Aims Activation mapping of premature atrial complexes (PACs) proves challenging due to interference by mechanical bumping and non-targeted ectopies. This study aims to compare the mapping efficacy, instant success, and long-term recurrence of catheter ablation for PACs with non-pulmonary vein (PV) and non-superior vena cava (SVC) origins between the novel dual-reference approach (DRA) and the routine single-reference approach (SRA) of mapping. Methods and results Patients with symptomatic, drug-refractory PACs, or frequent residual PACs after atrial tachyarrhythmia ablation were enrolled. During activation mapping, the coronary sinus (CS) catheter was used as the only timing reference in the SRA group. In the DRA group, another catheter, which was spatially separated from the CS catheter, was used as the second reference. The timing difference between the two references was used to discriminate the targeted PACs from the uninterested rhythms. Procedural parameters and long-term recurrence were compared. A total of 188 patients (109 in SRA and 79 in DRA) were enrolled. The baseline characteristics were similar. Compared with the SRA group, the DRA group had less repeated mapping (1.2 ± 0.4 vs. 1.4 ± 0.5, P = 0.004), shorter mapping (15 ± 6 vs. 23 ± 7 min, P < 0.001) and procedural time (119 ± 28 vs. 132 ± 22 min, P = 0.001), similar procedural complication rates (3.6 vs. 3.8%, P > 0.999), higher instant success (96.2 vs. 87.2%, P = 0.039), and lower recurrence rate (15.2 vs. 29.3%, hazard ratio 1.943, P = 0.033) during a 24-month follow-up. Conclusion As a novel strategy, the DRA shortens the procedural time and improves both instant and long-term success of PAC ablation, serving as a promising approach in mapping PACs with non-PV and non-SVC origins.
Background: Artificial sweeteners (AS) are widely used as sugar substitutes to reduce calorie intake. However, high doses of AS induced glucose tolerance by modulating gut microbiota. The objective of this study was to investigate the effects of lower doses of sucralose on fecal microbiota in obesity. Methods: Eight weeks after high-fat diet, the male Sprague Dawley rats were randomly divided into four groups (n=24) and administrated by a daily gavage of 2ml normal saline (CON), 0.54mM sucralose (N054), 0.78mM sucralose (N078) and 324mM sucrose (S324) respectively. After four weeks, fecal samples were obtained and used in 16S ribosomal RNA gene sequencing. Results: The richness and diversity of fecal microbiota did not change by these sucralose and sucrose dosage. Both 0.54mM (0.43mg) and 0.78mM (0.62mg) tended to reduce the beneficial bacteria, Lactobacillaceae and Akkermansiaceae. The relative abundance of family Acidaminoccaceae and its genus Phascolarctobacteriam were increased with 0.54mM sucralose. In functional prediction, 0.54mM sucralose increased profiles of carbohydrate metabolism, whereas 0.78 mM sucralose enhanced that of amino acids metabolism. Conclusions: The lower doses of sucralose altered the compositions and the metabolic functions of fecal microbiota. The benefits of sucralose and its recommended dose for obese patients should be reassessed comprehensively.
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