Biomarkers for Predicting Left Atrial or Left Atrial Appendage Thrombus in Anticoagulated Patients with Nonvalvular Atrial Fibrillation

Purpose. Although atrial fibrillation (AF) is often associated with thromboembolic complications, there is no definite biomarker for detecting the presence of thrombi in the left atrial (LA) or left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF). Methods. NVAF patients who underwent transesophageal echocardiography (TEE) to evaluate LA/LAA thrombus and spontaneous echo contrast (SEC) before AF ablation were included. Multivariate logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the independent risk factors of LA/LAA thrombus and indicate the best cutoff point. Results. Of the 260 consecutive subjects (mean age: 63.67 ± 9.39 years; 42% women), 45 (17.3%) patients were with LA/LAA thrombus, 131 (50.4%) were with SEC, and 84 (32.3%) were with neither thrombus nor SEC. The results of multivariate logistic regression analysis showed that N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR, 2.179; 95% CI: 1.191–3.987; p=0.012) and red cell distribution width (RDW) (OR, 2.398; 95% CI: 1.075–5.349; p=0.033) were independently correlated with the presence of LA/LAA thrombus but not D-dimer (OR, 0.999; 95% CI: 0.998–1.000; p=0.210). When all patients were divided into four groups based on the combination between RDW (cutoff value: 12.95%) and NT-proBNP levels (cutoff value: 368.9 ng/L), the rate of LA/LAA thrombus was the highest in the high RDW and NT-proBNP group. Conclusion. In anticoagulation patients with NVAF, elevated NT-proBNP and RDW are related to LA/LAA thrombus. Therefore, these might be considered as useful prognostic markers in the management and treatment of NVAF patients

Efficacy of Wenxin Keli Plus Amiodarone versus Amiodarone Monotherapy in Treating Recent-Onset Atrial Fibrillation

Background. Use of amiodarone (AMIO) in atrial fibrillation (AF) has significant side effects over prolonged periods. Wenxin Keli (WXKL), a Chinese herb extract, has been shown to be effective in atrial-selective inhibiting peak INa and hence beneficial in treating atrial arrhythmias, including atrial fibrillation. The aim of this randomized controlled trial was to evaluate potential effects of AMIO plus WXKL on conversion rate and time in patients with recent-onset AF. Methods. A total of 41 patients (71 ± 12 years, 44% male) with recent-onset (<48 h) AF eligible for conversion were randomized to receive either intravenous amiodarone (loading dose 5 mg/kg in 1 hour followed by 50 mg/h; n=21) or amiodarone with same dosage plus oral WXKL 18 g thrice daily (n=20) for 24 hours. Results. Conversion rate at 24 hours was of no difference between the two groups (75.0% vs. 81.0%, P=0.72); however, conversion time was markedly shorter in the AMIO + WXKL group compared to the AMIO group (291 ± 235 minutes vs. 725 ± 475 minutes, P=0.003). There were no serious adverse events during the study. Conclusion. Administration of amiodarone plus WXKL for recent-onset AF conversion was safe and effective, with faster sinus rhythm restoration compared with amiodarone alone

Dependence on the probability of observing ILPs based on substrate type and number of ILPS relative to substrate burden visualized on the basis of co-registered EAM and CMR images (LGE and T2*).

<p>(<b>A</b>) Shows the overall incidence of ILPs (fraction of the total) that were coincident with regions containing iron (IRON+) and regions without iron (IRON−). (<b>B</b>) Shows the mean number of ILPs per volume of substrate, with the substrate being the total scar (i.e., scar with and without iron), scarred regions with iron (IRON+) and scarred regions without iron (IRON−).</p

Mean values of important surface ECG parameters over day, night and a 24-hour period from Iron (>1.5%) and Iron (<1.5%) dogs.

<p>The mean values from dogs with and without iron over the period of interest for heart rate (<b>A</b>), QT (<b>B</b>), QTc (<b>C</b>) and QTcd (<b>D</b>) are shown.</p

Representative co-registered CMR images and endocardial EAMs showing the association between ILPs and iron deposition following myocardial infarction.

<p>Co-registered late-gadolinium enhancement images projected onto the segmented blood pool surface (<b>A</b>) with infarcted territory (color coded in red), border zone (yellow and blue shades) and remote territories (purple)) with the corresponding bipolar map (<b>B</b>, color-coded to indicate low voltage areas) are shown. For reference, an ILP deep within the scar tissue (white arrow) is shown. The voltage traces from V1 and at the coronary sinus (CS), along with bipolar and unipolar mapping traces are also shown. Note the presence of an isolated low-voltage sharp late potential in the bipolar and unipolar traces following the local ventricular activation (yellow arrow) in <b>C</b>. The activation map (<b>D</b>), a map of the ILPs (<b>E</b>), and iron containing regions (in red, <b>F</b>) are also shown for reference. Note that iron-containing regions have a greater incidence of ILPs and slow activation regions.</p

Representative specific impedance spectra from Remote, IRON-, and IRON+ myocardial samples.

<p>Note that for a given AC frequency, the specific impedance of IRON+ samples is higher than that of the Remote and IRON− samples.</p