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Objective@#To evaluate the results of catheter ablation of ventricular tachycardia (VT) via direct ventricle puncture access in patients without traditional approach.@*Methods@#Two idiopathic left fasicular VT patients with mechanical aortic and mitrial valve repalcement and 1 patient with right ventricular originated VT post mechanical tricuspid valve repalcement from March 2010 to July 2012 in Fuwai hospital were enrolled in this study. For left fasicular VT patients, catheter ablation was performed using transapical left ventricular access via minithoracotomy. For the patient with right ventricular originated VT, catheter ablation was performed via percutaneous right ventricle puncture at xiphoid. Abaltion was guided under EnSite NavX mapping system. The feasibility of VT ablation via direct ventricle puncture access and long-term VT recurrence were investigated.@*Results@#Catheter ablation was successful in all patients, and all clinical VTs were eliminated. The procedure time was 53, 62 and 74 minutes respectively with radiation time 11, 16 and 20 minutes. The ablation time was 130, 170 and 240 seconds individually. No procedure related complication occurred. After a follow-up time of 76, 55 and 82 months respectively, no VT recurrence was found in patients with left fasicular VT. New-onset VT with different morphology with previous VT was recorded in the patient with right ventricular originated VT, subcutaneous implantable defibrillator was implanted finally in this patient.@*Conclusions@#For patients with endocardial origined ventricular arrhythmias which could not be ablated via traditional approaches, direct ventricle puncture access with hybrid techniques provides a new approach foreliminating VTs in these patients.
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Objective: To study the safety and efifcacy of hematoma aspiration with manual compression for treating the patients of femoral pseudoaneurysm after cardiac catheterization under ultrasound guidance. Methods: A total of 27 patients suffering from post-catheterization iatrogenic femoral pseudoaneurysm were analyzed including 14 male and 13 female at the mean age of (53.5±11.4) years. The body, neck and blood supply area of pseudoaneurysm were located by ultrasonography; 18 gauge needle was punctured into the center of pseudoaneurysm to aspirate blood, meanwhile the neck and body of pseudoaneurysm were manually compressed to block blood supply for relevant artery under ultrasound guidance. Manual compression was conducted for 15 min followed by bandage compression; the patients were lie on the back and kept lower extremity straight for 12 hours. Ultrasonography was performed at 24 hours and 1 month after the operation in all patients respectively. Results: There were 24/27 (88.9%) patients having successful aspiration with manual compression at ifrst time; 2 (7.4%) having incomplete occlusion at ifrst time and the success was obtained by second time; 1 having incomplete occlusion due to coexisted femoral arteriovenous ifstula, while the body of pseudoaneurysm was obviously decreased. The overall success rate was 96.3% (26/27), no procedural complication occurred. Conclusion Ultrasonography guided hematoma aspiration with manual compression has been safe and effective for treating the patients of iatrogenic femoral pseudoaneurysm.
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Objective: To evaluate the safety and feasibility of hybrid thoracoscopic surgery and catheter ablation in treating the patients of long-standing persistent atrial fibrillation (AF) with preliminary experience. Methods: A total of 15 consecutive relevant patients treated in our hospital by hybrid thoracoscopic surgery and catheter ablation from 2014-04 to 2016-03 were studied. The average AF time was (4.0±3.9) years including 13 male. All patients received thoracoscopic surgical ablation including pulmonary vein isolation, left atrial (LA) posterior wall isolation, Waterston's groove Ganglionated plexi ablation by bipolar radiofrequency ablation clamp and LA appendage removal, Marshall ligament dividing. Then establishing LA 3D-modeling, based on LA 3D voltage mapping, catheter ablation was conducted to reinforce surgical ablation or modification in order to confirm bidirectional blocking. Meanwhile, LA ridge and mitral isthmus ablation was performed, some patients received LA anterior wall and tricuspid isthmus ablation. The patients were followed-up at 3, 6 and 12 months after the procedure. Results: 13 patients were restored to sinus rhythm after the procedure and no operative complications occurred. The average follow-up time was (12.1±11.5) months. 2 patients with recovered sinus rhythm had re-catheter ablation since atrial flutter at 3 months post-procedure and sinus rhythm was restored. The overall success rate was 86.7% (13/15), no patient had anti-arrhgthmia medication. Conclusion: Hybrid thoracoscopic ablation and catheter ablation have been a minimally invasive, safe and effective method in treating the patients of long-standing persistent AF.
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To explore the safety and efficacy of left atrial appendage (LAA) occlusion under the guidance of local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in patients with nonvavular atrial fibrillation (NVAF). Methods: A total of 16 NVAF patients received local anesthesia and percutaneous LAmbre or Amplatzer cardiac plug occluder implantation. There were 12 males and the patients mean age was at (71.0±6.0) years with CHA2DS2-VASc score at (4.1±1.5); all patients had walfarin contradiction or with walfarin related side effect. Transseptal puncture was conducted by coronary sinus catheter as the anatomic location marker. Results: All 16 patients finished transseptal puncture and no relevant complication occurred. 15/16 (93.8%) patients had successful LAA occlusion, 1 patient was abandoned because of LAA anatomic structure variation. The mean operative time was (65.0±23.0) min and the mean X-ray exposure time was (12.0±3.0) min. The mean diameter of occluder was (32.5±6.0)mm. Conclusion: LAA occlusion was safe and effective with local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in relevant patients.
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Objective To explore the value of diagnostic and differential diagnostic with the Neutrophil‐lymphocyte count ratio (NLCR) and C‐reactive protein cmmunity‐acquired pneumonia(CAP) .Methods The NLCR ,as well as white blood cell counts , neutrophil count ,lymphocyte count and the concentration of CRP were measured in 40 patients with bacterial pneumonia ,40 pa‐tients with mycoplasma pneumonia ,40 patients with viral pneumonia and 40 healthy subjects ,and the results was analyzed by statis‐tical methods .Results In bacterial group ,the NLCR and the concentration of CRP were significantly higher than those in myco‐plasma group ,viral group and normal controls(P<0 .05) .According to the results of ROC curve analysis in the diagnosis of bacte‐rial CAP ,the areas of NLCR and CRP under ROC curve are 0 .911 and 0 .896 ,respectively ,which have good diagnostic sensitivity and specificity .Conclusion The NLCR and CRP in peripheral blood have great significance in diagnosis and differential diagnosis of bacterial community‐acquired pneumonia .
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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 alterations of endothelial microparticles(EMPs) levels in patients with coronary heart dis‐ease(CHD) ,and to evaluate the relationship between EMPs and interleukin‐6(IL‐6) and C‐reactive protein(CRP) .Methods A to‐tal of 38 patients with CHD were divided into myocardial infarction(MI) group(13 cases) and unstable angina(UA) group(13 ca‐ses) and stable angina(SA) group(12 cases) ,and 12 healthy subjects were enrolled as control group .Levels of EMPs were meas‐ured by using flow cytometry technique .Concentration of IL‐6 and CRP were determined by using enzyme linked immunosorbent assay and special protein analysis respectively .Results Compared with SA group and control group ,levels of EMPs were signifi‐cantly increased in MI group and UA group(P<0 .05) .Levels of EMPs in patients with CHD were significantly correlated with IL‐6 and CRP ,with correlation coefficient of 0 .79 and 0 .50 respectively(P<0 .05) .Conclusion EMPs could contribute to monitoring and evaluating the degree of endothelial cells injury in patients with CHD as a laboratory indicator .EMPs might enhance the vascu‐lar inflammation in patients with CHD ,and further accelerate the development of CHD .
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Objective: To analyze the relationship between high-sensitivity C-reactive protein (hs-CRP) and P wave dispersion (Pd) in patients with lone atrial ifbrillation (AF), and to explore the effect of inlfammation on atrial electrophysiological remodeling. Methods: Our research included 2 groups. AF group, containing 71 consecutive paroxysmal lone AF patients, and Control group, containing 71 paroxysmal supra ventricular tachycardia patients with the matched age and gender. The clinical characteristics, electrocardiographic Pd assessment and plasma hs-CRP levels were compared between 2 groups. The relationship between hs-CRP and Pd was studied by linear and multi linear regression analysis. Results: Compared with Control group, AF group showed increased left atrial diameter, Pd and hs-CRP, all P Conclusion: Plasma hs-CRP level and electrocardiographic Pd were the important risk factors for paroxysmal lone AF, the interaction between hs-CRP and AF occurrence could be mediated by Pd, suggesting that inlfammation might be involved in atrial electrophysiological remodeling.
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Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF<45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF≥45%and 2 associated with HF. There was no sig-nificant difference between the two groups (9/37 vs. 2/17;P=0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unex-plained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring sys-tem represent a significant aspect of future studies.