Improved endothelial function in patients with atrial fibrillation through maintenance of sinus rhythm by successful catheter ablation

BACKGROUND

Although atrial fibrillation (AF) is a risk factor for endothelial dysfunction (ED), the effect of catheter ablation (CA) on AF-associated ED has not been evaluated. The aims of this study are to determine if the degree of ED predicts the outcome of AF ablation and to evaluate whether ED can be improved through restoring sinus rhythm (SR) by successful CA.

METHODS

This study prospectively enrolled 80 subjects who underwent CA for AF (paroxysmal AF = 61, persistent AF = 19). Eighty subjects with no history of AF were enrolled as controls, all of whom were matched by age, gender, body mass index, and atherosclerotic risk factor distribution. Brachial artery flow-mediated dilatation (FMD) was measured at baseline, and at 1 month and 6 months post CA in AF subjects who remained in SR. Among controls, FMD was measured at baseline and at 6 months. We used high sensitivity C-reactive protein (hs-CRP), interleukin-6, soluble E- or P-selectin, and endothelin-1 as biomarker indices for inflammation and/or ED.

RESULTS

Compared with controls, AF subjects had lower FMD at baseline (FMD(baseline), P < 0.001). After successful CA, FMD was significantly improved at 1 month and 6 months, nearly approaching control levels. A multivariate analysis revealed that FMD(baseline), hs-CRP, and left atrial volume (LAV) were independent predictors for arrhythmia recurrence after CA. Other biomarkers were not related to rhythm outcome.

CONCLUSION

AF subjects have significantly impaired FMD, which can be reversed through maintenance of SR by successful CA. FMD(baseline), hs-CRP, and LAV are important predictors for AF recurrence after CA.

Serological predictors for the recurrence of atrial fibrillation after electrical cardioversion

BACKGROUND AND OBJECTIVES

Although electrical cardioversion (CV) is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF), AF frequently recurs in spite of antiarrhythmic medications. We investigated the predictors of failed CV and AF recurrence after successful CV.

SUBJECTS AND METHODS

In 81 patients (M:F=63:18, 59.1+/-10.5 years old) with AF who underwent CV, clinical findings and pre-CV serologic markers were evaluated.

RESULTS

During 13.1+/-10.6 months of follow-up, 8.6% (7/81) showed failed CV, 27.16% (22/81) showed early recurrence atrial fibrillation (ERAF; </=2 weeks), 32.1% (26/81) had late recurrence atrial fibrillation (LRAF; >2 weeks), and 32.1% (26/81) remained in SR and had no recurrence (NR). Plasma levels of transforming growth factor beta (TGF)-beta were significantly higher in patients with failed CV than in those with successful CV (p=0.0260). Patients in whom AF recurred were older (60.4+/-9.0 years old vs. 55.3+/-12.5 years old, p=0.0220), and had lower plasma levels of stromal cell derived factor (SDF)-1alpha (p=0.0105). However, there were no significant differences in these parameters between ERAF patients and LRAF patients.

CONCLUSION

Post-CV recurrence commonly occurs in patients aged >60 years and who have low plasma levels of SDF-1alpha. High plasma levels of TGF-beta predict failure of electrical CV.

Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion

AIMS

Although electrical cardioversion (CV) is effective in restoring sinus rhythm in patients with atrial fibrillation (AF), AF frequently recurs in spite of antiarrhythmic medications. We investigated the predictors of failed CV and AF recurrence after successful CV.

METHODS AND RESULTS

In 81 patients (M:F = 63:18, 59.1 +/- 10.5 years old) with AF who underwent CV, clinical, image, and CV findings (energy requirement, immediate recurrence of AF < 15 min), and pre-CV serological markers were evaluated.

RESULTS

(i) During 13.1 +/- 10.6 months of follow-up, 8.6% (7/81) showed failed CV, 59.26% (48/81) showed AF recurrence, and 32.1% (26/81) remained in sinus rhythm (no recurrence). (ii) Failed CV showed higher plasma levels of transforming growth factor (TGF)-beta (P = 0.0260) than those with successful CV. (iii) Patients with AF recurrence were older (60.4 +/- 9.0 years old vs. 55.3 +/- 12.5 years old, P = 0.0220), had a higher incidence of spontaneous echo contrast (SEC; 68.1 vs. 40.0%, P = 0.0106), a lower prescription rate of angiotensin-converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB; 27.0 vs. 50.0%, P = 0.0248) or spironolactone (0.0 vs. 19.2%, P = 0.0007), and lower plasma levels of stromal cell-derived factor (SDF)-1alpha (P = 0.0105).

CONCLUSION

Post-CV recurrence commonly occurs in patients with age >60 years, SEC, under-utilization of ACE-I/ARB or spironolactone, and low plasma levels of SDF-1alpha. High plasma level of TGF-beta predicts failed CV.

Non-ischaemic titrated cardiac injury caused by radiofrequency catheter ablation of atrial fibrillation mobilizes CD34-positive mononuclear cells by non-stromal cell-derived factor-1alpha mechanism

AIMS

It has been known that myocardial ischaemia mobilizes CD34+ bone marrow-derived cells by the stromal cell-derived factor (SDF)-1alpha pathway. We hypothesized that non-ischaemic titrated cardiac injury caused by radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) recruits CD34+ cells by an alternative mechanism.

METHODS AND RESULTS

Fifty-six patients (39 males, 53.0 +/- 13.5 years old) who underwent electrophysiology study (EPS; n = 10) or RFCA of AF (n = 46) were included. Peripheral blood CD34+ cell count and multiple serologic markers were evaluated before, immediately after, at 24 h, and 10 days after the procedure. The results are as follows: (i) the per cent increase in CD34+ cells (%DeltaCD34+) was significant after RFCA compared with after EPS (P < 0.01), and correlated with RF duration and troponin I, respectively. (ii) In contrast, SDF-1alpha decreased after RFCA and had no correlation with %DeltaCD34+ cells while matrix metalloproteinase (MMP)-9 (P < 0.0001) and GRObeta (P < 0.001) increased after RFCA and had correlations with 24 h %DeltaCD34+ cells.

CONCLUSION

Non-ischaemic titrated cardiac injury caused by AF ablation mobilizes CD34+ cells to the peripheral blood through a non-SDF-1alpha pathway associated with MMP-9 and GRObeta.

Comparison of effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent implantation in hypertensive patients

We compared the effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent implantation in hypertensive patients. This was a prospective, randomized, single-blinded, 8-month follow-up study that included hypertensive patients with significant coronary artery stenosis treated with telmisartan (n=79) or valsartan (n=80). Risk factors such as diabetes, hyperlipidemia, smoking, and obesity were similar between groups. After 8 months of follow-up, only the telmisartan group showed significant decreases in interleukin-6 and tumor necrosis factor-alpha. The decreases from baseline level in total cholesterol and low-density lipoprotein cholesterol concentrations were significantly greater in the telmisartan group. The increase in adiponectin concentrations from baseline measurements was significantly greater in the telmisartan group than in the valsartan group (1.9+/-2.7 vs 0.4+/-2.0 microg/ml, respectively, p<0.05). Moreover, late lumen loss was significantly lower in the telmisartan group than in the valsartan group (0.1+/-0.4 vs 0.3+/-0.5 mm, respectively, p=0.001). Major adverse cardiac events were similar between groups. In conclusion, compared with valsartan, telmisartan was associated with a significant decrease in late lumen loss and inflammatory markers after sirolimus-eluting stent implantation in hypertensive patients with significant coronary narrowing.

Applications of three-dimensionally scanned models in orthodontics

The purpose of this study was to investigate clinical applications of the three-dimensional reverse engineering technologies for the analysis of orthodontic models. The measuring accuracy and the process of the 3D model scanning technique were evaluated with respect to linear, surface and volumetric parameters. Orthodontically induced dentoalveolar changes, which have been traditionally evaluated by cephalometric analysis, were assessed by the registration function of Rapidform 2002, a 3D-reverse modeling software in scanned maxillary casts. Three-dimensional digital models are valuable alternatives to conventional casts for model analysis and also yield information which could previously be gathered only by cephalometric superimposition.

Synergistic antinociception between zaprinast and morphine in the spinal cord of rats on the formalin test

BACKGROUND AND OBJECTIVE

The cyclic guanosine monophosphate level, which causes an antinociception, is increased in cells as a direct result of phosphodiesterase inhibition. This study used a nociceptive test to examine the nature of the pharmacological interaction between intrathecal zaprinast, a phosphodiesterase inhibitor, and morphine.

METHODS

Catheters were inserted into the intrathecal space through an incision in the atlantooccipital membrane of male Sprague-Dawley rats. As a nociceptive model, 50 microL of a 5% formalin solution was injected into the hind paw. After observing the effect of zaprinast (37, 111, 369 nmol) and morphine (1, 4, 10, 40 nmol) alone, the interactions of their combination were examined by an isobolographic analysis.

RESULTS

Intrathecal zaprinast (P < 0.05) and morphine (P < 0.05) dose-dependently suppressed the flinching observed during phase 1 and phase 2 in the formalin test. The ED50 values (95% confidence intervals) of zaprinast and morphine in phase 1 were 161.9 (87.9-298.3) and 11.6 nmol (4.8-27.9 nmol), respectively. The phase 2 ED50 values (95% confidence intervals) of zaprinast and morphine were 229.9 (142.5-370.9) and 3.9 nmol (1.9-7.6 nmol), respectively. Isobolographic analysis revealed a synergistic interaction after intrathecal delivery a zaprinast-morphine mixture in both phases. The ED50 values of (95% confidence intervals) zaprinast in the combination of zaprinast with morphine in phase 1 and phase 2 were 14.2 (4.9-40.6) and 10.4 nmol (3-35.9 nmol), respectively.

CONCLUSIONS

Intrathecal zaprinast and morphine are effective against acute pain and facilitated pain state. Zaprinast interacts synergistically with morphine.

Antinociception of intrathecal cholinesterase inhibitors and cholinergic receptors in rats

BACKGROUND

Intrathecal cholinesterase inhibitors have been shown to have an antinociceptive effect which is mediated through the spinal cholinergic receptors, mainly muscarinic receptor. Spinal nicotinic receptor also has been involved in the control of nociception. Authors characterized the respective role of muscarinic or nicotinic receptor for the antinociception of cholinesterase inhibitors and further determined the antinociceptive potency of them.

METHODS

Rats were prepared with intrathecal catheters. Formalin-induced flinching response was regarded as a nociceptive behavior.

RESULTS

Intrathecal neostigmine, physostigmine and edrophonium produced a dose-dependent suppression of flinching in both phases. Atropine and the M1 selective antagonist attenuated the effect of them, while the M2 selective antagonist did not affect. M3, M4 selective, and nicotinic receptor antagonists reversed the antinociception induced by edrophonium, but by neither neostigmine nor physostigmine. The ordering of potency was neostigmine > physostigmine > > edrophonium.

CONCLUSION

These data indicate that the nicotinic receptor may be involved, at least in part, in the antinociceptive action of cholinesterase inhibitor at the spinal level, and M1 receptor subtype may be a common pharmacologic site of action. Moreover, neostigmine is more potent than physostigmine and edrophonium.