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Atrial Fibrillation After Cardiac Surgery: Electrophysiological Mechanism and Outcome.

心脏手术后心房颤动: 电生理机制和结果。

  • 影响因子:1.80
  • DOI:10.1016/j.athoracsur.2019.12.069
  • 作者列表:"Ehrlich MP","Osorio-Jaramillo E","Aref T","Coti I","Andreas M","Laufer G","Ad N
  • 发表时间:2020-06-01
Abstract

BACKGROUND:Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with an inferior outcome. The high cure rate compared with non-POAF raises questions regarding the electrophysiologic mechanism. Despite being common, until now the electrophysiologic mechanism of POAF was never assessed. METHODS:Ten patients (5 men; mean age, 75 ± 5 years) with POAF underwent noninvasive 3-dimensional beat-by-beat mapping and were compared with 10 patients (6 men; mean age, 70 ± 10 years) with preoperative persistent AF (PEAF) undergoing open heart procedures. Three-dimensional mappings were compared by the nature and location of focal and rotor activity using the validated Bordeaux classification. RESULTS:Rotor activity was present in both atria of all patients; 299 rotors (mean, 30 ± 12) were mapped in the POAF group and 289 (mean, 29 ± 22) in the PEAF group. The most common region for macro reentry in both groups was the pulmonary vein area. Left atrium and left atrial appendage activity accounted for 59% (177/299 POAF group) and 62% (180/289 PEAF group) of all drivers. Rotor activity in the right atrium was documented in all patients. Focal activity was captured in only 2 patients in the POAF group and in 6 patients in the PEAF group. CONCLUSIONS:The mechanism of POAF is comparable with that of PEAF. Rotor activity was similar in both groups, but focal activity was numerically less common in the POAF group, which may be related to differences in atrial tissue remodeling. In POAF, transient substrate changes seem to facilitate the development of AF. A better understanding of atrial tissue changes by mapping and tissue analysis should lead to better preventive approaches.

摘要

背景: 术后心房颤动 (POAF) 是心脏手术后常见的并发症,预后较差。与非POAF相比,高治愈率提出了关于电生理机制的问题。尽管是常见的,但迄今为止尚未评估POAF的电生理机制。 方法: 10例POAF患者 (5例男性; 平均年龄,75 ± 5岁) 接受无创三维逐拍标测,并与10例术前持续性AF (PEAF) 患者 (6例男性; 平均年龄,70 ± 10岁) 进行心脏直视手术比较。使用经验证的波尔多分类,通过病灶和转子活动的性质和位置比较三维映射。 结果: 所有患者的两个心房都存在转子活动; POAF组有299个转子 (平均30 ± 12),PEAF组有289个转子 (平均29 ± 22)。两组中最常见的宏观折返区域是肺静脉区。左心房和左心耳活动占所有驾驶员的59% (177/299 POAF组) 和62% (180/289 PEAF组)。在所有患者中记录了右心房的转子活动。仅在POAF组的2名患者和PEAF组的6名患者中捕获了病灶活动。 结论: POAF的发病机制与PEAF相当。两组的转子活动相似,但POAF组的病灶活动在数值上较少,这可能与心房组织重构的差异有关。在POAF中,瞬时底物变化似乎促进了AF的发展。通过映射和组织分析更好地理解心房组织变化应该导致更好的预防方法。

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影响因子:4.08
发表时间:2020-01-01
来源期刊:European radiology
DOI:10.1007/s00330-019-06319-0
作者列表:["Delattre BMA","Boudabbous S","Hansen C","Neroladaki A","Hachulla AL","Vargas MI"]

METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

影响因子:0.96
发表时间:2020-02-01
DOI:10.1002/jcu.22762
作者列表:["Meng L","Zhao D","Yang Z","Wang B"]

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