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Objective To analyze the clinical characteristics and follow-up data of catheter ablation of recurrent atrial tachycardias (ATs) after Mini-Maze surgery,and to explore prognostic factors for recurrence.Methods 59 patients in Guangdong General Hospital with ATs post Mini-Maze and concomitant open-heart surgery from April.2010 to June.2015 were included.According to high density precise mapping,activation mapping,voltage mapping and entrainment mapping,they underwent electrophysiological study and ablation which was guided by three-dimensional mapping system.All patients were followed up regularly.We explored the prognostic factors for recurrence by the Cox regression analysis.Results There were 88 types of ATs being mappedwith mean (1.49 ± 0.75) types of ATs identified per case.Most ATs were macro-reentry ATs(67/88,76.1％)and focal ATs (20/88,22.7％),respectively.56 patients (94.9％) achieved immediate ablation success.In a mean follow-up of (30.8 ± 17.7) months,recurrences were observed in 12 patients after the first time catheter ablation.Recurrent time was 3.5 (1.3,12.0) months and the overall ablation success rate was 74.6％ (44/59).6 patients received second ablation and the achievement of freedom from arrhythmias reached 79.7％ (47/59).Multivariate analysis showed that the LA diameter was the independent predictor for recurrence (HR 1.108,95％ CI 1.002 to 1.226,P =0.045).Conclusion Catheter ablation of ATs post Mini-Maze with concomitant surgery is save and feasible.LA diameter is the independent predictor for recurrence.
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<p><b>UNLABELLED</b>Objective To compare the impact of right ventricular apical (RVA) versus right ventricular outflow tract (RVOT) pacing on left ventricular systolic synchronization.</p><p><b>METHODS</b>Sixty patients were prospectively recruited and randomized into RVA group (n=30) with the right ventricle leads placed in the RVA and RVOT group (n=30) with right ventricle leads placed in the septum of the RVOT. Speckle tracking imaging was performed with 100% ventricle pacing to measure the differences in the time to maximum left ventricle (LV) radial strain.</p><p><b>RESULTS</b>In RVA group, the difference in the time to 6-segment maximum LV radial strain after pacing was 105.27 ± 19.74 ms, significantly greater than that in RVOT group (41.65 ± 12.17 ms, P<0.001). The standard difference of time to 6-segment maximum LV radial strain was also significantly greater in RVA group than in RVOT group (42.71 ± 17.63 vs 17.63 ± 5.62 ms, P<0.001).</p><p><b>CONCLUSION</b>Left ventricle systolic synchronizaition after RVOT pacing is superior to RVA pacing.</p>
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Humans , Cardiac Pacing, Artificial , Methods , Heart , Heart Ventricles , SystoleABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical effect of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death.</p><p><b>METHODS</b>According to ACC/AHA Guideline of ICD implantation (2005), 35 patients successfully received ICD/CRT-D implantation for primary prevention of sudden cardiac death in our hospital from January 2006 to December 2009. All the patients were followed up for a mean of 2 years.</p><p><b>RESULTS</b>During the follow up, 11 (31.43%) patients experienced ventricular arrhythmic episodes, for which 16 defibrillation therapies and 75 anti-tachycardia pacing (ATP) therapies were delivered without mistaken shock or death. The incidence rate of NVM was 100%, that of PVT was 66.67%, Brugada syndrome 50%, HCM 25% and DCM 16.67%. Of these episodes, the incidence of VF episodes among PVC patients was 87.5% (14 beats), ventricular tachycardia PVC was 82.28% (65 times), 5 beats in NVM patients, 4 beats in HCM and Brugada syndrome patients, and 1 beat in DCM patients. No ICD implantation-related complication was detected, and no ventricular tachycardia induced syncope occurred in these cases. All patients showed improved quality of life after the implantation.</p><p><b>CONCLUSION</b>ICD implantation can prevent malignant ventricular arrhythmia episodes, especially for PVT, NVM and Brugada syndrome in high risk SCD patients, demonstrating the value of implantation of ICD as a primary prevention in high-risk SCD patients.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Death, Sudden, Cardiac , Epidemiology , Defibrillators, Implantable , Primary PreventionABSTRACT
Objective To investigate the effects of p38 mitogen-activated protein kinase (MAPK) short hair RNA (shRNA) delivered by lentiviral vectors (pGLV) on cardiac function after myocardial infarction (MI) in aldosterone overload rats and to explore the mechanism.Methods Aldosterone overload rat myocardial infarction model was obtained by ligating the left anterior descending coronary artery.The pGLV-shRNA was constructed,sequenced and injected into rats via tail vein.Rats were divided into 3 groups:pGLV-shRNA group (n=6),pGLV-shRNA-NC group (n=6,contained a nonsense shRNA) and the sham-operation group (n=6).Cardiac function was measured by cardiac ultrasound.Apoptosis was assessed by transferase (TdT)-mediated biotin-16-dUTP nick-end labelling (TUNEL).The p38 MAPK mRNA expression was analyzed by RT-PCR.The protein expressions of p38 MAPK and caspase-3 were detected by Western blot.Results Compared with the sham-operation group,cardiac systolic function was reduced and myocardial apoptosis index was significantly increased [(31.26 ± 4.45) ％ vs.(15.20 ± 2.18) ％,P ＜ 0.01] in pGLV-shRNA-NC group.The mRNA and protien expressions of p38MAPK and caspase 3 protein expression were significantly increased in pGLV-shRNA-NC group (all P＜0.01).Compared with pGLV-shRNA-NC group,cardiac function was improved,myocardial cell apoptosis index was reduced [(22.35±3.59)％ vs.(31.26±4.45)％,P＜0.05],and the mRNA and protien expressions of p38MAPK and caspase 3 protein expression were decreased in pGLV-shRNA group (all P＜0.05).Conclusions Cardiac dysfunction is associated with p38MAPK-mediated myocardial apoptosis in aldosterone overload MI rats.pGLV-shRNA may inhibit cardiomyocyte apoptosis and improve postMI cardiac function.
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ATM: To explore the effect and mechanism on blood pressure and heart protection of renal hypertension in rats treated with ?_1 receptor antisense oligodeoxynucleotides (?_1-AS-ODN) by delivery with cationic liposomes DOTAP/DOPE. METHODS: 24 SD rats were divided randomly into 4 groups of 6 each group: two groups of 2K1C rats were treated via tail vein injection with ?_1-AS-ODN or inverted oligonucleotides against rat ?_1-AR mRNA (?_1-IN-ODN) of 0.5 mg?kg~(-1) once. 6 untreated 2K1C rats and shamed rats served as positive and normal controls. Blood pressure (BP), cardiac haemodynamics, and left ventricular index (LVW/BW) were measured. The histological changes of myocardium were observed by optical microscope and the expressions of Bcl-2 and Bax in myocardium were examined by immunohistochemical method. RESULTS: The single dose management of ?_1-AS-ODN decreased blood pressure to 120 mmHg for 27 days and improved the LV function obviously (P
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Objective To explore the inhibiting effect of valsartan and spironolactone on cardiac fibrosis and the expression of integrin ? 1 and fibronectin in the heart of spontaneously hypertensive rats. Methods Eighteen 6 week old SHR were randomly divided into 3 groups with 6 in each: SHR control group, valsartan treating group(30 mg?kg -1 ?d -1 ) and spironolactone treating group ( 20 mg?kg -1 ?d -1 ). Six homogenous male WKY rats served as normal group. After 14 weeks of treatment, systolic blood pressure, left ventricular mass, the ratio of left ventricular mass to body weight (LVM/BW), collagen volume fraction(CVF) and perivascular collagen area(PVCA) were determined and compared among these groups. The expression of integrin ? 1 and fibronectin were also examined by immunohistochemical method. Results Compared with the untreated SHR S, systolic blood pressure was significantly decreased in both treatment groups. LVM/BW〔(2 84?0 14)?10 -3 vs(3 22?0 15)?10 -3 〕, CVF〔(3 21?0 22)%vs(4 00?0 28)%〕, PVCA〔(0 62?0 15)%vs(0 94?0 56)%〕 were lower in both treatment groups, these parameters in SHR V group were even lower than those in SHR S group. Compared with the untreated SHR S, the expression of integrin ? 1 was significantly reduced in SHR V group, while the expression of fibronectin was markedly reduced in both treatment groups. Conclusions Both valsartan and spironolactone could control blood pressure, and effectively inhibit the cardiac fibrosis. Valsartan could also inhibit the expression of cardiac integrin ? 1 and fibronectin, which might be the reason that valsartan is better than spironolactone in inhibiting cardiac fibrosis.
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0.05),and that in valsartan group was higher than that in WKY group(P