简介：Atrialfibrillation(AF)isthemostcommonsustainedcardiacrhythmdisturbanceinclinicalpractice,increasinginprevalencewithage.CurativetreatmentofAFwithcatheterablationisnowalegitimateoptionforanumberofpatients.ThedominantablationforAFmainlyconcentratesonpulmonaryveins(PVs)orcomplexfragmentatrialelectrograms(CFAEs).However,theoptimalapproachforablationofAFarousedsomecontroversy.ThebulkoftheevidencesuggeststhattheintrinsiccardiacautonomicnervoussystemmaycontributetotheformationofrapidfiringfromthePVsitesornon-PVsitesandCFAEs,andplayacriticalroleintheinitiationandmaintenanceofAF.WehypothesizedthatganglionatedpleximaybeanidealstrategyforAFablation.

简介：BackgroundComparedtoclopidogrel,Ticagrelorsignificantlyreducestheriskofcardiovasculareventsinpatientswithacutemyocardialinfarction(AMI)howeverincreasestheincidenceofbleedingandtheriskoffatalintracranialhemorrhage.Inthisstudy,wescreenedtheAMIpatientswithclopidogrelresistence,anddeterminedwhetherticagrelorsequentialtherapycouldreducetheriskofcardiovasculareventsandbleedingrisk.MethodsAtotalof319AMIpatientswereenrolledinthisprospectiveclinicalstudy.Theplateletinhibitionratesinadenosine5'-diphosphate(ADP)pathwaysweremeasuredbyathrombelastography(TEG)system.ThepatientswithclopidogrelresistanceweredividedintoTicagrelorsequentialtherapygroup(ticagrelorfor3monthsandclopidogrelfor9months,n=143)andClopidogrelgroup(clopidogrelfor12months,n=176).Theriskofmajoradversecardiacevents(MACE)andthesafetyendpointsat1-yearfollow-upwereanalyzed.ResultsTheratesofstentthrombosis(ST)(2.1%vs.8.0%,P=0.017)orMI(2.8%vs.10.2%,P=0.009)werelowerintheticagrelorsequentialtherapygroupthanintheclopidogrelgroup.Dyspneawasmoreoftenintheticagrelorsequentialtherapygroupthanintheclopidogrelgroup(17.5%vs.4.5%,P<0.001).Nosignificantdifferenceintherateofmajorbleedingwasfoundbetweenthegroups(3.4%vs.3.9%,P=0.528).ConclusionsInAMIpatientswithhyporesponsivenesstoclobidogrelticagrelorsequentialtherapygroupsignificantlydecreasedtheratesofSTandMIwithoutincreasedriskofmajorbleedingascomparedwithclopidolgrel.