Retrospective analysis on the clinical features and management of acute and subacute right ventricular perforation by pacemaker lead / 中华心血管病杂志

<p><b>OBJECTIVE</b>To describe the clinical characteristics and management of the acute and subacute cardiac perforation by pacing leads.</p><p><b>METHODS</b>We retrospectively analyzed clinical data of patients with acute and subacute right ventricular perforation by pacemaker lead occurred in our hospital between 2006 and 2011.</p><p><b>RESULTS</b>Seven cases of confirmed acute and subacute right ventricular perforation by pacemaker lead were enrolled. The perforation rate was 0.15%, 2 cases of perforation occurred during the procedure. The main manifestation was low blood pressure and pericardial effusion. These two patients with cardiac tamponade underwent urgent percutaneous pericardiocentesis and patients recovered without complication. The remaining 5 cases of perforation occurred within 4-16 days after the pacemaker implantation. The main symptoms were diaphragm stimulation and chest pain. Signs of leads dysfunction were observed in all 5 patients. The diagnosis of cardiac perforation was confirmed by chest X-ray, echocardiography, or computed tomography. In all these 5 patients, the leads were removed by simple traction under fluoroscopic guidance with surgical backup support, no complication was observed.</p><p><b>CONCLUSION</b>Acute and subacute right ventricular perforation is a rare but serious complication of pacemaker implantation. In most patients, the leads can be safely removed under fluoroscopic guidance with surgical backup support and close monitoring.</p>

Right phrenic injury after radiofrequency catheter ablation of atrial tachycardia at crista terminalis / 中华医学杂志(英文版)

A 62-year-old woman with frequent occurrence of symptomatic atrial tachycardia with a foci located at the root of the upper crista terminalis was found to have right diaphragm paresis after receiving a total of 8 radiofrequency energy deliveries (40-60 W, 50-60ºC) and a total duration of 540 seconds of ablation therapy (7Fr 8 mm deflectable ablation catheter). The right diaphragm paresis remained resolved up to 14 months after the procedure as confirmed by repeated chest X-rays.

Clinical features of unexpected sudden death clustered in 7 families in Yunnan Province / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of unexpected sudden death (SUD) clustered in families in Yunnan province.</p><p><b>METHODS</b>This retrospective study analyzed the clinical features of SUD occurred between July to September 2005 in 7 families in Yunnan province.</p><p><b>RESULTS</b>All 16 SUD patients shared common clinical features such as fatigue and repeated syncope and one group of SUD patients (n = 8 from 4 families) presented with the gastric intestinal tract manifestations including nausea, vomiting, abdominal pain and diarrhea with suspected dietary history and abnormal laboratory enzyme findings (GOT/GPT, CK/CKMB, LDH/LDH1 etc.). In SUD patients without gastric intestinal tract manifestations (n = 8 from 3 families), there were no clear symptoms before death and repeated ventricular tachycardia and ventricular fibrillation were recorded in one survivor. There was no clear evidence for the involvements of hereditary and infectious factors for observed SUD.</p><p><b>CONCLUSION</b>The reason for the unexpected sudden death clustered in 7 families in Yunnan remains unclear. Repeated syncope and fatigue served as the common clinical features in the presence or absence of gastric intestinal tract manifestations in all SUD cases. Further studies are needed to clarify the pathology and detailed clinical manifestations of SUD occurred in this area.</p>

Electrocardiogram analysis in high risk population of unexplained sudden death in Yunnan province / 中华心血管病杂志

<p><b>OBJECTIVE</b>The purpose of this study was to analyze the electrocardiographic features of the people living in the area with high incidence of unexplained sudden deaths in Yunnan province.</p><p><b>METHOD</b>The electrocardiograms of 338 residents from three villages (Dayao, Ninglang, Heqing) with high incidence of unexplained sudden deaths and one control village (Dali) were analyzed [averaged age was (33.4 +/- 11.7) years, 175 men and 163 women].</p><p><b>RESULTS</b>The incidence of cardiac arrhythmias was similar low in all groups. The left ventricular hypertrophy was observed in 34.6% of residents from Dayao. QTc significantly prolonged in the residents from all 3 high incidence areas compare the control area of Dali [control (386.8 +/- 27.22) ms, Ninglang (428.92 +/- 25.71) ms, Heqing (440.67 +/- 28.03) ms, Dayao (417.7 +/- 24.00) ms, P < 0.05 vs. control]. Incidence of U wave was significantly higher in Heqing village than that in control village (P < 0.05). The QUc of these 3 villages was: (613.67 +/- 37.34) ms, (597.19 +/- 46.47) ms, (608.59 +/- 39.59) ms respectively, and also significantly longer than the control village of Dali (589.33 +/- 41.27) ms (P < 0.05). The typical pattern of U wave presents as enlarged U wave and apparent T-U complex. In the 7 residents who have the family history of unexplained sudden death, 6 residents have U wave, and 4 of them present typical U wave pattern.</p><p><b>CONCLUSION</b>The significant ECG changes in villages with high incidence of unexplained sudden death in Yunnan province were prolonged QTc, enlarged U wave and apparent T-U complex and these ECG features suggested the repolarization abnormalities of the heart in these subjects.</p>