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Abstract Objective To investigate the effect of pulmonary vein antrum enlargement combined with left atrial roof cryoballoon ablation in patients with persistent atrial fibrillation (PeAF) by analyzing the relationship between left atrial isolation area surface area (ISA) and early postoperative recurrence. Methods 93 patients with PeAF were classified into recurrence and non-recurrence groups according to the results of the 1-year follow-up. Three-dimensional electroanatomical labeling map was constructed and merged with that of the left atrial pulmonary vein CTA, and the ISA and the left atrial surface area (LASA) were measured and analyzed to determine the relationship between ISA/LASA in relation to early postoperative recurrence. Results 93 patients were included and followed up for 1 year with AF-free recurrence rate of 75.3%. The ISA of the recurrence group was lower than that of the non-recurrence group. Left atrial internal diameter (LAD), left common pulmonary vein, the ISA, the ISA/LASA and early-term recurrence had statistical significance in both groups. The factors that significantly predicted early-term recurrence were left common pulmonary vein and the ISA/LASA. ISA/LASA (HR 0, 95% CI 0–0.005, P = 0.008) and left common pulmonary vein trunk (HR 7.754, 95% CI 2.256–25.651, P = 0.001) were the independent risk factors for early recurrence. ROC curve analysis showed that ISA/LASA predicted the best early recurrence after operation with a cut-off value of 15.2%. Conclusion A greater ISA/LASA reduces early recurrence after cryoablation in patients with PeAF. An ISA/LASA of 15.2% may be the best cut-off value for predicting early recurrence after cryoablation for PeAF.

Objective: to retrospectively investigate the efficacy and safety of the application of 28 mm cryoballoon for pulmonary vein electrical isolation (PVI) combined with top left atrial linear ablation and pulmonary vein vestibular expansion ablation for persistent atrial fibrillation. Methods: From July 2016 to December 2020, 413 patients diagnosed with persistent atrial fibrillation were evaluated, including 230 (55.7%) in the PVI group (PVI only) and 183 (44.3%) in the PVIPLUS group (PVI plus ablation of the left atrial apex and pulmonary vein vestibule). The safety and efficacy of the two groups were retrospectively analyzed. Results: The AF/AT/AFL-free survival rates at 6, 12, 18, 24 and 30 months after procedure was 86.6%, 72.6%, 70.0%, 61.1% and 56.3% in the PVI group and 94.5%, 87.0%, 84.1%, 75.0% and 67.9% in the PVIPLUS group, respectively. At 30 months after procedure, the AF/AT/AFL-free survival rate was significantly higher in the PVIPLUS group than in the PVI group (P = 0.036; HR:0.63; 95% CI:0.42 to 0.95). Conclusion: The application of 28-mm cryoballoon for pulmonary vein electrical isolation combined with linear ablation of the left atrial apex and expanded ablation of the pulmonary vein vestibule improves the outcome of persistent atrial fibrillation.

Abstract Background Since the coronavirus disease 2019 (COVID-19) pandemic outbreak, the incidence of mental health problems in perinatal women has been high, and particularly prominent in China which was the first country affected by COVID-19. This paper aims to investigate the current situation and the related factors of maternal coping difficulties after discharge during COVID-19. Methods General information questionnaires (the Perinatal Maternal Health Literacy Scale, Postpartum Social Support Scale and Post-Discharge Coping Difficulty Scale-New Mother Form) were used to investigate 226 puerperal women in the third week of puerperium. The influencing factors were analyzed by single factor analysis, correlation and multiple linear regression. Results The total score of coping difficulties after discharge was 48.92 ± 12.05. At the third week after delivery, the scores of health literacy and social support were 21.34 ± 5.18 and 47.96 ± 12.71. There were negative correlations among health literacy, social support and coping difficulties after discharge (r = -0.34, r = -0.38, P

This paper constructs an economic dispatch model of an integrated energy system including grid, wind power, photovoltaic and energy storage devices based on combined cooling, heating and power system, and optimizes the dispatch model based on improved krill swarm optimization algorithm with the system integrated cost as the objective function, taking into account the electric power balance constraint, cooling and heating load balance constraint and each micro-source output constraint. The simulation results show that the improved krill swarm algorithm can reduce the daily integrated cost by $124.1 and $50.3 respectively, which can save 9.5% and 3.9% of the daily integrated cost compared with the conventional krill swarm algorithm and the artificial bee colony algorithm. The constructed integrated energy system model can effectively improve the energy utilization and economic efficiency of the system.

Introduction and objectives: Pulmonary vein isolation (PVI) technique has become the cornerstone of atrial fibrillation (AF) catheter ablation. The objective of this study was to assess the efficacy and safety of extended antrum ablation based on electrophysiological substrate mapping plus PVI in AF patients who underwent cryoballoon ablation. Methods: In this observational study, a total of 121 paroxysmal AF patients and 80 persistent AF patients who did not achieve the procedure endpoint after cryoballoon ablation received extra extended antrum ablation (EAA) based on electrophysiological substrate mapping via radiofrequency ablation (EAA group). As a control group (PVI group), among paroxysmal AF and persistent AF patients, we conducted a propensity score-matched cohort, in whom only PVI was completed. Results: The average follow-up time was 15.27±7.34 months. Compared with PVI group, paroxysmal AF patients in the EAA group had a significantly higher rate of AF-free survival (90.1% vs. 80.2%, p=0.027) and AF, atrial flutter, or atrial tachycardia (AFLAT) -free rate survival (89.3% vs. 79.3%, p=0.031). Persistent AF patients in the EAA group also had a significantly higher rate of AF-free survival (90.0% vs. 75.0%, p=0.016) and AFLAT-free survival (88.8% vs. 75.0%, p=0.029) than PVI group. Complication rates did not significantly differ between both groups, in either paroxysmal AF or persistent AF patients. Conclusion: Our findings demonstrate that extra extended antrum ablation based on electrophysiological substrate mapping is effective and safe. Moreover, the strategy can improve the outcome of AF cryoablation. Resumo: Introdução e objetivos: A técnica de isolamento das veias pulmonares (IVP) tornou-se a pedra angular da ablação por cateter da fibrilhação auricular (FA). O objetivo deste estudo consistiu em avaliar a eficácia e a segurança da ablação antral alargada com base no mapeamento do substrato eletrofisiológico, para lá do IVP em doentes com FA, submetidos a crioablação. Métodos: Neste estudo observacional, 121 doentes com FA paroxística e 80 doentes com FA persistente que não alcançaram o objetivo do procedimento após a crioablação foram submetidos a ablação antral alargada com base no mapeamento do substrato eletrofisiológico, através de ablação por radiofrequência (grupo de Ablação Antral Alargada, grupo AAA). Como grupo controlo (grupo do Isolamento das Veias Pulmonares, grupo IVP), em doentes com FA paroxística e com FA persistente, realizámos um score de propensão agrupado, no qual só foi efetuado o IVP. Resultados: O tempo médio de seguimento foi 15,27±7,34 meses. Quando comparados com o grupo IVP, os doentes com FA paroxística no grupo AAA apresentaram uma taxa significativamente mais elevada de sobrevivência livre de FA (90,1% versus 80,2%, p=0,027) e de sobrevivência livre de AFLAT (FA, flutter auricular ou taquicardia auricular) (89,3% versus 79,3%, p=0,031). Os doentes com FA persistente no grupo AAA também apresentaram uma taxa significativamente mais elevada de sobrevivência livre de FA (90,0% versus 75,0%, p=0,016) e de sobrevivência livre de AFLAT (88,8% versus 75,0%, p=0,29) do que no grupo de IVP. As taxas de complicações não diferiram significativamente entre dois grupos, tanto nos doentes com FA paroxística como nos com FA persistente. Conclusão: Os nossos resultados demonstraram que a ablação antral alargada com base no mapeamento de substrato eletrofisiológico é eficaz e segura. Além disso, a estratégia pode melhorar os resultados da FA por crioablação.