Aims: To assess the effect of oral anticoagulant (OAC) administration on incidence of dementia in patients with atrial fibrillation (AF) with Systematic review and meta-analysis in according with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. Methods: We systematically searched the electronic databases including Pubmed, Embase, Cochrane library, and ClinicalTrails.gov for relevant articles. The primary outcome was the incidence of dementia. The adjusted risk ratio (RR), odds ratio, or hazard ratio were extracted and pooled by the random-effects models. Subgroup analysis was performed according to the setting observational window. Risk of bias was assessed using the Newcastle-Ottawa Scale, while publication bias was assessed by the Begg’s and Egger’s tests. Results: Nine studies included in this review (2 prospective and 7 retrospective observational studies, including 613,920 patients). The results presented the significant association between OAC therapy and the reduced risk of dementia compared with no treatment (RR [95%CI] =0.72 [0.60, 0.86], I2=97.2%; P =0.000). In the subgroup analysis, the pooled RR became statistically non-significant (including four studies, RR [95%CI] =0.75 [0.51, 1.10], I2=98.8%; P =0.000). There is no significant risk of bias and publication bias. Conclusions: This study indicated the protective effect of OAC therapy for dementia in patients with AF. However, the results are limited because of high heterogeneity, inconsistent direction of effect in subgroup analysis. Further prospective well-designed study is needed with longer follow-up duration in younger patients.

Background: Although epicardial adipose tissue (EAT) has been proved be associated with atrial fibrillation (AF) and post-ablation AF recurrence, the relationship between EAT and AF after cardiac surgery (AFACS) is not evident, yet. Objective: In the study, we aim to perform a systematic review and meta-analysis to assess the association between EAT and AFACS and whether it is independent of the measurement methods. Methods: Systematic reach was implemented until May, 30, 2020, which “atrial fibrillation” and “epicardial adipose tissue” were as the main items in electronic databases. Analysis was stratified by EAT measurement methods into three pooled meta-analyses on 1) total EAT volume, 2) left atrium (LA)-EAT volume and 3) EAT thickness between two groups with and without AFACS, estimating standardized mean difference (SMD) with a random effect model. Results: Eight articles with ten studies (546 patients) were included. Accordingly, the results of meta-analysis showed that EAT was higher in AFACS subjects, regardless of the methods of EAT measurement.[ total EAT volume: SMD = 0.56 ml; 95% confidence interval (CI) = 0.56-1.10ml, I2 = 0.90, P=0.04; EAT thickness: SMD = 0.85mm; 95% CI = 0.04-1.65mm, I2 = 0.90, P=0.04; LA-EAT volume: SMD = 0.57ml, 95% CI = 0.23-0.92ml, I2 = 0.00, P=0.001.] And there was no evidence of publication bias. Conclusion: EAT may be a potential marker and therapeutic target for AFACS. However, larger scale studies are still required, and evaluation is needed to for further estimation.

Instruction Cessation of oral anticoagulation (OAC) is common after the first 3 months of catheter ablation of atrial fibrillation (AF); however, thromboembolic risk has not been defined in patients with and without AF recurrence (RAF vs. NRAF) post ablationMethods and Results We identified 796 patients who discontinued OAC at 3 months post AF ablation from January 2015 to May 2018 in our center. Regular follow-up was performed to detect RAF, collect medication management and thromboembolic and major bleeding events. CHA2DS2-VASc score was 1.79±1.50; 547 (68.7%) patients were at intermediate and high risk (i.e. CHA2DS2-VASc score ³1 in male patients, or ³2 in female patients); 169 (21.2%) were RAF. During 29.2±12.2 months follow-up, the incidence rate of thromboembolism was 1.62 per 100 patient-year (7 in 431 years) in RAF, 0.33 per 100 patient-year (5 in 1503 years) in NRAF. After adjusting for potential confounding factors, RAF was associated with more 3.5-fold higher rate of thromboembolism compared with NRAF (adjusting HR, 4.488; 95%CI, 1.381-14.586). Rate of thromboembolism was even higher in patients with intermediate and high risk (2.16 per 100 patient-year [7 in 323 years] versus 0.38 per 100 patient-year [4 in 1043 years], aHR, 5.807; 95%CI, 1.631-20.671). In multivariate logistic regression analysis, RAF was the only independent predictor of thromboembolism (4.837 [1.498-15.621], P=0.008).

Introduction：LAmbre occluder (Lifetech Scientific, Shenzhen, China), a new device for left atrial appendage (LAA) occlusion, is increasingly used, but the procedure for retrieval after dislodgement has rarely reported in human. Methods and Results：An 80-year-old male patient with permanent atrial fibrillation underwent the implantation of LAA occlusion device. The occluder dislodged to left atrium (LA) at the end of procedure. We failed to retrieve device in LA with a LASSO catheter and forceps with the 8.5F sheath. After it suddenly flowing into aortic arch, we successfully retrieved with a 14F flexible sheath and forceps. We also discussed reasons for the device dislodgment and reported experiences for device retrieval. Conclusion: Combination of the 14F flexible sheath and forceps could be used to retrieve the dislocation of LAA occlusion device.