姜黄素诱导Nrf2核转位对氧化应激诱导人肝细胞胰岛素抵抗的影响

目的：研究姜黄素诱导转录因子NF-E2相关因子2（NF-E2-related factor 2,Nrf2）核转位对氧化应激诱导人肝细胞L02胰岛素抵抗的影响。方法：用15μM和30μM姜黄素干预L02肝细胞6 h和l2 h,Western blot检测Nrf2核转位水平;将肝细胞分为对照组、模型组、干预组,对照组用RPMI1640正常培养,模型组用100U/L葡萄糖氧化酶（GO）干预2 h,干预组用15μM和30μM姜黄素分别干预12h后给予100U/LGO干预2h,各细胞均给予100nM胰岛素干预30min。流式细胞术检测细胞内活性氧簇（ROS）,用荧光强度（FI）来表示ROS水平。分光光度法检测检测细胞MDA、GSH,葡萄糖氧化酶-过氧化物酶法检测细胞培养液中葡萄糖的水平,Western blot检测胰岛素受体底物-1（IRS-1）磷酸化水平。结果：①姜黄素明显诱导Nrf2核转位。②模型组FI、MDA水平较对照组显著升高（P〈0.01）,干预组FI、MDA水平均较模型组显著降低（P〈0.01）,姜黄素15μM组FI、MDA水平高于30μM组（P〈0.01）。模型组GSH水平较对照组显著降低（P〈0.01）,干预组GSH水平较模型组显著升高（P〈0.01）,姜黄素15μM组FI、MDA水平高于30μM组（P〈0.01）。③模型组上清液葡萄糖浓度显著高于对照组（P〈0.01）,干预组上清液葡萄糖浓度显著低于模型组（P〈0.01）,姜黄素15μM组上清液葡萄糖浓度高于30μM组（P〈0.01）。模型组IRS-1磷酸化水平较对照组降低,干预组IRS-1磷酸化水平均较模型组增高,姜黄素30μM组IRS-1磷酸化水平高于15μM组。结论：姜黄素通过诱导Nrf2核转位,降低细胞内氧化应激水平,进而逆转氧化应激诱导的胰岛素抵抗。     

清胰汤对大鼠急性坏死性胰腺炎IL-6,IL-10及肠道通透性影响

目的：探讨清胰汤改善大鼠急性坏死性胰腺炎（acute necrotizing pancreatitis）ANP炎症反应及肠道通透性功能的治疗效果及机制。方法：将72只雄性SD大鼠随机分为3组,其中2组大鼠采用从胰腺被膜下多点缓慢均匀注入3.8%牛黄胆酸钠（0.5ml/100g）建立大鼠急性坏死性胰腺炎模型,再分为急性坏死性胰腺炎常规治疗组（A组）、清胰汤干预治疗组（B组）,其他24只大鼠为假手术组（S组）,每组再随机分为24h、48h、72h组。各组于12h后给于肠内营养,B组肠内营养后给于2次清胰汤2.5ml/100g,A组、S组给于同等剂量生理盐水。各组于建模后24h、48h、72h处死,腹腔动脉取血检测血清淀粉酶浓度、IL-6、IL-10、D-乳酸水平。结果：48h时点B组IL-10水平较A组高（P〈0.05）;72时点B组血清淀粉酶水平较A组低（P〈0.01）,IL-6水平较A组低（P〈0.01）,IL-10水平较A组高（P〈0.01）,D-乳酸水平较A组低（P〈0.01）。结论：清胰汤可以上调IL-10改善大鼠急性胰腺炎炎症反应从而降低肠道通透性。     

骨髓间质干细胞移植对大鼠脑缺血再灌注凋亡蛋白Caspase-3的影响

目的研究静脉移植骨髓间充质干细胞（MSCs）对脑缺血再灌注模型大鼠神经功能及凋亡相关蛋白caspase-3的影响。方法体外培养及扩增MSCs后,用绿色荧光染料羟基荧光素二醋酸盐琥珀酰亚胺脂（CFSE）标记,通过静脉途径移植给大脑中动脉缺血2 h再灌注的SD大鼠,按不同时间点取材,荧光显微镜观察BMSCs在脑内的分布,免疫组织化学染色及RT-PCR检测大鼠脑内caspase-3蛋白表达情况。结果移植组在移植后第6天神经功能明显好于对照组（P〈0.05）。移植组移植后3、12、24、48、72 h caspase 3免疫组化阳性目标面密度分别为（1.34±0.31）%、（3.98±0.67）%、（5.58±0.92）%、（4.65±0.69）%、（3.51±0.63）%,对照组分别为（2.09±0.19）%、（5.23±0.30）%、（6.89±0.57）%、（5.93±0.56）%、（4.39±0.57）%,移植组和对照组比较均（P〈0.05）。6h及7 d移植组caspase 3阳性目标面密度分别为（2.81±0.35）%、（1.64±0.29）%,与对照组（3.92±0.44）%,（2.29±0.21）%比较差异显著（P〈0.01）。移植组相应时间点caspase-3的表达明显低于对照组（P〈0.05,P〈0.01）;移植组大鼠缺血侧皮层的caspase-3 mRNA相对量明显低于对照组（P〈0.01）。结论经静脉注射骨髓间充质干细胞可明显改善神经功能。其可能通过下调caspase-3表达方式对脑缺血再灌注损伤起保护作用。     

产后抑郁症患者听感觉门控P50的研究

目的：探讨产后抑郁症患者感觉门控P50 的变化特征,为产后抑郁患者的早期预防提供参考依据。方法：采用配对听觉条件（S1）、测试（S2）刺激范式,对本院2011 年1 月至2012 年6 月收治的26 例产后抑郁症患者（实验组）进行听觉诱发电位P50检测,测量P50 的潜伏期、波幅,并与25 例健康被试者（对照组）的结果进行比较。结果：（1） 与对照组相比,实验组S1-P50 潜伏期[（56.62± 17.42） ms vs. （49.86 ± 15.21） ms],S2-P50 潜伏期[（57.36 ± 15.42） ms vs. （50.04 ± 16.27） ms]的差异均无统计学意义（P〉0.05）;（2）与对照组相比,实验组S1-P50 波幅[（3.58 ± 1.72） μV vs. （1.13 ± 0.91） μV]显著降低,差异有统计学意义（P〈0.05）;S2-P50 波幅[（1.32 ± 1.16） μV vs. （1.48 ± 1.05） μV]差异无统计学意义（P〉0.05）;（3） 与对照组相比,实验组S2/S1 波幅比值[（1.17 ± 0.26） vs.（0.41 ± 0.13）]显著升高,差异有统计学意义（P〈0.05）。结论：产后抑郁症患者感觉门控抑制能力有缺陷,P50 受损指标可能为评估产后抑郁症患者的潜在生物学指标。     

As_2O_3干预口腔鳞癌A431细胞EGFR表达的研究

目的：研究三氧化二砷（As2O3）对人口腔鳞癌A431细胞生长的抑制作用,探讨其抗肿瘤的机制。方法：合成特异性靶向到肿瘤细胞表面表皮生长因子受体（EGFR）的近红外荧光分子对比剂EGF-Cy5.5,验证试剂合成的靶向特异性。口腔鳞状细胞癌A431细胞系暴露于浓度分别为0μM,0.5μM,2.5μM和5.0μM的三氧化二砷溶液中0,24 h,48 h和72 h。共聚焦显微镜、流式细胞仪及免疫组化证实EGFR的表达水平,上述实验均测量三次,结果取平均值。结果：EGF-Cy5.5靶向荧光对比剂的标记率为68%~70%。对比对照组,越高浓度的三氧化二砷处理的肿瘤细胞其获得的细胞荧光信号强度越小,这与药物浓度越高细胞表面表达EGFR的量越少相一致。流式细胞仪显示,在72小时,作用于细胞的三氧化二砷药物浓度分别为0.5μM,2.5μM,和5.0μM,其相对应获得的细胞EGFR表达量分别为57.28±3.2%（P〈0.05）,29.91±2.2%（P〈0.01）和10.73±2.4%（P〈0.01）,明显低于对照组的细胞EGFR表达量74.42±1.8%,（P〈0.05）。结论：本研究应用近红外荧光分子成像的方法体外检测口腔鳞状细胞癌A431的EGFR表达水平,实验证明三氧化二砷对其EGFR具有明显的抑制作用,且抑制作用具有时间-剂量依赖性。     

内毒素在大剂量顺铂所致大鼠急性肾损伤过程中的变化及意义

目的利用大剂量顺铂（cisplatin,DDP）所致大鼠急性肾功能衰竭的动物模型,观察外周血内毒素（endotoxin）在大鼠急性肾损伤中的变化及其意义。方法SD大鼠36只,雌雄各半,依体重随机分为DDP用药6h、48h、对照组和生理盐水（NS）用药6h、48h、对照组,每组6只。10mg／kgDDP单次腹腔内注射,等量Ns对照。观察并记录用药后对照组大鼠的毒副反应;用药6、48h各组大鼠无菌条件下心脏穿刺取血、肝素抗凝,检测外周血内毒素含量,同时内眦静脉取血,测定血清尿素氮、肌酐浓度,并进行统计学分析。结果DDP用药后6h,大鼠体重开始明显降低,用药48h后,大鼠腹泻逐渐加重,用药3d后大鼠死亡。DDP用药后6h大鼠血尿素氮、肌酐的含量与对照组比较差异无显著性（P〉0．05）;DDP用药后48h血尿素氮升至（18．71±9．9）mmol／L,明显高于对照组（7．48±0．6）mmol／L（P〈0．05）,同时血肌酐含量亦升至（49．6±14．1）μmol／L,与对照组（27．17±1．7）μmol／L比较差异具有显著性（P〈0．05）。DDP用药后6h所有大鼠外周血内毒素含量都低于0．0218Eu／rrd最低检出限,明显低于NS对照组大鼠（0．3141±0．1477）Eu／ml（P〈0．01）;DDP用药后48h大鼠外周血内毒素的含量增高均超过0．70Eu／ml最高检出限,明显高于NS对照组大鼠（0．1661±0．1198）Eu／ml（P〈0．01）。结论外周血内毒素含量的变化与大剂量顺铂所致大鼠急性肾损伤早期的发病机制无关,但与大鼠肾功能衰竭有关的发生相关。     

热量限制对SH-SY5Y细胞氧化损伤的影响

目的观察热量限制培养条件下,SH-SY5Y细胞抗氧化应激损伤的能力。方法建立过氧化氢诱导的SH-SY5Y细胞损伤模型。体外培养SH-SY5Y细胞,分为对照组、损伤组（50、100、250、500、1 000μmol/L H2O2）、低糖组（2 g/L）、低糖＋损伤组,进行细胞形态观察、测定各组细胞的噻唑蓝（MTT）代谢率、乳酸脱氢酶（LDH）漏出率。结果与对照组比较,（50、100、250、500、1 000）μmol/L H2O2损伤1 h后MTT代谢率测定细胞活力,50μmol/L组与对照组比较差异无统计学意义（P〉0.05）;其他组与对照组比较,随着H2O2浓度的增加,细胞活力呈递减趋势,差异具有显著性（P〈0.01）;选定250μmol/L H2O2组为损伤应激源。用低糖预处理细胞24 h,给与250μmol/L H2O2损伤1 h后测定MTT代谢率显示,与对照组比较,损伤组活力明显下降,低糖组活力上升（P〈0.01）;与损伤组比较,低糖＋损伤组活力明显上升（p〈0.01）;继续培养至7 h发现,与对照组比较,低糖组活力上升（P〈0.01）;与损伤组比较,低糖＋损伤组活力明显上升（P〈0.01）。进一步检测LDH漏出率显示,损伤1 h后结果显示,与对照组比较,损伤组漏出率明显增加（P〈0.05）,低糖组漏出率稍有减少（P〉0.05）;与损伤组比较,低糖＋损伤组漏出率明显减少（P〈0.01）;继续培养7h显示,低糖7h组与低糖1 h组比较,漏出稍有增多（P〉0.05）,低糖＋损伤组7 h组与低糖＋损伤组1 h比较漏出率稍有增加（P〈0.05）;细胞形态学观察显示,未加损伤之前,低糖组的细胞形态,与对照组比较无明显改变。加入损伤药物1h后的细胞形态与对照组比较无明显改变。加入损伤药物7 h后的细胞形态,低糖组和对照组细胞突起伸展良好细长,损伤组可见细胞数目明显减少,死细胞多,突起回缩,细胞明显变圆,贴壁性不好,透光性差。结论热量限制能提高神经细胞的抗氧化应激能力,增加细胞生存率,降低死亡率。     

姜黄素诱导Nrf2核转位对脂多糖引起库普弗细胞分泌炎症细胞因子的影响

目的：研究姜黄素诱导大鼠Kupffer细胞Nrf2核转位对脂多糖（LPS）引起的炎症细胞因子分泌的影响。方法：分别用10μM、20μM和30μM干预Kupffer细胞8h,诱导Nrf2核转位水平;将Kupffer细胞随机分为对照组、LPS组和干预组,对照组正常培养未加姜黄素和LPS,LPS组用10μg／mL的LPS加入Kupffer细胞培养液共同培养2h;干预组用30μM姜黄素干预8h后,余处理同LPS组。Western blot检测Nrf2核转位水平,分光光度法检测细胞MDA、GSH水平,ELISA法检测上清液TNF-α和IL-6,放免法检测IL-1β。结果：①姜黄素诱导Kupffer细胞Nrf2核转位,核转位水平随浓度增加而增高。②LPS组MDA水平较对照组显著升高（P〈0．01）,干预组MDA水平较LPS组显著降低（P〈0．01）,仍显著高于对照组（P〈0．01）。LPS组GSH水平较对照组显著降低（P〈0．01）,干预组GSH水平较LPS组显著升高（P〈0．01）,仍显著低于对照组（P〈0．01）。③LPS组上清液TNF-α,IL-1β和IL-6显著高于对照组（P〈0．01）,干预组均显著低于模型组（P〈0．01）,但显著高于对照组（P〈0．01）。结论：姜黄素通过诱导Kupffer细胞Nrf2核转位,降低LPS诱导的氧化应激损伤,抑制Kupffer细胞分泌炎症细胞因子。     

氧化应激在高原重体力劳动过程中急性高原反应发生中的作用

目的：观察氧化应激在高原重体力劳动过程中急性高原反应（AHAR）发生中的作用。方法：由低海拔（1500m）快速进入高原（3700m）并从事重体力劳动的男性官兵96名,年龄18～35岁。根据AHAR症状评分,分为重度AHAR组（A组,n=24）、轻中度AHAR组（B组,n=47）和无AHAR组（C组,n=25）,在该高度逗留50d后下撤前及返回低海拔（1500m）后12h、15d分别测定血清8．异前列腺素F2a（8-iso-PGF2a）、超氧化物歧化酶（SOD）、丙二醛（MDA）,并与低海拔（1500m）50名健康官兵（D组）比较。结果：A组血清8-iso-PGF2a、MDA[分别为（9．53±0．47）μg／L、（8．91±0．39）μmol／L]水平显著高于B组[分别为（8．34±O．42）μg／L、（7．31±0．32）μmol／L]、C组[分别为（7．02±0．48）μg／L、（6．41±0．23）μmol／L和D组[分别为（5．13±0．56）μg／L、（5．48±0．33）μmol／L]（均P〈0．01）,SOD（52．08±3．44）μ／mL水平显著低于B组（62．27±2．54）μ/mL、C组（71．99±3．35）μ/mL和D组（80．78±3．44）μ/mL,（均P〈0．01）,B组与c组之间和C组与D组之间亦有显著性差异（均P〈0．01）。海拔3700mAHAR总计分与血清8-iso-PGF2α、ⅣⅡ）A呈显著正相关（均P〈0．01）,与血清SOD显著负相关（P〈0．01）;8-iso-PGF2α、MDA与SOD显著负相关（均P〈0．01）。海拔3700m50d,血清8-iso-PGF2α、MDA水平显著高于,SOD水平显著低于海拔1500m12h、15d和D组（均P〈0．01）,海拔1500m12h与15d之间有显著性差异（均P〈0．01）,海拔1500m 15d与D组之间无显著性差异。结论：人体在高原低氧并重体力时氧化应激和氧化．抗氧化失衡与AHAR的发病和程度有密切关系,氧化应激和氧化．抗氧化失衡越严重,AHAR越重。返回低海拔后12h有显著改善,15d恢复到正常水平。     

高脂血症对大鼠心电图的影响及其作用机制

目的：探讨在高脂血症状态下,大鼠心电图的变化情况,及高胆固醇血症对心肌电生理特性影响的机制。方法：将20只Wistar大鼠随机分为空白对照组和高脂饮食组,喂养10周后,检测大鼠的血脂水平、心电图和室颤阈值,并通过全细胞膜片钳记录心室肌细胞的ICa,L;利用组织病理学方法评价对照组及高脂饮食组的大鼠动脉粥样硬化的程度。结果：高脂饮食组的大鼠血脂水平与对照组相比明显增高（P〈0．01）;在高脂饮食组的大鼠动脉血管管壁中,可见广泛分布的粥样硬化斑块。在高脂饮食组的大鼠心电图中,室颤阈值为（4．23±0．12）V,明显低于对照组（12．80±6．34）V,P〈0．05。高脂饮食组大鼠的QTe间期（94±16）ms,与对照组（67±12）ms相比明显延长,P〈0．05。高脂饮食组大鼠的心室肌细胞的ICa,L密度为（12．83±3．28）pA／pF,与对照组（9．21±2．16）pA／pF相比明显高,P〈0．05。结论：高脂饮食后,大鼠的心电图有明显变化,QTe间期延长;高胆固醇血症能明显增加大鼠心肌细胞的ICa,L的,延长复极时程,降低室颤阈值。     

Evaluating the novel parameters for assessing the LAA function and thrombus formation with nonvalvular atrial fibrillation

The dysfunction of left atrial appendage (LAA) is prone to form thrombus when atrial fibrillation (AF) sustained more than 48 h. Traditional 2D-TEE (transesophageal echocardiography) can not accurate evaluate the function of LAA. The purpose of this study is to analyze the relationship of LAA function parameters and thrombus formation in patients with non-valvular atrial fibrillation (NVAF) by real-time three-dimensional transesophageal echocardiography (RT-3D-TEE). High risk patients can be identified according to the characteristics of ultrasonic index in patients with left atrial appendage thrombosis, which has important clinical value and significance in the risk assessment, guiding treatment and judging prognosis. We examined the relationship between the echocardiographic parameters of LAA function and the incidence of thrombus in 102 NVAF patients. They underwent RT-3D-TEE and left atrial appendage thrombus (LAAT)/severe spontaneous echocardiographic contrast (SSEC) was found in 67 patients (thrombus group) but absent in the remaining 35 patients (non-thrombus group). After measured by QLAB software, the LAA functional parameters were significantly associated with LAAT/SEC formation. Univariate analysis indicated that AF time, LAD, LVEF, LAA-OAmax, LAAVmax, LAAVI and LAAEF demonstrated a positive association (P < 0.05). However, logistic regression analysis identified that AF time (OR:1.73, P < 0.05)、LAAEF (OR:4.09, P < 0.01)and LAAVI (OR:3.28, P < 0.01) were independent predictors of LAAT/SSEC. In patients with nonvalvular atrial fibrillation, echocardiographic parameters of LAA function are significantly associated with LAAT/SSEC.     

High-density activation map of atrial tachycardia within left atrial appendage

Identification of the critical isthmus of the reentrant tachycardia is essential to maximize the effect of catheter ablation (CA) and to minimize the myocardial injury of CA. An 81-year-old woman presented recurrent palpitations after CA of atrial fibrillation (AF) and atrial tachycardia (AT). She had moderate aortic valve stenosis and coronary artery disease. She had received a pulmonary vein isolation, left atrial (LA) posterior wall isolation, and LA anterior linear ablation for atrial fibrillation 1 year prior. At the start of the procedure, she was in sinus rhythm. Atrial burst pacing induced an AT (230msec). High-density mapping revealed a figure-of-eight activation pattern within the LA appendage (LAA), accounting for 99% of the tachycardia cycle length. The critical isthmus was identified at the mid LAA and the local electrogram of the critical isthmus was not fractionated. A single radiofrequency application at the critical isthmus of the AT, terminated the AT. She was free from any ATs for 28 months.Radiofrequency ablation of the localized reentrant AT was usually performed targeting long fractionated electrograms. In our case, the local electrogram at the critical isthmus was not fragmented compared with the LAA distal part. Long fractionated electrograms were recorded at a more distal part of the LAA than the common isthmus and we could avoid the potential risk of a perforation. A recent developed 3-dimensional electro-anatomical mapping system can identify the critical isthmus and allow us to select a new therapeutic strategy for a critical isthmus ablation of an AT within the LAA.     

心房肌胞内钙浓度变化对心房颤动患者小电导钙激活钾通道电流的影响

目的：SK通道存在于心肌细胞上,其中SK2亚型主要表达在心房。SK2通道对胞内游离钙离子高度敏感,可快速将钙离子浓度的变化转换成细胞膜电位变化。本实验应用穿孔膜片钳技术记录人心肌细胞SK2电流,观察心房肌细胞SK2电流在窦性患者和心房颤动患者之间的差别,以及电极液中不同的钙浓度对两组细胞SK2电流的影响。方法：将接受体外循环手术的患者分为两组：心房颤动组和窦性心律组。以心房肌细胞为研究对象,用穿孔膜片钳技术记录人心肌细胞电流,观察窦性组与房颤组SK2通道电流的差异以及两组细胞SK2电流对电极液中钙敏感性的不同。结果：在全细胞穿孔膜片钳模式下,电极液中游离钙离子浓度为5×10-7mol/L时,记录到房颤组SK2通道电流明显大于窦性组,尤其是在超极化水平。膜电位在-130 mV时,窦性组与房颤组的SK2通道电流密度分别为（-2.92±0.35）pA/pF（n=6）,（-6.83±0.19）pA/pF（n=3,P〈0.05）。在电极液游离钙离子浓度分别为0 mol/L、5×10-7mol/L、10-6mol/L,膜电位为-130 mV时,窦性组SK2通道电流密度分别为（-1.43±0.33）pA/pF（n=7）,（-2.92±0.35）pA/pF（n=6）,（-10.11±2.15）pA/pF（n=8,P〈0.05）;房颤组SK2通道电流密度分别为（-2.17±0.40）pA/pF（n=4）（-6.83±0.19）pA/pF（n=3）（-14.47±2.89）pA/pF（n=4）（P〈0.05）。结论：人心房肌细胞SK2通道具有电压不敏感、内向整流、apamin敏感的特性。电极液中钙浓度相同的情况下,房颤组的SK2电流密度明显大于窦性组,SK2通道电流对钙离子的敏感性高于窦性组,提示SK2通道钙敏感性增加可能与心房颤动的发生发展密切相关。     

Cryoballoon ablation of focal atrial tachycardia originating from right atrial appendage: Case report and review of the literature

The right atrial appendage (RAA) is a rare site of focal atrial tachycardia (AT). Sometimes, catheter ablation cannot successfully be accomplished at this location due to the difficulty in reaching the exact ablation site as well as the associated possible life-threatening complications like pericardial tamponade or perforation. Although radiofrequency (RF) ablation is preferred for the treatment of RAA tachycardias, alternative tools may be required in rare instances. This report presents a case of RAA tachycardia that was not terminated by RF ablation, instead, has been successfully ablated using cryoballoon. In addition, an overview of the literature and therapeutic options for the AT originating from RAA have also been included.     

Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation

Background

Percutaneous left atrial appendage (LAA) closure can be an alternative to coumadin treatment in patients with atrial fibrillation (AF) at high risk for thromboembolic events and/or bleeding complications. We report the initial experience with this new technique.

Methods

Patients were eligible if they had AF with a high stroke risk (CHADS₂ score >1), and/or contraindication for coumadin therapy. The procedure was performed under general anaesthesia, using biplane fluoroscopy and (3D) transoesophageal echocardiography (TEE) guidance. Patients were discharged on coumadin until a TEE was repeated at 45 days after closure to evaluate LAA occlusion. If LAA occlusion was achieved, oral anticoagulation was discontinued and aspirin started.

Results

Percutaneous LAA closure was performed in 10 patients (50% male, age 61.6 ± 9.6 years). The median CHADS₂ score was 3 (range 2–4), median CHA₂DS₂-VASc score 3.5 (range 2–6) and HAS-BLED score 1.5 (range 1–4). Nine patients had a history of stroke and 2 patients had a history of major bleeding while on coumadin. Concomitant pulmonary vein isolation was performed in 9 patients. The device was successfully placed in all patients within a median of 56 min (38–137 min). Asymptomatic catheter thrombus occurred in one patient. At 45-day follow-up, no thromboembolic events occurred, TEE showed minimal residual flow in the LAA in three patients. In one patient the LAA device was dislocated, requiring successful percutaneous retrieval.

Conclusion

Device closure of the LAA may provide an alternative strategy to chronic coumadin therapy in patients with AF and high risk of stroke and/or bleeding complications using coumadin.     

Left Atrial Appendage Dysfunction in a Patient with Premature Ventricular Contractions - A Risk Factor for Stroke?

A 16-year-old female with ventricular dysfunction and frequent ventricular arrhythmia presented with a cardioembolic stroke. Prior electrophysiology study and ablation was performed for ventricular tachycardia (VT). For remaining ventricular ectopy, the patient was maintained on carvedilol and mexiletine. After one year on this regimen, she presented with an acute stroke. Transesophageal echocardiography revealed no evidence of an intracardiac or ventricular thrombus but demonstrated markedly decreased left atrial appendage (LAA) flow velocity worsened during frequent premature ventricular contractions (PVC). In the absence of atrial fibrillation (AF), the LAA dysfunction was considered secondary to the frequent PVCs and was thought to be the underlying cause for the stroke. We present this case to highlight a potential under recognized association between LAA dysfunction and ventricular arrhythmia, similar to that observed with atrioventricular dyssynchronous pacing.     

Concomitant epicardial left atrial appendage ligation and left atrial ablation of atrial fibrillation: Safety,feasibility and outcome

IntroductionWe present initial results of patients undergoing a combined procedure of epicardial LAA ligation in addition to left atrial ablation for AF.Methods9 patients were included for additional use of LARIAT as an individual treatment approach for AF. First an epicardial LAA ligation was performed, in the same procedure left atrial ablations consisting of PVI and additional substrate based modifying ablations were performed. Follow–up at 3 months and 12 months was performed.ResultsThere was only 1 minor procedural complication (11%) involving epicardial bleeding and 2 late adverse events of pericardial tamponade and stroke. At the final follow-up (median 20 months) 7 patients were in stable sinus rhythm (78%) and 2 pts had reduced AF burden.ConclusionConcomitant epicardial LAA ligation and ablation is feasible in selected patients with a reasonable risk profile. More prospective data are required to validate the safety and efficacy.     

Incidence and predictors of left atrial thrombus in patients with atrial fibrillation prior to ablation in the real world of China

BackgroundThe present study was to evaluate the value of CHADS2 and CHA2DS2VASC scores on predicting left atrial (LA) or left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients prior to ablation in the real world of China.Methods and resultsA total of 397 patients with non-valvular AF were analyzed to determine the relationship between CHADS2 and CHA2DS2VASC scores and LA/LAA thrombus identified on transesophageal echocardiography prior to radiofrequency ablation(RFA). LA/LAA thrombus was present in 38 patients (9.6%). There was a strong association between higher CHADS2 score or CHA2DS2VASC score and LA/LAA thrombus. No thrombus was identified in patients with CHA2DS2VASC score of 0 regardless of anticoagulation status. However, LA/LAA thrombus was detected in 2.9% patients with CHADS2 score of 0 without adequate anticoagulation, while no thrombus was present in the patients with CHADS2 score of 0 with adequate anticoagulation. Univariate analysis showed that heart failure (LVEF＜50%), LA≥40 mm, diabetes mellitus, previous stroke or TIA, CAD, hypertension, inadequate anticoagulation therapy, CHADS2 score of ≥2 and CHA2DS2VASC score of ≥2 were significantly associated with LA/LAA thrombus. Multivariable Cox regression analysis demonstrated that CHA2DS2VASC score of ≥2 (p = 0.02) and previous stroke or TIA (p = 0.04) were independently associated with LA/LAA thrombus regardless of anticoagulation status. ROC curve analysis showed that higher CHADS2 score and CHA2DS2VASC score could be similarly used to predict the presence of LA thrombus.ConclusionsBoth higher CHA2DS2VASC and CHADS2 scores were associated with LA/LAA thrombus in non-valvular AF patients prior to ablation. Although CHA2DS2VASC score and CHADS2 score had similar value to predict LA/LAA thrombus, CHA2DS2VASc score was better to identify low-risk patients for LA/LAA thrombus than CHADS2 score without anticoagulation. There will be a possibility of performing AF ablation or cardioversion in patients with a CHA2DS2VASC of 0 without TEE or anticoagulation therapy. The safety need to be verified by more multicentre randomized controlled clinical trails.     

Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.