ABSTRACT
Objective To study the feasibility and safety of coronary sinus (CS) ventricular pacing comparing with traditional right ventricular (RV) pacing in ordinary pacing treatment.Methods Sixty-one patients with an indication of pacemaker implantation were randomized into traditional RV pacing group and CS ventricular pacing group.The success rate,complications,preoperative and postoperative QRS wave duration and pacemaker parameters were compared between the two groups.Results (1) The instant success rate in traditional RV pacing and the CS pacing groups were 100％ and 68.97％ (P＜0.01);the surgical success rate was significantly higher by using left ventricular electrode than the ventricle tined electrode in CS pacing group (85.71％ and 25％,P＜0.05).There was no significant difference in the incidence of complications between the two groups (P＞0.05);(2) The increase of QRS complex width at postoperative 1 month in CS pacing group is significantly less than the RV pacing group (P＜0.05);(3) Although the pacing threshold and electrode impedance during operation,postoperative 1 month and 3 months in CS pacing group were higher than RV pacing group (P＜0.05),the CS pacing was effective.Conclusion The CS ventricular pacing is as safe and effective as traditional RV pacing,and is more consistent with physiological ventricular activation sequence.Using left ventricular electrode can significantly improve the success rate of CS ventricular pacing.
ABSTRACT
[Abstract ] Objective Cardiac shock wave therapy (CSWT) can promote arteriogenesis in ischemic myocardia , but the mo-lecular mechanism remains unclear .The study aimed to explore the effect of CSWT on arteriogenesis in human cardiac microvascular endothelial cells ( HCMEC ) and the role of focal adhesion kinase (FAK) and Calcium-activated potassium channels (KCa) in the sig-nal conduction pathway of CSWT arteriogenesis . Methods HC-MEC cells cultured in vitro were randomly divided into control group , CSWT group , CSWT +T ( FAK inhibitor PF-573228 ) group and CSWT+F( SCa inhibitor iberiotoxin ) group.Each group received one CSWT(0.09 mJ/mm2, 200Times) 48 h after added stimulant.24 hours'conventional culture later , tests were made on the levels of endothelial nitric oxide synthase ( eNOS ) and vascular endothelial growth factor ( VEGF) mRNA as well as the changes of related protein expression . Results ①QPCR test showed that eNOS , VEGF mRNA expressions increased in CSWT group compared with control group (4.61 ±0.19 vs 3.99 ±0.17, P<0.05), while compared with CSWT group, eNOS, VEGF mRNA expressions in CSWT +T group were decreased (0.62 ±0.10 vs 0.40 ±0.02, P<0.05), eNOS, VEGF mRNA expressions in CSWT +F group were also decreased (0.53 ±0.02 vs 0.64 ±0.02, P<0.05), all the differ-ences were of statistical significance .②Western blot showed that eNOS , VEGF protein expressions increased in CSWT group compared with control group(0.63 ±0.02 vs 0.43 ±0.02, P<0.05), while compared with CSWT group , eNOS, VEGF protein expressions in CSWT+T group were decreased (0.36 ±0.01 vs 0.29 ±0.02, P<0.05), eNOS, VEGF protein expressions in CSWT +F group were also decreased (0.37 ±0.02 vs 0.30 ±0.02, P<0.05), all the differences were of statistical significance . Conclusion CSWT can improve eNOS , VEGF mRNA and protein expressions in HCMEC cells and FAK and KCa may participate in the signal conduction pathway of CSWT arteriogenesis .