Repeated stellate ganglion blockade for the treatment of ventricular tachycardia storm in patients with nonischemic cardiomyopathy: a new therapeutic option for patients with malignant arrhythmias / 中华心血管病杂志

Objectives: This study sought to describe our institutional experience of repeated percutaneous stellate ganglion blockade (R-SGB) as a treatment option for drug-refractory electrical storm in patients with nonischemic cardiomyopathy (NICM). Methods: This prospective observational study included 8 consecutive NICM patients who had drug-refractory electrical storm and underwent R-SGB between June 1, 2021 and January 31, 2022. Lidocaine (5 ml, 1%) was injected in the vicinity of the left stellate ganglion under the guidance of ultrasound, once per day for 7 days. Data including clinical characteristics, immediate and long-term outcomes, and procedure related complications were collected. Results: The mean age was (51.5±13.6) years. All patients were male. 5 patients were diagnosed as dilated cardiomyopathy, 2 patients as arrhythmogenic right ventricular cardiomyopathy and 1 patient as hypertrophic cardiomyopathy. The left ventricular ejection fraction was 37.8%±6.6%. After the treatment of R-SGB, 6 (75%) patients were free of electrical storm. 24 hours Holter monitoring showed significant reduction in ventricular tachycardia (VT) episodes from 43.0 (13.3, 276.3) to 1.0 (0.3, 34.0) on the first day following R-SGB (P<0.05) and 0.5 (0.0, 19.3) after whole R-SGB process (P<0.05). There were no procedure-related major complications. The mean follow-up was (4.8±1.1) months, and the median time of recurrent VT was 2 months. Conclusion: Minimally invasive R-SGB is a safe and effective method to treat electrical storm in patients with NICM.

Relationship between social support and parental burnout in COVID-19 among Chinese young parents / 北京大学学报(医学版)

OBJECTIVE@#To explore potential categories of parental social support for young parents under the coronavirus disease 2019 (COVID-19) epidemic, and to examine correlations of different types of parents' social support with parental burnout.@*METHODS@#In April 2020, we conducted an online voluntary survey among young parents across China with scales and a self-designed questionnaire. The latent profile analysis method was used to analyze parents' received social support and perceived social support. The social support categories were taken as independent variables and parental burnout as dependent variables, and multiple regression analysis was carried out to explore the relationship between received social support, perceived social support and parental burnout. Finally, the moderating effect of resilience between social support groups and parental burnout was discussed.@*RESULTS@#The results of latent profile analysis revealed three potential types of received social support, namely isolate, normal, and multi-support and the proportions of the respondents with the three profiles were 14.1%, 78.0%, and 7.9%. Four potential types of perceived social support, namely, indigent, medium, affluent and divergent and the proportions of the respondents with the four profiles were 13.7%, 29.6%, 25.3%, and 31.3%. Among them, the parents with divergent perceived social support had more perception of social support from the couple, family and relatives, but less perception of social support from net-friend, social organizations and the government. Regression analysis showed that there was no statistically significant correlation between different profiles of received social support and parental burnout, and among the groups of perceived social support, there was a statistically significant correlation between indigent and divergent types of social support and parental burnout. The divergent parents had lower levels of parental burnout compared with indigent (β=-0.120, P=0.003). Also, resilience moderated the effect of divergent perceived social support and parental burnout. Compared with the parents with low resilience, the parents with high resilience perceived divergent social support with lower parenting burnout.@*CONCLUSION@#There are prominent latent types of received social support and perceived social support under epidemic. People with divergent perceived social support (more perceived supports from partner, family and friends) are prone to have a relatively lower risk of parental burnout. Parents with higher resilience will be more sensitive to the support of close acquaintances, and can better resist parental burnout.

Clinical characteristics and long-term follow-up results of radiofrequency ablation for the treatment of ventricular tachycardia in patients with arrhythmogenic left ventricular cardiomyopathy / 中华心血管病杂志

Objective: To investigate the acute and long-term outcome of catheter ablation for the treatment of ventricular tachycardia (VT) in patients with arrhythmogenic left ventricular cardiomyopathy (ALVC). Methods: This retrospective, cross-sectional study enrolled ALVC patients undergoing radiofrequency ablation for the treatment of VT at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2018 and collected their clinical characteristics and intraoperative electrophysiological examination. Patients were followed up every 6 months after radiofrequency ablation until August 2021. Echocardiographic results and VT recurrence post radiofrequency ablation were analysed. Results: Totally 12 patients were enrolled (mean age: (42±15) years, 11 males(11/12)). The mean of left ventricular end diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were (51±5)mm and (65±5)%, respectively. Twelve VTs were induced in 10 patients during the electrophysiological study, and the mean tachycardia cycle length was (293±65) ms. Three-dimensional substrate mapping revealed the diseased area at endocardial site in one patient, at epicardial sites in the other 11 patients (involved endocardial sites in 2 cases) with the basal part near the mitral annulus being the predilection for the substrate (10/11). After the catheter ablation at the endocardial and epicardial sites respectively, the complete procedure endpoint was achieved in all patients (VT cannot be induced post ablation). The median follow-up time was 65 (25, 123) months. One patient was lost to follow-up, and the other 11 patients survived without VT. No significant cardiac function deterioration was detected by the echocardiographic examination ((51±5)mm vs. (52±5)mm, P>0.05 for LVDd, (65±5)% vs. (60±6)%, P>0.05 for LVEF) at the end of follow-up. Conclusion: After radiofrequency ablation, the complete procedure endpoint is achieved in ALVC patients, and the catheter ablation provides long-term ventricular tachycardia control during the long-term follow-up.

A new caffeoyl glucoside from Hedyotis caudatifolia with antitumor activity / 中草药

Objective To study the chemical constituents of Hedyotis caudatifolia. Methods These compounds were isolated from H. caudatifolia and purified by repeated silica gel, polyamine, Sephadex LH-20 column chromatography and other methods. Their structures were identified by NMR, MS, and physico-chemical properties. Results Ten compounds were isolated and elucidated as hedycaffeoylglucoside A (1), β-sitosterol (2), 5α-stigmastane-3,6-dione (3), 7-hydroxy-6-methoxycoumarin (4), oleanolic acid (5), ursolic acid (6), pomolic acid (7), 3α,19α-dihydroxyurs-12-en-24,28-dioic acid (8), 2α,3β,24-trihydroxyolean-12-en-28-oic acid (9), and 2α,3α-dihydroxyolean-12-en-28-oic acid (10), respectively. Conclusion Compound 1 is a new caffeoyl glucoside and compounds 7-10 are isolated from this plant for the first time. Compound 1 exhibits cytotoxicity against four tumor cells.

Preparation and characterization of timolol maleate cubic nanoparticles for ocular administration / 药学学报

Timolol maleate cubic nanoparticles (TM-LCNPs) were prepared via fragmentation of a bulk GMO/poloxamer 407 cubic phase gel by high-pressure homogenization. The optimal prescription was selected based on particle size and entrapment efficiency by orthogonal design method. Malvern particle sizer, polarized light microscopy, and differential scanning calorimetry were used to characterize the cubic nanoparticles. Commercial eye drops were used as a control for the release and corneal permeation experiment in vitro. Fluorescence imaging was used to observe the retention of Rhodamine B cubic nanoparticles (RhB-LCNPs) in rabbit cornea. The results indicated that the optimal prescription and preparation of TM-LCNPs was oil-water ratio (7:3), homogenous pressure (900 bar), the number of homogenizations (6) and drug loading (1%). Corneal permeability of TM-LCNPs was significantly higher than that of commercially available eye drops. The residence time in eyes was longer which suggested a sustained release behavior. The pathology result of rabbit corneal after multiple administration of TM-LCNPs showed that there was no apparent damage.

Efficacy of catheter radiofrequency ablation for the treatment of ventricular arrhythmia storm post cardioverter-defibrillators implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the acute and long-term effects of catheter radiofrequency ablation for the treatment of ventricular arrhythmia storm (VAS) post implantable cardioverter-defibrillators (ICD) implantation.</p><p><b>METHODS</b>Acute and long-term effects of catheter radiofrequency ablation for the treatment of VAS post ICD implantation were retrospectively assessed in 11 patients from September 2008 to August 2011.</p><p><b>RESULTS</b>A total of 15 ablation procedures were performed in 11 patients. Six ablation procedures were performed through epicardial approach. In 9 patients, 20 types of ventricular tachycardia (VT) (including 20% hemodynamically unstable VT) were induced during the procedures [mean cycle length (384 ± 141) ms] and polymorphic ventricular tachycardia were induced in 7 patients. The average X-ray fluoroscopy time and procedural time were (26 ± 17) min and (189 ± 60) min, respectively. Complete success, partial success, and failure rates immediately post catheter radiofrequency ablation were 46.7% (7/15), 26.7% (4/15) and 26.7% (4/15), respectively. All patients are alive at follow-up[(2.45 ± 9.6) months after the last catheter ablation] and the complete success, partial success, and failure rates during follow-up were 72.7% (8/11), 9.1% (1/11) and 18.2% (2/11), respectively.</p><p><b>CONCLUSION</b>VAS can be effectively treated by catheter radiofrequency ablation in patients post ICD implantation.</p>

Catheter ablation of epicardial accessory pathway associated with coronary sinus musculature / 中华心血管病杂志

<p><b>OBJECTIVE</b>To report the single-center clinical experience of catheter ablation of epicardial accessory pathway associated with coronary sinus musculature.</p><p><b>METHODS</b>The data of 721 cases of left sided accessory pathway ablation were retrospectively analyzed. Ablation in the coronary sinus was performed in 17 (2.4 %) cases [11 males, mean age (37 ± 11) years].</p><p><b>RESULTS</b>Among the 17 cases, the accessory pathway was successfully ablated in middle cardiac vein and posterior lateral coronary sinus in 11 and 6 cases, respectively. Deverticulum of middle cardiac vein was seen in 2 cases. Mean time required to block the accessory pathway was (4.7 ± 2.7) s. An accessory pathway potential could be recorded at the target site in 10 out of 17 patients (59%). During a mean (21 ± 16) months follow up, only one patient experienced recurrence who was successfully cured by a second ablation session. No procedure related complication was reported.</p><p><b>CONCLUSION</b>About 2.4% of left accessory pathway may have epicardial connection locating at middle cardiac vein or lateral part of the coronary sinus and require epicardial ablation. The epicardial ablation is safe and effective, warrants an excellent long-term results.</p>

Clinical characteristics and long-term outcome of non-pulmonary vein foci ablation in patients with paroxysmal atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and long-term results of non-pulmonary veins (PV) trigger ablation in patients with paroxysmal atrial fibrillation (AF).</p><p><b>METHODS</b>Eighty-six patients [48 men, mean age (52.3 ± 10.2) years] were included in the study. Circumferential pulmonary vein antrum isolation guided by a 3-D mapping system was performed. Aggressive high right atrium programmed stimulation and burst pacing were made before and after isoproterenol infusion. Additional ablation was performed if other trigger foci were found or other sustained tachycardias could be induced.</p><p><b>RESULTS</b>PV triggers were observed in 59 patients (group I), and non-PV triggers were observed in 27 patients (group II), 12 non-PV triggers were identified during the first procedure. Among them, one was located in the roof of left atrium, 11 were originated from superior vena cava. After a mean follow-up of [37.1 ± 10.4 (range 15-60)] months, the AF recurrence rate was significantly higher in the Group II than in the Group I (55.5% vs. 20.3%, P = 0.001). The number of performed ablation was also significantly in group II than in group I higher difference (1.7 ± 0.8 vs. 1.1 ± 0.4, P < 0.001). In the group II, 15/15 (100%) patients had a repeated ablation procedure for AF recurrence, and 15 patients had new non-PV foci after isoproterenol infusion which were originated from the superior vena cava (n = 11) and coronary sinus (n = 2), respectively. After the second ablation procedure, AF recurrence was observed in three patients, two patients accepted third procedure, the non-PV triggers were located in left atrial septum and coronary sinus, and one patient accepted fourth procedure, the non-PV foci was located in left posterior wall.</p><p><b>CONCLUSIONS</b>Non-PV foci may occur at any age and the main area is located in the super vena cava, Non-PV serves as a major cause of AF recurrence after successful PVAI.</p>

Catheter ablation of focal atrial tachycardia:the topographic distribution and long-term outcome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the topographic distribution and long-term outcome of catheter ablation for focal atrial tachycardia (AT).</p><p><b>METHOD</b>The data of 207 patients who underwent electrophysiologic study for AT were retrospectively analyzed.</p><p><b>RESULTS</b>A total of 200 AT were identified in 185 patients. The most common site for AT was ostium of the coronary sinus (23.8%), followed by crista terminalis (20.5%), perinodal area (20.0%), cava vena (17.8%), annulus (13.0%), and appendage (10.3%). Eighty percent AT originated from the right atrium, 17.8% originated from the left atrium. AT originated from the left atrium was more common in male than in female (25.0% vs. 13.3%, P = 0.042), while AT originated from the right atrium was more common in female than in male (69.4% vs. 86.7%, P = 0.004). Among the 185 patients, acute success ablation rate was 93.5% (n = 173). The acute success rate in the conventional mapping group was lower than that in the three-dimensional mapping group (79.3% vs. 96.5%, P < 0.01). During a median of 36 months follow up, the AT recurred in 20 patients (success ablation rate 88.4%). Success ablation rate was similar between the conventional mapping group and the three-dimensional mapping group (P > 0.05).</p><p><b>CONCLUSIONS</b>Focal AT commonly originates from ostium of coronary sinus, crystal terminalis, perinodal area, and cava veins. There is a gender related difference in the distribution of focal AT. The radiofrequency catheter ablation yields a satisfying success rate and very low complication rate and could be the first line choice for treating ATs in experienced electrophysiological center.</p>

Myocardial injury resulting from radiofrequency catheter ablation: comparison of circumferential pulmonary vein isolation and complex fractionated atrial electrograms ablation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Radiofrequency catheter ablation (RFCA) necessarily produces an area of myocardial necrosis. However, the difference of the extent of myocardial injury between circumferential pulmonary vein isolation (CPVI) and complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) has not been investigated before.</p><p><b>METHODS</b>Twenty-nine consecutive male patients (n = 29) with either paroxysmal or persistent AF were selected for CPVI or CFAE ablation. The CPVI or CFAE ablation was performed with a three-dimensional electroanatomical mapping system (CARTO). Serum cardiac biomarkers, for example, cardiac troponin T (cTnT), aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase myocardial bound (CKMB) were determined by the Elecsys STATE immunoassay. Cardiac structure and function were measured with echocardiography.</p><p><b>RESULTS</b>Echocardiography showed that there was no significant difference of atrioventricular structure or function parameters between the CPVI group and the CFAE ablation group. Serum cTnT showed a significant increase in the CFAE ablation group over the CPVI group at 12 and 24 hours after the procedure (P < 0.05, respectively), and then it was reduced to a normal level after 48 hours. Serum AST showed a significant increase in the CFAE ablation group over the CPVI group at post-procedure, 4 and 12 hours after the procedure (P < 0.05, respectively), and then it reached to a normal level after 24 hours. There was no significant difference in LDH, CK, or CKMB levels between the CFAE ablation group and the CPVI group at any time point (P > 0.05).</p><p><b>CONCLUSIONS</b>cTnT and AST other than LDH, total CK or CKMB activity significantly increased more in the CFAE ablation group than the CPVI group. However, the difference of the serum levels of cTnT, AST between two groups was temporary.</p>

Impact of metoprolol use in the treatment of patients with electrical-storm after cardioverter defibrillators implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the effectiveness of the metoprolol dosage adjustment on reducing the incidence of electrical-storm (ES) in patients with Implantable Cardioverter Defibrillators (ICDs).</p><p><b>METHODS</b>Data from patients with ICD implantation between Jan, 2003 and Jun, 2006 in our hospital were retrospectively analyzed. ES was defined as either ≥ 3 times of ventricular tachyarrhythmias (VTAs) resulting in ICD therapy or VTAs lasting more than 30 s detected by ICD without any therapy within 24 hours.</p><p><b>RESULTS</b>During a follow-up period of (27.5 ± 21.2) months, ES was recorded in 39 cases [34 males, average age (52.0 ± 13.1) years] out of 119 patients (32.8%) and 9 patients died after ES. During the period of storm attack, ES was successfully controlled in 25/30 patients by various interventions, including predisposing factors corrected in 5 cases, ICD reprogramming and antiarrhythmic drugs therapy optimized in 16 cases (one received intravenous injection of metoprolol), and VTAs eliminated by catheter ablation in 4 cases. ES was spontaneously resolved in the remaining 5 cases. In the chronic phase, 2 patients with Brugada syndrome were treated with Quinidine mono-therapy while the dosage of metoprolol was adjusted in the remaining 23 patients and the dosage of metoprolol was increased gradually from (26.8 ± 13.9) mg/d to (88.9 ± 53.5) mg/d without any adverse effects (9 patients received also oral amiodarone 200 mg/d). Post dosage adjustment, the total VTA episodes [(1.9 ± 1.7) times/month vs. (0.8 ± 0.6) times/month, P = 0.004], incidence of antitachycardia pacing therapies [(4.2 ± 3.8) runs/month vs. (2.3 ± 2.0) runs/month, P = 0.003], as well as electrical cardioversion or defibrillation [(1.1 ± 0.9) times/month vs. (0.4 ± 0.2) times/month, P = 0.001] were significantly decreased. ES was not controlled until a extremely high dosage [225 - 300 (255.3 ± 41.7) mg/d] of metoprolol was reached in the remaining 5 patients.</p><p><b>CONCLUSIONS</b>Metoprolol use is essential and its dosage should be individualized in the majority of ICD recipients with ES. In approximately 1/6 patients, the dosage of metoprolol should be higher than 200 mg/d.</p>

Clinical characteristics of congenital ventricular aneurysm and diverticula in inland China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics of congenital ventricular aneurysm and diverticula in inland China.</p><p><b>METHODS</b>To identify the literature of congenital aneurysm and diverticula from Wanfang, China National Knowledge Infrastructure (CNKI) and PubMed databases, and to analyze the clinical characteristics of congenital aneurysm and diverticula from January of 2001 to December of 2009.</p><p><b>RESULTS</b>A total of 116 patients [78 men, 1 - 80 (33.5 ± 21.3) years old] with congenital aneurysm or diverticula were included in 109 articles. Twenty-five patients (13 men) were congenital ventricular aneurysm, including a family of 4 patients. Ninety-one patients (65 men) were congenital ventricular diverticula. One hundred patients were detected by echocardiography during medical examination, 34 patients combined with other cardiac anomalies, 4 of which with extracardiac structures. There were 8 patients with ventricular arrhythmia, 8 patients with thrombosis, 2 patients died of cardiac rupture, 4 patients died of sudden death, surgical operation was performed in 46 patients and 3 patients received ablation procedure. All patient did not receive implantable cardioverter defibrillator (ICD) implantation.</p><p><b>CONCLUSIONS</b>Congenital ventricular aneurysm or diverticulum is a rare cardiac malformation. Most congenital left ventricular aneurysms and diverticula are asymptomatic and detected by echocardiography. Congenital ventricular aneurysm or diverticulum may cause ventricular tachycardia, ventricular wall rupture, systemic embolization or sudden death, which had to be treated individually.</p>

The anti-apoptotic effects of N-acetylcysteine in neonatal rat cardiomyocytes underwent hypoxia-reoxygenation injury / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effects of N-acetylcysteine (NAC) on hypoxia-reoxygenation (H/R) injury induced apoptosis in neonatal rat cardiomyocytes.</p><p><b>METHODS</b>Neonatal rat cardiomyocytes were cultured for 48 h and then randomized into control group, H/R group and H/R + NAC group. Cardiomyocytes underwent hypoxia for 6 h, reoxygenation for 72 h in the absence (H/R group) or presence (H/R + NAC group) of NAC (100 micromol/L). Cell viability was assayed with trypan blue staining. Early stage of apoptosis was detected by flow cytometry with Annexin V, late stage of apoptosis was assessed by TUNEL staining. ROS in culture medium was assayed by Image-iT(TM) LIVE green reactive oxygen species detection kit.bcl2 and bax mRNA levels were determined by real-time quantitative PCR (RT-PCR). bcl2, bax, p38 and pp38 protein levels were measured by Western blot.</p><p><b>RESULTS</b>The percentage of viable cardiomyocytes (93.5%, 74.9%, 89.9%) was significantly reduced while percentage of early stage of apoptotic cardiomyocytes (6.5%, 25.2% and 11.1%) and late stage of apoptotic cardiomyocytes (3.5%, 33.5% and 13.5%) were significantly increased in H/R group compared to control group and these changes could be largely reversed by NAC (all P < 0.01). Significantly increased ROS generation in H/R group could also be attenuated by NAC (P < 0.01). The band density ratio of pp38 and p38 was significantly upregulated in H/R group (13.4 vs. 3.89), the mRNA and protein expressions of bcl2 were significantly lower and bax expressions were significantly higher in H/R group than those in control group and these changes could also be attenuated by NAC.</p><p><b>CONCLUSION</b>NAC significantly reduced apoptosis through inhibiting the phosphorylation of p38 signal pathway.</p>

Prevalence of Epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).</p><p><b>METHODS</b>The epsilon wave was detected in 32 patients [24 men, mean age (42.3 +/- 13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordial leads ECG (F-ECG). The Epsilon wave was defined as wiggler, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment.</p><p><b>RESULTS</b>Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar (P > 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P < 0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves.</p><p><b>CONCLUSION</b>Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.</p>

N-acetylcysteine promoted aging through adjusting expression of cell cycle related protein in neonatal SD rat cardiomyocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the effects of N-acetylcysteine (NAC) on aging in neonatal SD rat cardiomyocytes and explore related mechanisms.</p><p><b>METHODS</b>Cultured cardiomyocytes were randomized assigned to 6 groups: 1-day, 5-day, 10-day, 1-day + NAC (1 mmol/L), 5-day + NAC (1 mmol/L) and 10-day + NAC (1 mmol/L). Flow cytometry was used to examine cell cycle. Real-time quantitative PCR and Western blot were used to determine mRNA and protein expression of p16INK4a, p21WAF1 and Rb gene. beta-galactosidase staining kit was used to investigate beta-galactosidase activity.</p><p><b>RESULTS</b>Numbers of cardiomyocytes resided in G(0)/G(1) phase were significantly higher in the group of 5-day + NAC and 10-day + NAC compared with 5-day, 10-day, respectively (P < 0.05). The mRNA and protein expression of p16INK4a and p21WAF1 were also significantly higher in the group of 5-day + NAC and 10-day + NAC compared with 5-day, 10-day, respectively (P < 0.05 or P < 0.01). The mRNA and protein expression of Rb was significantly lower in the group of 5-day + NAC and 10-day + NAC compared with 5-day, 10-day, respectively (P < 0.01). beta-galactosidase activity was not affected by NAC in the 1-day + NAC group but was significantly higher in 5-day + NAC and 10-day + NAC groups compared with the 5-day, 10-day groups (all P < 0.05).</p><p><b>CONCLUSION</b>NAC could promote aging through upregulating the expression of p16INK4a and p21WAF1 and inhibiting Rb phosphorylation in neonatal SD rat cardiomyocytes.</p>

Detection of gene mutations of SCN5A in 7 patients with Brugada syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>Brugada syndrome is linked to sodium channel mutations and could induce arrhythmias that even lead to sudden death. The purpose of this study was to detect if there was gene mutation of SCN5A in 7 patients with Brugada syndrome and explore the molecular genetic characteristics of this disease.</p><p><b>METHOD</b>Genomic DNA was extracted from peripheral blood of all 7 patients with Brugada syndrome and 41 pairs of PCR primers were designed to amplify all the 28 exons of SCN5A.</p><p><b>RESULT</b>There was no novel mutation in exons of Gene SCN5A in these patients with Brugada syndrome.</p><p><b>CONCLUSION</b>Brugada syndrome might associated gene mutation or other mechanisms independent of SCN5A gene mutation.</p>

Tpeak-Tend interval and risk of cardiac events in patients with Brugada syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the possible association between Tpeak-Tend (Tp-e) interval in surface standard ECG and cardiac events in patients with Brugada syndrome (BrS).</p><p><b>METHOD</b>Tp-e interval in surface standard ECG was compared between BrS patients (n = 23, all males) and paroxysmal supraventricular tachycardia (PSVT) patients (n = 20, all males) as well as between BrS patients with (n = 16) or without (n = 7) cardiac events.</p><p><b>RESULTS</b>There was significant difference in Tp-e interval between BrS patients and PSVT patients [(109.57 +/- 22.86) ms vs. (88.50 +/- 13.08) ms, P < 0.05]. Tp-e interval was also significantly longer in BrS patients with cardiac events (syncope, clinical ventricular fibrillation and induced VF during electrophysiological study) than BrS patients without cardiac events [(118.12 +/- 20.40) ms vs. (90.00 +/- 15.27) ms, P < 0.05] while Tp-e interval was similar between BrS patients without cardiac events and PSVT patients (P > 0.05).</p><p><b>CONCLUSION</b>The prolongation of Tp-e (> or = 120 ms) was associated with higher cardiac events in BrS patients.</p>

Electrophysiological findings and ablation strategies in patients with atrial tachyarrhythmias after left atrial circumferential ablation in the treatment of atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To report the electrophysiological findings and the ablation strategies in patients with atrial tachyarrhythmias (ATAs) or atrial fibrillation (AF) recurrence after left atrial circumferential ablation (LACA) in the treatment of AF.</p><p><b>METHODS</b>91 patients with AF had LACA procedure from April 2004 to May 2006, 19 of which accepted the second ablation procedure due to ATAs or AF recurrence. In all the 19 patients [17 male, 2 female, age 25 - 65 (53 +/- 12) years], 11 presented with paroxysmal AF before the first ablation procedure, 2 with persistent AF and 6 with permanent AF. Pulmonary vein potentials (PVP) were investigated in both sides in all the patients.</p><p><b>RESULTS</b>Delayed PVP was identified inside the left circular line in 5 patients, in the right in 1 and both in 2 during sinus rhythm. "Gap" conduction was found and successfully closed guided by circular mapping catheter. In 3 cases, irregular left atrial tachycardia was caused by fibrillation rhythm inside the left ring via decremental "gap" conduction. Reisolation was done successfully again guided by 3-D mapping and made the left atrium in sinus rhythm but the fibrillation rhythm was still inside the left ring. Pulmonary vein tachycardia with 1:1 conduction to the left atrium presented in one case and reisolation stopped the tachycardia. No PVP was discovered in both sides in 4 patients but other tachycardias could be induced, including two right atrial scar related tachycardias, two supraventricular tachycardias mediated by concealed accessory pathway, one cavo-tricuspid isthmus dependent atrial flutter and one focal atrial tachycardia near the coronary sinus ostium. All the tachycardias in these 4 patients were successfully ablated with the help of routine and 3-D mapping techniques. In the rest 3, which were in AF rhythm, LACA was successfully done again. After a mean follow-up of 4 - 26 (11.5 +/- 8.5) months, 16 patients were symptom free without anti-arrhythmic drug therapy; 1 of them had frequent palpitation attack with Holter recording of atrial premature contractions; 2 of them with permanent AF became paroxysmal in one, and still in AF in the other.</p><p><b>CONCLUSIONS</b>Reconduction between the left atrium and the pulmonary veins is the dominant factor for post-LACA ATAs and AF recurrence. Other forms of atrial tachycardias or supraventricular tachycardias may coexist with AF or sometimes trigger AF. LACA can not sufficiently modify AF substrate in some permanent AF patients.</p>

Time distribution of ventricular arrhythmias in patients with Brugada syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the characterization of time distribution of ventricular arrhythmias in patients with Brugada syndrome (BrS) using Holter monitoring and ICD follow-up.</p><p><b>METHODS</b>Patients with BrS [all male, mean age (41.07 +/- 11.49) years], were divided into ventricular fibrillation (VF) group (n = 7) and no ventricular fibrillation (N-VF) group (n = 7). Premature ventricular capture (PVC) and VF episodes were detected by Holter monitoring and ICD recording.</p><p><b>RESULTS</b>The 24 hours total number of PVCs ranged from 0 to 74 (mean 9.61 +/- 17.23) in most of the patients and were similar between VF group and N-VF group. The percentage of PVC episodes in VF group was significantly higher than that in N-VF group from nocturnal time to early morning (22:00 to 7:00, 98.67% vs. 44.14%, P < 0.01). There were total 75 VF episodes during (23.18 +/- 17.96) months' follow-up in 5 patients with BrS, 93.3% of which occurred from nocturnal time to early morning (22:00 to 7:00).</p><p><b>CONCLUSIONS</b>The episodes of PVC were enriched from nocturnal time to early morning in BrS patients, this time distribution could be a new noninvasive risk stratification factor for BrS. The episodes of VF in BrS patients were also enriched from nocturnal time to early morning and this time characteristic of episodes of VF could be used to guide drug therapy.</p>

Left atrium linear lesion encircling pulmonary veins guided by EnSite-NavX and double-Lasso technique for paroxysmal atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of left atrium linear lesion encircling pulmonary veins (PV) guided by EnSite-NavX and double-Lasso technique for paroxysmal atrial fibrillation (PAF).</p><p><b>METHODS</b>Twenty-two patients (male 19, mean age of 48.5 years +/- 11.4 years) with symptomatic PAF were enrolled. After a geometry of the left atrium was reconstructed by EnSite-NavX system, PV ostia were marked on the map based on venography. Two Lasso catheters were placed within the ipsilateral superior and inferior PVs. Irrigated radiofrequency energy was applied at 0.5-1.0 cm of distance from the PV ostia. Continuous linear lesion was done to obtain the disappearance of pulmonary vein potentials. Patients were on propafenone and perindopril for three months after the procedure.</p><p><b>RESULTS</b>The endpoint for ablation was reached in 21 Patients and 1 patient was not successful because of cardiac tamponade. The mean procedure time was 6.6 h +/- 1.3 h and the mean X-ray exposure time was 56.1 min +/- 18.0 min. After a mean 5.3 months +/- 2.7 months of follow-up, 10 patients were free of symptoms. Two patients had no PAF recurrence after the second procedure. Three patients had clinical recurrence of PAF in the first month. The total success rate in this study was 81% (17/21). Mortality was 0% and the overall complication rate was about 9% (2/22).</p><p><b>CONCLUSION</b>Left atrium circumferential linear ablation surrounding PV ostia guided by EnSite-NavX and double-Lasso technique is effective in PAF, but some patients will need more than one procedure in order to achieve a success.</p>