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Simple hematological predictors of AF recurrence in patients undergoing atrial fibrillation ablation

Journal of Geriatric Cardiology 2019年第9期16卷 671-675页

作者： George Bazoukis Konstantinos P Letsas Konstantinos Vlachos Athanasios Saplaouras dimitrios asvestas Konstantinos Tyrovolas Aikaterini Rokiza Eirini Pagkalidou Gary Tse Stavros Stavrakis Antonios Sideris Michael Efremidis Department of Cardiology Electrophysiology Laboratory Evangelismos General Hospital of Athens Athens Greece Department of Hygiene and Epidemiology School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR China Department of Medicine Cardiovascular Section Heart Rhythm Institute University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA

Backgound Red cell distribution width(RDW) and neutrophil-to-lymphocyte ratio(NLR) are simple hematologic indices that have been used to predict adverse outcomes in different clinical settings. The aim of our study is to determine whether RDW and NLR can predict atrial fibrillation(AF) recurrence in patients undergoing AF ablation. Methods Consecutive patients, without known hematological disorders, who underwent AF catheter ablation between January 2014 and April 2017 were enrolled into this study. Blood samples were taken one day before and five hours after the ablation procedure. Results A total of 346 patients(224 males(65%), mean age: 59 ± 11 years old) were included. After a mean follow up of 26.2 ± 12.1 months, 80(23.1%) patients experienced late AF recurrence(defined as any recurrence after the blanking period of three months), while 97(28%) patients experienced early AF recurrence during the blanking period. Univariate analysis showed that early arrhythmia recurrence, type of AF and NLR after the procedure were significantly associated with late AF recurrence, while early arrhythmia recurrence and NLR remained significant in multivariate analysis. RDW was not associated with late AF recurrence. None of the parameters above predicted early arrhythmia recurrence. Conclusions Simple and inexpensive hematological indices such as NLR should be evaluated for their ability to predict AF recurrence in patients undergoing catheter ablation in larger prospective studies.

关键词： Atrial fibrillation Neutrophils Radiofrequency ablation

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Mechanisms of drug-induced proarrhythmia in clinical practice

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World Journal of Cardiology 2013年第6期5卷 175-185页

作者： Arkadia Konstantopoulou Spyros Tsikrikas dimitrios asvestas Panagiotis Korantzopoulos Konstantinos P Letsas Second Department of Cardiology Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of Athens Department of Cardiology University Hospital of Ioannina

Drug-induced proarrhythmia represents a great challenge for those involved in the development of novel pharmaceuticals and in the regulatory bodies for drug approval as well as for the prescribing *** understanding of the mechanisms that underlie druginduced proarrhythmia has grown dramatically over the last two decades.A growing number of cardiac and non-cardiac agents have been shown to alter cardiac repolarization predisposing to fatal cardiac arrhythmias such as ventricular tachycardia or ventricular fibrillation and sudden cardiac *** agents may induce the phenotype of long QT syndrome and less commonly of short QT syndrome and Brugada syndrome(BS).Although,genetic susceptibility underlie drug-induced proarrhythmia in certain cases,current data are limited regarding this *** present review surveys the current published literature on the mechanisms and the offending medical agents that predispose to drug-induced long QT syndrome,short QT syndrome and ***-induced proarrhythmia should be considered as a predictor of sudden cardiac death and should prompt critical re-evaluation of the risks and benefits of the suspicious *** of drug-induced proarrhythmia and family members require careful examination and possibly genetic testing for the presence of a *** physicians are advised to follow the lists of agents implicated in drug-induced proarrhythmia in order to minimize the risk of arrhythmia and sudden cardiac death.

关键词： Drugs Sudden cardiac death Long QT syndrome Short QT syndrome Brugada syndrome

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Headache:An unusual presentation of acute myocardial infraction

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World Journal of Cardiology 2014年第6期6卷 514-516页

作者： dimitrios asvestas Konstantinos Vlachos Anastasios Salachas Konstantinos P Letsas Antonios Sideris Second Department of Cardiology Evangelismos General Hospital10676 AthensGreece

Acute myocardial infarction should be diagnosed as early as possible for the appropriate management to salvage ischemic myocardium. Accurate diagnosis is typically based on the typical symptoms of angina. Headache is an unusual symptom in patients with acute myocardial infraction. We report a patient with ST-segment elevation acute myocardial infarction who presented to the emergency department complaining of severe occipital headache without chest discomfort.

关键词：头疼咽峡炎心肌的梗塞

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Catheter ablation of persistent atrial fibrillation:The importance of substrate modification

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World Journal of Cardiology 2015年第3期7卷 111-118页

作者： Konstantinos P Letsas Michael Efremidis Nikolaos P Sgouros Konstantinos Vlachos dimitrios asvestas Antonios Sideris Second Department of Cardiology Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of Athens

Accumulating data have shown that elimination of atrial fibrillation(AF) sources should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions and complex fractionated atrial electrograms(CFAEs) ablation have shown limited efficacy in patients with persistent AF. A combined approach using voltage, CFAEs and dominant frequency(DF) mapping may be helpful for the identification of AF sources and subsequent focal substrate modification. The fibrillatory activity is maintained by intramural reentry centered on fibrotic patches. Voltage mapping may assist in the identification of fibrotic areas. Stable rotors display the higher DF and possibly drive AF. Furthermore, the single rotor is usually consistent with organized AF electrograms without fractionation. It is therefore quite possible that rotors are located at relatively "healthy islands" within the patchy fibrosis. This is supported by the fact that high DF sites have been negatively correlated to the amount of fibrosis. CFAEs are located in areas adjacent to high DF. In conclusion, patchy fibrotic areas displaying the maximum DF along with high organization index and the lower fractionation index are potential targets of ablation. Prospective studies are required to validate the efficacy of substrate modification in left atrial ablation outcomes.

关键词： Ablation Atrial fibrillation Persistent Substrate Dominant frequency

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