Introduction: Interventional cardiology procedures (ICPs) have become the mainstay treatments in cardiology diseases and increased rapidly. This study aims to assess the occupational health hazards (OHHs) related to the long-time wearing of lead personal protective equipment and reveal health protection needs in interventional cardiologists. Methods and Results: We invited interventional and non-interventional cardiologists in tertiary III hospitals in China to participate in an online cross-sectional survey on their health status, utilization of personal protective equipment (PPE), and personal health protection (PHP) needs. Propensity score methods were used for comparisons of OHHs between the matched interventional and non-interventional cardiologists. Totally, 642 interventional and 402 non-interventional cardiologists completed the survey. The interventional cardiologists had significantly higher incidence of body pain (56.6% vs. 24.2%, p<0.001), bone and joint disease (21.7% vs. 8.6%, p=0.001), cataract (3.5% vs. 0%, p=0.039), and anxiety (8.1% vs. 2.5%, p=0.029) than the matched non-interventional cardiologists. The risk of back pain was independently associated with female gender, performing percutaneous coronary intervention procedure or ≥2 types of ICP, and the personal annual volume of ICPs. Only 3.3% of interventional cardiologists were satisfied with PPE and 83.0% of them complained of physical toll caused by heavy PPE. 90.7% were willing to conduct ICP without radiation exposure. Conclusions: Body pain was the main OHH in interventional cardiologists likely due to wearing heavy lead PPE for long working hours. Besides training more interventional cardiologists, the adoption of emerging technologies without heavy lead PPE will be a promising way to reduce the OHH burden.

Introduction: The safety and effectiveness of catheter ablation in patients with atrial fibrillation (AF) who underwent mechanical mitral valve replacement (MVR) have been reported. However, the impacts of different types of mitral valves on the safety and effectiveness of catheter ablation in patients with AF who underwent MVR have not been elucidated. Methods and results: From 2015 to 2021, 17,496 patients underwent catheter ablation of AF for the first time in Beijing Anzhen Hospital were screened. The inclusion criteria were (1) aged 18 years or older; (2) diagnosed with AF; (3) history of mitral valve replacement. The exclusion criteria were a history of catheter ablation, surgical maze procedure, left atrial appendage closure or resection. A total of 68 patients were enrolled in the study. The patients were divided into two groups: the bioprosthetic MVR group (n=12) and the mechanical MVR group(n=58). The size of the left atrial was larger (49.5mm vs. 46.0mm, p<0.05), the thickness of the left interventricular septum was larger (11.0mm vs. 10.0mm, p<0.05), and the mitral ring area was smaller (2.3mm2 vs. 2.6mm2, p<0.05) for the bioprosthetic MVR group than the mechanical MVR group. During 23.4 (6.1, 36.5) months of follow-up, the incidence of the endpoint events was not significantly different between the two groups (33.3% vs. 30.4%, log-rank p=0.48). There were 2 cases (3.4%) of pseudoaneurysm and 1 case of acute cerebral infarction in the mechanical MVR group. No complication was observed in the bioprosthetic MVR group. No significant clinical bleeding events were observed in the bioprosthetic group while eight patients in the mechanical MVR groups had bleeding events (p=0.368) during the follow-up. Conclusion: The safety and effectiveness of catheter ablation of AF were comparable between the patients with mechanical MVR and bioprosthetic MVR.

Introduction: We describe one rare case of successful ablation of a right epicardial accessory pathway (AP) via the right ventricular diverticulum in a patient with Wolff-Parkinson-White syndrome. Methods: A 42-year-old woman being referred to the hospital for a catheter ablation of a Wolf-Parkinson White syndrome. Earliest activation was shown to be present in the region of the tricuspid annulus. However, ablation had no effect on the AP. Results: We decided to do a selected angiography, in which a big diverticulum near to the right tricuspid annulus was shown to be present. Ablation in this region successfully repressed the AP without any recurrences within a follow-up period of 12 months. Conclustion: The ventricular diverticulum mediated AP is a novel variant of pre-excitation. It can serve as an anatomical substrate of supraventricular tachycardia, and can be ablated endocardially using an irrigation tip catheter within the diverticulum.

Background: CLBBB and AF are not uncommon coexisted. The impact of CLBBB on long-term prognosis of catheter ablation of AF has not been well determined. Objectives: This study aims to explore the long-term outcomes of patients with atrial fibrillation (AF) and complete left bundle branch block (CLBBB) after catheter ablation. Methods: Forty-two patients with CLBBB of the 11,752 patients who underwent catheter ablation of AF from 2011 to 2020 were enrolled as CLBBB group. After propensity score matching in a 1:4 ratio, 168 AF patients without CLBBB were enrolled as Non-CLBBB group. The primary endpoint was a composite of stroke, all-cause mortality, and cardiovascular hospitalization. The secondary endpoint was AF recurrence after single ablation. Results: The incidence of the primary endpoint in the CLBBB group was significantly higher than in the Non-CLBBB group (21.4% vs. 6.5%, HR 3.98, 95%CI 1.64-9.64, P = 0.002). The recurrence rates in the CLBBB group and the Non-CLBBB group were 54.8% and 31.5% (HR 1.71, 95%CI 1.04-2.79, P = 0.034), respectively. Multivariate analysis showed that CLBBB was an independent risk factor for both primary endpoint (HR 2.92, 95%CI 1.17-3.34, P = 0.022) and secondary endpoint (HR 2.19, 95%CI 1.09-4.40, P = 0.031) in patients with AF after catheter ablation. Conclusions: CLBBB significantly increased the risk of a composite endpoint of stroke, all-cause mortality, and cardiovascular hospitalization after catheter ablation in patients with AF. CLBBB also independently predicted recurrence in these patients.

Background: There exist sex differences in the clinical profile, management, and outcome of atrial fibrillation (AF). Catheter ablation of AF has become a first-line therapy and has markedly made headway over recent decades. Little is known about sex differences and temporal trends in hospitalization for catheter ablation of AF in the real-world setting. Conclusions: Safety of catheter ablation for AF were comparable in both sexes. In contrast, the women showed a higher CHA2DS2-VA score compared with the men. The percentage of patients with CHA2DS2-VA score ≥2 increased more quickly in women than men. Further sex-specific research is warranted to reduce this sex disparity.

Abstract Introduction: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). Methods and results: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, EI-VOM was firstly performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the ‘upgraded 2C3L’ procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). Conclusion: Compared with the conventional ‘2C3L’ approach, the ‘upgraded 2C3L’ approach has higher effectiveness for ablation of PeAF.

Background: Atrial fibrillation (AF) is common in abdominal solid organ transplant recipients and a cause of morbidity and mortality in this population. However, the outcomes of catheter ablation (CA) in transplant recipients with AF remain unclear. This study aimed to elucidate the outcomes of CA in renal and hepatic transplant recipients. Methods and Results: Between 2015 and 2019, 14 transplant recipients (9 with kidney transplantation and 5 with liver transplantation) were enrolled from among 10,741 AF patients and underwent CA at Anzhen Hospital. Another 56 patients matched by age, sex and AF type were selected as the control group (4 controls for each transplant recipient). During a mean follow-up of 30.0±13.3 months after the initial procedure, 10 (71.4%) of the transplant patients, compared to 41 (73.2%) of the control patients, remained free from AF recurrence(P=1.000). A repeated procedure was performed in 1 transplant patient and in 6 control subjects. Consequently, 11 (78.6%) of the transplant patients, compared to 46 (82.1%) of controls, were in sinus rhythm after the repeated ablation (P=0.715). Notably, Kaplan–Meier analysis did not demonstrate any significant differences in the atrial arrhythmia-free rate after the initial and repeated procedure between the two groups. Vascular complications were identified in 1 transplant patient and 2 control subjects, while no life-threatening complications were observed in either group. There was no transient allograft dysfunction in transplant recipients after CA. Conclusion: CA is safe and effective in abdominal solid transplant recipients, and may be an optimal therapeutic strategy for this group.

Objective: Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder (Boston Scientific) remains uncertain. This study aimed to investigate the efficacy and safety of a 3-month dual antiplatelet therapy (DAPT) after LAAC. Methods: This was a post hoc analysis of a prospective study of patients who underwent successful LAAC with Watchman devices at the REGIOMED Hospitals of Coburg and Lichtenfels (Germany). Those treated from 11/2016 to 05/2018 received DAPT for 3 months (DAPT group); those from 02/2012 to 04/2017 received 45-day anticoagulant+aspirin followed by 4.5-month DAPT (ACT group). The primary efficacy outcome and safety outcome were analyzed. The net clinical benefit and bleeding events 1 year after treatment, and their independent risk factors were also explored. Results: There were 220 and 304 patients in the DAPT and ACT groups. The primary efficacy outcome were 9.5% vs. 6.3% [hazard ratio (HR), 1.58; 95% confidence interval (CI), 0.84-2.97; P=0.14]; the primary safety outcome were 4.5% vs. 5.9% (HR, 0.80; 95% CI, 0.38-1.69; P=0.57); the net clinical benefit were 13.6% vs. 11.8% (HR, 1.23; 95% CI, 0.75-2.02; P=0.39) over 1 year in DAPT and ACT groups, respectively. Age ≥75 years (HR, 2.08; 95%CI, 1.13-3.84; P=0.02) was identified as an independent predictor for the net clinical benefit. ACT (HR, 1.97; 95%CI, 1.12-3.50; P=0.02) was independently associated with bleeding events after procedure. Conclusions: In patients who underwent LAAC using the Watchman occluder, 3-month DAPT is associated with fewer bleeding events compared with ACT regimen.

Background There are distinct results for the relationship between new-onset atrial fibrillation (NOAF) and subsequent incident cancer. To date, no systematic analysis has been conducted on this issue. This study aims to explore the relationship between NOAF and the risk of developing cancer through a meta-analysis with a large sample size. Methods Electronic databases, such as PubMed and EMBASE, were searched for published relevant studies on NOAF patients diagnosed with cancer after and during follow-ups, including reported records of baseline information and the statistical result of morbidity. Two investigators independently reviewed the articles and extracted the data using uniform standards and definitions. The meta-analysis was conducted using the Cochrane Program Review Manager. Results This meta-analysis consisted of five cohort studies and one case-control study, which comprised of 533,514 participants. The pooled relative risk (RR) for incident cancer was 1.24 (95% CI: 1.10-1.39, P=0.0003). The temporal trends analysis demonstrated that an increased risk of cancer was observed during the initial 90 days (RR: 3.44, 95% CI: 2.29-5.57, P<0.00001), but not after that. Lung cancer (RR: 1.51, 95% CI: 1.47-1.55, P<0.00001) was associated with NOAF, but not colorectal cancer and breast cancer. Conclusion This meta-analysis provides evidence that NOAF is associated with increased risk of cancer. The risk of incident cancer particularly increases within 90 days after NOAF diagnosis, but not after that.

Background Nodo-ventricular(NV) fiber-related reentrant tachycardias are so rare that most of them were reported by case, while few reports have summarized their common and individual features. Objectives To clarify the electrophysiological mechanism of supra-ventricular tachycardias (SVT) related to concealed NV fibers. Methods and Results We studied the intra-cardiac electrograms during electrophysiological study of 3 cases of SVT concerning concealed NV fibers. Maneuvers including ventricular entrainments, His bundle refractory period ventricular stimuli, adenosine triphosphate injection and so on were done for differential diagnosis before ablation. Among these patients, one had AVNRT with a bystander NV fiber, the other 2 had NV fiber-mediated orthodromic reentrant tachycardias (NVRT). VA dissociation were observed during SVT in all with antegrade His bundle conduction sequence. His bundle refractory period ventricular stimuli reset tachycardias with resetting of the H-H interval advancing the V-V interval, suggesting the existence of an accessory pathway. The cycle length of an NVRT prolonged during the status of functional right bundle branch block. Multiple QRS fusion morphologies during ventricular entrainments on a fixed site could be observed. Conclusions Concealed NV fibers can mediate orthodromic SVT or be a bystander of AVNRT. V-A dissociation usually occur during such SVTs. An NV fiber not only expresses the characteristics of an AP, but also the characteristics of the AV node. Multiple QRS fusion morphologies during ventricular entrainments or His bundle refractory period ventricular stimuli on a fixed site can discriminate NV fibers from NF fibers.