ABSTRACT
BACKGROUND:Presently used pulmonary vein antrum location methods mainly performed by three-dimensional electroanatomy combined with X-ray image or CT image fusion.These methods conducted vein antrum location and ablation by anatomy instructions.It is still poorly understood whether the ablation hit the key part of atrial fibrillation.OBJECTIVE:To explore the feasibility of catheter ablation guided by three-dimensional electroanatomic mapping system in conjunct with pulmonary vein antrum potential in patients with atrial fibrillation.DESIGN,TIME AND SETTING:The verification clinical study was performed at the Department of Cardiology of Jinan Fourth People's Hospital and Hebei People's Hospital from March 2007 to June 2009.PARTICIPANTS:Fifty-one patients with drugs refractory,paroxysmal atrial fibrillation were included.METHODS:All patients underwent circumferential pulmonary vein antrum ablation guided by three-dimensional electroanatomic mapping system (CARTO) in conjunct with pulmonary vein antrum potential with the endpoint of electrical isolation.Relevant parameters and ablation success rate were observed.MAIN OUTCOME MEASURES:Procedure-related parameters,such as procedure duration,fluoroscopy duration,cumulative success rate and complication were observed.RESULTS:Pulmonary veins were isolated in all 51 patients.The mean procedure duration,fluoroscopy time and radiofrequency ablation duration are respectively (207±36.7) minutes,(38.2±14.3) minutes,(56.4±15.7) minutes.After (17.5±3.8)-months follow-up,forty (78.4%) patients did not have recurrence of atrial fibrillation,atrial flutter or atrial tachycardia.No severe procedure-related complication had happened.CONCLUSION:Pulmonary vein antrum potential can be used as a landmark to define pulmonary vein antrum,that combined with CARTO system to guide pulmonary vein antrum ablation is effective,safety and feasible for catheter ablation of atrial fibrillation.
ABSTRACT
BACKGROUND:Circumferential pulmonary vein antrum ablations guided by CARTO system or integration of a computed tomographic or magnetic resonance imaging scan (CARTO-Merge) are two main locating methods.Theoretically,CARTO-Merge provides a detailed appreciation of the pulmonary vein anatomy,however,whether it can improve the safety and success of catheter ablation of atrial fibrillation remains uncertainly.OBJECTIVE:To explore the effect of CT image integration into three-dimensional (3D) electroanatomical mapping system on clinical outcomes of catheter ablation of atrial fibrillation.DESIGN,TIME AND SETTING:The randomized contrast observation was performed at Department of Cardiology of Beijing Anzhen Hospital from October 2005 to May 2007.PARTICIPANTS:A total of 93 patients with drugs refractory,paroxysmal atrial fibrillation who underwent circumferential pulmonary vein antrum ablation.METHODS:All patients underwent circumferential pulmonary vein antrum ablation using irdgated radiofreguency ablation with the endpoint of electrical isolation.Ablation was guided by 3D mapping alone in 50 patients (CARTO group) or by CT image integration in 43 patients (CARTO-Merge group).MAIN OUTCOME MEASURES:Procedure-related parameters,such as procedure duration,fluoroscopy duration,cumulative success rate and complication,were compared between the two groups.RESULTS:Pulmonary veins were isolated in all patients.After (12.6±2.9) months follow-up,73 (78.5%) patients did not have recurrence of atrial fibrillation at 3 month after the procedure.The fluoroscopy time in CARTO group was significant longer than that in CARTO-Merge group (P<0.05).The mean procedure duration,radiofrequency ablation duration,procedure-related complication and cumulative success rate were comparable between the 2 groups.CONCLUSION:Circumferential pulmonary vein antrum ablation guided by 3D mapping alone or by CT integration had similar safety and success rate in paroxysmal atrial fibrillation patients.But CT integration,which facilitated to a detailed representation of the anatomy of left atrium,is associated with reduced fluoroscopy duration.
ABSTRACT
BACKGROUND:Bone marrow stem cell transplantation can improve heart function and prevent ventricle remodeling.At present,the adult bone marrow stem cells used for transplantation primarily included bone marrow mononuclear cells (BM-MNCs) and mesenchymal stem cells (MSCs),and endothelial progenitor cells.The curative effects and precise mechanisms of transplantation of various bone marrow stem cells remain unknown.OBJECTIVE:To compare the effects of transplantation of autologous BM-MNCs and MSCs via the coronary artery on ventricle remodeling subsequent to acute myocardial infarction (AMI). DESIGN,TIME AND SETTING:Randomized controlled animal experiment performed at the Center for Clinical Research,Hebei Provincial People's Hospital,Electron Microscope Room,Hebei Medical University between March 2005 and December 2006.MATERIALS:Thirty-six male Jizhong pigs,were randomly divided into 4 groups:control group (n = 6),infarct model group (n = 10),BM-MNC group (n = 10),and MSC group (n = 10).METHODS:Porcine autologous BM-MNCs were isolated by gradient density centrifugation,and MSCs were obtained by adherence method.Prior to transplantation,both BM-MNCs and MSCs were colloidal gold labeled.Except the infract model group,pigs in the other 3 groups were developed into AMI models by oppressing the left anterior descending branch with balloon catheter.Ninety minutes after modeling,(6.0±1.3)×107 autologous BM-MNCs and (4.5±2.1)x 107 MSCs were respectively transplanted into pigs in the BM-MNC group and the MSC group via the coronary artery and cultured for 28 days.MAIN OUTCOME MEASURES:Observation of pathological changes of cardiac muscle tissue by light and electron microscope;Examination of cardiac function by ultrasonograph;Detection of the number of blood vessels and apoptotic myocardial cells,and expression of nuclear factor-κB (NF-κB) and troponin Ⅰ and its correlation to cardiac function by immunohistochemistry;Detection of mRNA expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in the cardiac tissue as well as its correlation to cardiac function by reverse transcription-polymerase chain reaction (RT-PCR).RESULTS:In the MSC group,there was proliferation of a great deal of blood vessels as well as growth of abnormal cell masses around the coronary vessels,while the BM-MNC group exhibited the "budding" of many capillary vessels.Prior to transplantation,cardiac function indices were basically similar among each group (F = 1.550,P＞0.05).Twenty-eight days after transplantation,left ventricular ejection fraction was significantly lower in the control,BM-MNC,and MSC groups than in the infarct model group (F = 5.30,P＜0.05),while endocardial fractional shortening was significantly higher (F = 10.67,P＜0.01).Compared with the infarct model group,the number of blood vessels in the infarct zone and infarct border zone was increased in the BM-MNC group (F=29.56-34.87,P＜0.01) and had no apparent change in the MSC group.In the BM-MNC and MSC groups,apoptotic myocardial cells in the infarct zone and infarct border zone were significantly reduced (F=14.31-35.34,P＜0.01 ) and troponin I expression rate was significantly increased (F=19.05,P＜0.01 ),as compared with the infarct model group.In addition,NF-κB positive rate in the infarct border zone was significantly lower in the BM-MNC and MSC groups than in the infarct model group (F=19.05,P＜0.01).VEGF gene expression level in the infarct border zone was significandy higher in the BM-MNC group than in the infarct model group and MSC group (F = 49.41,P＜0.01).bFGF gene expression level in the infarct border zone was significantly higher in the MSC group than in the infarct model and BM-MNC groups (F=4.71,P＜0.01).LVEF was negatively correlated to myocardial cell apoptosis rate and NF-κB level (r=-0.441 1,P＜0.05;r=-0.579 6,P＜0.01 ).LVEF was positively correlated to number of blood vessels,VEGF and bFGF expression (r=0.775,P＜0.01;r=0.565 1,P＜0.05;r=0.573 5,P＜0.05).CONCLUSION:Transplantation of both autologous BM-MNC and MSC via coronary artery can improve the condition of left ventricular remodeling subsequent to myocardial infarction.The improvement of cardiac functions is related to the increase of blood vessels,VEGF and bFGF expression,the decrease of myocardial cell apoptosis and NF-κ B level in cardiac muscle tissues after stem cell transplantation.BM-MNC transplantation better promotes blood vessel proliferation and VEGF expression in the cardiac tissue but produces worse effects on bFGF gene expression than MSC transplantation.
ABSTRACT
Objective To investigate the influence of two different dose of atorvastatin on the prognosis and endothelial function in post-PCI acute coronary syndrom patients.Methods 92 post-PCI ACS patients were randomly divided into two groups,atorvastatin 20mg and atorvastatin 10 mg group.In each group the patients were treated with atorvasta- tin 20mg or 10mg respectively.After one month we add or decrease the dose of atorvastatin according to the blood lipid level.After 12 month the blood lipid level、FMD、NO、ET、NOS、UAP、AMI were compared between two groups. Results The clinical setting have no significant association between two groups before treating,After treated 1 and 12 month the TC,LDL-C level were significantly decreased as compared with the base level before treating in each group. After treated 1 month,in atorvastatin 20 mg group the TC,LDL-C level were significantly decreased and NO、NO/ET level were significantly higher than those in atorvastatin 10 mg group.During 12 month follow up the incidence of angina pectoris onset and rehospitalization were significantly higher in atorvastatin 10 mg group(P