events including pericardial effusion, stroke, transient ischemic attack or major bleeding and so on, analyze whether these adverse events related to device or procedure. Transesophageal echocardiography were performed in 3 and 12 months to evaluate the location and stableness of occluder device.Results:From March 2014 to March 2015,21 patients in cardiology department in Renmin Hospital of Wuhan University were enrolled, including 5 paroxysmal AF,11 persistent AF and 5 permanent AF. Mean CHADS2 score 2.3±1.0, mean CHA2DS2-VASc score 3.9±1.2, mean HAS-BLED score 2.3±1.0. All patients were successfully implanted with occluder device, mean procedure time 59.2±12.0 minutes and mean dose of contrast media 42.1±17.4ml.6 patients (28.6%) had pericardial effusion early after procedure,1 patients had cerebral infarction on the right side of the cerebellum, no major bleedings or sudden death happened. After left atrial appendage occlusion,18 patients (85.7%) took aspirin and clopidogrel in combination and at the time of 12 months,90.5%(19 cases) changed into aspirin only. After a year's follow-up, mean left atrial diameter (LAD) is 46.4±6.1mm, which is significantly bigger than baseline (P=0.04). Mean left ventricular diameter (LVD) is 47.47±5.64mm, mean left ventricular ejection fraction (LVEF) is 0.53±0.07, showed no difference compared with baseline.Conclusion:In a long term of follow-up, LAmbreTM device in preventing stroke in AF patients is safe and effective. |
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