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Background One of the major challenges in arrhythmogenic right ventricular cardiomyopathy (ARVC) ablation is ventricular tachy-cardia (VT) non-inducibility. The study aimed to assess whether fast rate (≥ 250 beats/min) right ventricular burst stimulation was useful for VT induction in patients with ARVC.Methods Ninety-one consecutive ARVC patients with clinical sustained VT that underwent electro-physiological study were enrolled. The stimulation protocol was implemented at both right ventricular apex and outflow tract as follows: Step A, up to double extra-stimuli; Step B, incremental stimulation with low rate (< 250 beats/min); Step C, burst stimulation with fast rate (≥ 250 beats/min); Step D, repeated all steps above with intravenous infusion of isoproterenol.Results A total of 76 patients had inducible VT (83.5%), among which 49 were induced by Step C, 15 were induced by Step B, 8 and 4 by Step A and D, respectively. Clinical VTs were induced in 60 patients (65.9%). Only two spontaneously ceased ventricular fibrillations were induced by Step C. Multivariate analysis showed that a narrower baseline QRS duration under sinus rhythm was independently associated with VT non-inducibility (OR: 1.1; 95% CI: 1.0–1.1;P = 0.019).ConclusionFast rate (≥ 250 beats/min) right ventricular burst stimulation provides a useful supplemental method for VT induction in ARVC patients.
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Objective: To explore the safety and efficacy of left atrial (LA) endocardial vagal denervation catheter ablation for treating the patients with refractory vasovagal syncope (VVS). Methods: A total of 57 consecutive refractory VVS patients with severe symptom and positive response to head-up tilt test (HUT) were enrolled. There were 22 male at the mean age of (43 ± 13) years. The patients had no response or couldn’t tolerate routine treatment. LA model was re-established by three-dimensional mapping system, 10 patients received high-frequency stimulation technique for ganglionated plexi (GP) ablation and 47 received regional catheter ablation at 5 anatomic sites of GP for LA endocardial vagal denervation treatment. In-operative vagal response including hypotension, sinus bradycardia or asystole were observed, the endpoint of ablation was abolition of evoked vagal relfexes. Periodical follow-up was conducted to record the syncope recurrence and to re-examine ECG and HUT in all patients. Results: There were 52/57(91.2%) patients had positive vagal response by radiofrequency application and reached the endpoint of ablation; 4 patients couldn’t receive obvious evoked vagal relfexes. During (36 ± 22) months follow-up period, there were 52 (91.2%) cases without syncope recurrence, 11 cases still having palpitation, amaurosis and dizziness as the precursors of syncope while the symptoms were much better then they were before. No complication occurred. Conclusion: LA endocardial vagal denervation catheter ablation is a safe and effective method for treating the patients with refractory VVS, it may also effectively prevent VVS recurrence.
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Objective: To quantitatively evaluate the abnormal tense of parasympathetic nerve via measuring the heart rate deceleration capacity (DC) and heart rate variability (HRV) in patients with vasovagal syncope (VVS). Methods: Our research included 2 groups: VVS group,n=28 patients with positive head-up tilt test treated in our hospital from 2013-06 to 2014-08 and Control group,n=30 patients without cardiovascular disorders. The DC and HRV were examined and compared between 2 groups. Results:① The overall deceleration capacity (ODC) (9.4 ± 2.9) ms and daytime deceleration capacity (DDC) (8.9 ± 2.9) ms in VVS group were higher than those in Control group (7.5 ± 2.5) ms and (7.5 ± 2.5) ms respectively,P1 than those in Control group (9/28, 32.1% vs 2/30, 6.7%),P=0.019.③ The SDNN (139.8 ± 34.0) ms, SDSD (29.9 ± 15.7) ms and rMSSD (40.9 ± 18.8) ms in VVS group were higher than those in Control group, (115.5 ± 29.4) ms, (21.8 ± 6.6) ms and (28.9 ± 8.4) ms respectively,P Conclusion: VVS patients have abnormally increased indexes of DC and HRV, HDC is the predictor for vasovagal syncope occurrence.
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Objective To investigate the effects of bone marrow mesenchymal stem cells administration on VEGF,SDF-1 and TGF-?1 expressions and heart function in myocardial infarcts rats.Methods MSCs were harvested from SD rats,cultured and passaged in vitro,then the cells were purified by density gradient centrifugation and adhesive-screening method.Rats were randomly divided into 2 groups.In the control group(n=8) the animals were treated with saline of the same volume as placebo.Four weeks after the injection,the VEGF,SDF-1 and TGF-?1 expressions and heart function were examined.Results Four weeks after the transplantation,Immunohistochemistry showed expression of VEGF and SDF-1 increased markedly in experiment group,and expression of TGF-?1 decreased.Heart function was improved in the experiment group(P