Objective Little is known about the outcome of repeat catheter ablation of long-standing persistent atrial fibrillation (AF) in patients with a total AF duration of more than 2 years. The main objective of this study was to explore the results and factors affecting the clinical success rate of these repeat procedures. Methods We enrolled 99 patients with a total AF duration of more than 2 years and recurrent atrial arrhythmias after the initial catheter ablation of long-standing persistent AF. The enrolled patients were divided into two groups named the AF-recurrence group (50 patients) and the atrial tachycardia (AT)-recurrence group (49 patients) and all underwent a strict follow-up. The quality of life (QOL) and AF-related symptom classification were assessed at baseline and at 24 months post re-ablation.Results After a mean follow-up of 31 months, 30 (30.3%) patients were free from arrhythmia recurrence, and the success rate in the AT-recurrence group was higher than that in the AF-recurrence group (32.7% vs. 28.0%, p=0.614). A Cox regression analysis revealed a CHA2DS2-VASc score ! 3 to be a predictor of recurrence. AF recurrent patients with an abnormal renal function were more prone to undergo a failed procedure. However, an abnormal renal function had no effect on the outcome of the repeat procedure for patients with AT recurrence. At the 24-month follow-up, patients maintaining sinus rhythm (SR) had a significantly improved QOL and AF-related symptoms. Conclusion The success rate of repeat procedures for long-standing persistent AF and a total AF duration of more than 2 years is poor for patients with a CHA2DS2-VASc score ! 3. An impaired renal function has an unfavorable effect on the outcome for patients with AF recurrence. For patients maintaining SR, both the QOL and AF symptomatology improve significantly.

Background Heart rate acceleration and deceleration capacities are novel parameters that can quantify sympathetic and vagal modulation. However, how acceleration and deceleration capacities associated with circadian blood pressure (BP) variation remains unknown. Methods A total of 141 patients with essential hypertension were included in our study. Based on the nocturnal decline rate of systolic BP (SBP), patients were divided into two groups, as dippers and nondippers. Baseline demographic characteristics, ambulatory blood pressure monitoring (ABPM) parameters, Holter recordings, and echocardiographic parameters were collected. Results The absolute values of acceleration capacity (AC) (−7.75 [−8.45 ~ −6.3] ms vs. −6.6 [−8.25 ~ −5.2] ms, p = .047) and deceleration capacity (DC) (7.35 [6.1 ~ 8.1] ms vs. 6.3 [5.1 ~ 7.6] ms, p = .042) were significantly higher in dippers than in nondippers. By multivariate logistic regression analysis, left atrial diameter (LAd) was found to be an independent risk factor for nondipper status in acceleration capacity model (odds ratio 1.174, 95% confidence interval 1.019–1.354, p = .027) and deceleration model (odds ratio 1.146, 95% confidence interval 1.003–1.309, p = .045). Sleep SBP was positively correlated to acceleration capacity ( r = .256, p = .002) and negatively correlated to deceleration capacity ( r = −.194, p = .021). Conclusions The absolute values of acceleration capacity and deceleration capacity were higher in patients with dipper hypertension than in patients with nondipper hypertension. However, acceleration and deceleration capacities were not independent risk factors for blunted BP variation. Sleep SBP seemed to be better correlated to the impairment of autonomic nervous system (ANS) function than other ABPM parameters.

Background Identify idiopathic ventricular tachycardia in patients with ventricular premature beats was required to have effectively treatment. Hypothesis The aim of this study is to investigate the predictive value of Tp−Te interval, Tp−Te/QT ratio, and QRS‐T angle of idiopathic ventricular tachycardia in patients with idiopathic ventricular premature beats. Methods One hundred and seventy‐eight patients who had undergone premature ventricular complex/ventricular tachycardia (PVC/VT) ablation between January 1, 2020 and August 30, 2022 constituted our study population as ventricular arrhythmia group. Seventy‐five healthy people were selected as control group. Patients with no episode of VT were classified as PVC group, while with any episode of VT that has the same morphology with PVC were classified as PVC with VT group. Patients in PVC with VT group were divided into two groups: nonsustained VT group (duration of any episode of VT below 30 s) and sustained VT group (duration of any episode of VT over 30 s). Tp–Te interval, Tp–Te/QT ratio and QRS‐T angle were compared in groups. Results Tp–Te interval, Tp–Te/QT ratio and patients with increased QRS‐T angle in PVC with VT group were higher or more than those in PVC group (p < .001). The value of combined diagnosis of these indexes was higher. Tp–Te interval was longer in the sustained VT group compared to the nonsustained VT group (p = .009). Conclusion Tp–Te interval, Tp–Te/QT ratio, and QRS‐T angle may have a predictive value of presence of idiopathic VT in patients with premature beats and the combined prediction of these indexes is more valuable. Tp–Te interval maybe helpful for prediction of sustained idiopathic VT.

AbstractBackgroundThe relationship between electrocardiographic evaluation and circadian blood pressure (BP) variation in young and middle-aged hypertensive patients remains unknown.MethodsA total of 171 hypertensive patients were included in the study. First, patients were divided into a young and middle-aged group and an elderly group. The two groups were then separately classified into three subgroups on the basis of circadian variation of BP as dippers, non-dippers and reverse-dippers. The electrocardiographic evaluation was calculated from 12-lead electrocardiography (ECG).ResultsQTc intervals were shortest in the dippers and longest in the reverse-dippers in the young and middle-aged group (QTc dipper: 416.53±18.37ms; non-dipper: 438.30±29.71ms; reverse-dipper: 444.93±25.47ms; for dipper vs non-dipper, and dipper vs reverse-dipper P<0.05). QTc interval was found to be an independent risk factor for the non-dipper BP pattern (Odds ratio 1.049; 95% CI 1.01-1.089; P=0.012) and reverse-dipper BP pattern (Odds ratio 1.051; 95% CI 1.007-1.098; P=0.023) in young and middle-aged hypertensive patients. No significant differences in other ECG parameters were found among the three subgroups in the young and middle-aged group.ConclusionOur study suggested that QTc interval might serve as a risk factor for non-dipper BP pattern and reverse-dipper BP pattern in young and middle-aged hypertensive patients.

Aims: Atrial fibrosis is the hallmark of atrial fibrillation (AF). Accumulating evidence have shown that mesenchymal stem cells (MSCs) can alleviate fibrosis in diverse organs. However, the role of MSCs-derived exosome (MSCs-Exo) in the pathogenesis of atrial fibrosis and vulnerability to AF was unknown.Methods: Exosomes were isolated from cultured MSCs. Transmission electron microscopy and western blot were used to examine the purity of MSCs-Exo. 8-week-old BALB/c mice were randomized into sham group, angiotensin-II (Ang-II) group, and Ang-II+MSCs-Exo group. A mini-pump was implanted for subcutaneous infusion of Ang-II for 4 weeks to induce atrial fibrosis. In the Ang-II+MSCs-Exo group, 300μg/150μl MSCs-Exo were injected into tail veins twice a week after establishing the animal model. Echocardiography was used to evaluate heart structure and function. Intracardiac electric stimuli was used to analyze AF inducibility. Masson staining was used to evaluate the degree of atrial fibrosis. Ang-II-induced proliferation, migration, phenotypic switching and the capacity of extracellular matrix synthesis were examined after MSCs-Exo preconditioning. We reanalyzed two public expression datasets of MSCs-Exo and selected a few most highly expressed microRNAs. After literature search and experimental validation, we narrowed down our candidates to miR-148a-3p. Then, we predicted the potential target genes of miR-148a-3p, and determined ALK5 and SMAD2 as the targets of miR-148a-3p. Western blot was used to quantify Ang-II-induced protein expressions of TGF-β1/ALK5/SMAD2 pathway in fibroblasts after exposure to miR-148a-3p-rich MSCs-Exo.Results: Compared with mice in Ang-II group, mice in Ang-II+MSCs-Exo group showed less atrial enlargement, atrial fibrosis, a lower AF inducibility and AF duration. Ang-II-induced proliferation, migration, phenotypic switching, and capacity of extracellular matrix synthesis were ameliorated in fibroblasts after co-incubation with MSCs-Exo. After exposure to miR-148a-3p inhibitor, MSCs derived Exosomes (MSCs-148a-3p inhibitor-Exo) can significantly reverse above phenomenon. As the targets of miR-148a-3p, the expressions of ALK5 and Smad2 were lower in Ang-II+MSCs-Exo group compared with the Ang-II group. Furthermore, MSCs-Exo treatment inhibited Ang-II-induced activation of TGF-β1/ALK5/Smad2 pathway, and MSCs-148a-3p inhibitor -Exo reverse above phenomenon.Conclusions: MSCs-Exo can alleviate Ang-II induced atrial fibrosis and AF vulnerability through transferring miRNA-148a-3p to inhibit the activation of TGF-β1/ALK5/Smad2 pathway, providing a new avenue to AF treatment.