Network Meta-analysis of randomized controlled trials of Chinese patent medicine for bradyarrhythmia / 中国中药杂志

To assess the clinical efficacy of Chinese patent medicine for bradyarrhythmia(BA) by using network Meta-analysis method. Relevant randomized controlled trials(RCTs) of Chinese patent medicine for BA were retrieved from China National Knowledge Infrastructure(CNKI), WanFang Database, VIP database, SinoMed, PubMed and Cochrane Library. The retrieval time ranged from the commencement of each database to February 2019. We completed the literature screening and data extraction according to the pre-determined inclusion and exclusion criteria. The quality of inclusion studies was assessed using the bias risk assessment tool recommended by the Cochrane Handbook of Systematic Review 5.3. The data were analyzed by WinBUGS, and STATA software was used for plotting. Finally, 46 RCTs were included, involving 4 Chinese patent medicines and 3 306 patients. According to the network Meta-analysis, the total effective rate in alleviating BA symptoms had 7 direct comparisons and 3 indirect comparisons. The efficacy of the 4 Chinese patent medicines combined with routine therapy was superior to that of routine therapy, with statistically significant differences. The order of the four Chinese patent medicines by efficacy was as follows: Shenxian Shengmai Oral Liquid>Shensong Yangxin Capsules>Xinbao Pills>Ningxinbao Capsules. The average heart rate had 7 direct comparisons and 3 indirect comparisons. The efficacy of Shenxian Shengmai Oral Liquid and Shensong Yangxin Capsules combined with routine therapy was superior to that of routine therapy, with statistically significant differences. The order of the four Chinese patent medicines by efficacy was as follows: Shenxian Shengmai Oral Liquid>Shensong Yangxin Capsules>Xinbao Pills>Ningxinbao Capsules. The results showed that the Chinese patent medicines combined with routine therapy were effective in the treatment of BA. Due to the differences in the quantity and quality of the included studies on different Chinese patent medicines, the sequencing results of Chinese patent medicines need to be further verified.

A pilot study comparing two sites for incision during pacemaker implantation and their influence on the scar

Objective There are two most common incisions that are used during most pacemaker implantation procedures, with the first type of incision being inferior and parallel to the clavicle (Group C) and the second type of incision along the deltopectoral groove (Group D). We evaluated the scars resulting from the two types of incision to objectively evaluate the degree of superiority in cosmetic outcomes, between these two types of incisions. Methods Seventy-six patients who underwent left pre-pectoral pacemaker insertion were evaluated, close to 6 months after the date of the pacemaker implantation, using a simple scoring system based on atrophy, contour and colour of the scar. The likelihood of reduced severity in scar scores were compared between the two groups and the number of patients with elevation or inversion of the scar and with keloid formation were quantified. Results Seventy-six patients, with 47 belonging to the ‘Group C’ and 29 belonging to the ‘Group D’ were evaluated. The average length (C: 25 ± 2 mm; D: 24 ± 3 mm) and thickness (C: 25 ± 3 mm; D: 26 ± 2 mm) of the scars were not significantly different. The mean cumulative total scores in ‘Group C’ (1.98 ± 1.50) and ‘Group D’ (1.93 ± 1.31) were comparable. The odds ratio (OR) estimate showed that outcomes for atrophy (OR:0.73), contour (OR:0.53) and the cumulative total scores (OR:0.72) were also comparable. Conclusion This pilot study showed that the deltopectoral groove incision as a site of incision is comparable to the infraclavicular incision.

Bloqueo auriculoventricular fetal completo: enfoque diagnóstico y terapéutico. Reporte de caso en Bogotá, Colombia, y revisión de la literatura / Complete foetal atrioventricular block: diagnostic and therapeutic approach. Case report in Bogotá, Colombia, and review of the literature

RESUMEN Objetivo: reportar un caso de bloqueo auriculoventricular completo congénito y realizar una revisión de la literatura del diagnóstico y tratamiento. Materiales y métodos: se reporta el caso de una gestante de 27 años quien consulta a un hospital general de alto nivel de complejidad, con un embarazo de 33 semanas, con feto único, con diagnóstico de bloqueo auriculoventricular completo y cardiomiopatía dilatada secundaria. Se inició manejo prenatal con betamimético con pobre respuesta, por lo cual fue necesario finalizar el embarazo. El recién nacido requiere implantación de marcapasos ventricular en el primer día de vida con excelentes resultados en el seguimiento a un año. Se realiza revisión de la literatura publicada en las bases de datos: Medline vía PubMed, Lilacs y SciELO mediante los términos: "fetal complete atrioventricular block", "congenital complete heart block", con límites de año de 2000 a 2016, en español e inglés. Resultados: se obtuvieron 21 publicaciones; siete reportes de caso, diez revisiones de literatura, cuatro estudios de cohorte. El diagnóstico se basa en la ecocardiografía fetal para determinar el intervalo PR, la relación auriculoventricular y la detección de anomalías intracardiacas, entre las que se encuentran: regurgitación valvular, hiperecogenicidad miocárdica/valvular-fibroelastosis endocárdica, contracciones atriales prematuras y efusión pericárdica. Respecto al tratamiento prenatal, los medicamentos más utilizados son los corticoesteroides y los betamiméticos. El tratamiento de la bradiarritimia severa refractaria neonatal puede requerir la implantación de un marcapaso como manejo definitivo. Conclusión: el bloqueo AV congénito de tercer grado requiere diagnóstico temprano y tratamiento oportuno, ya que se acompaña de alta morbimortalidad perinatal. Se requieren estudios con mayor calidad metodológica que permitan avalar otras opciones y esquemas terapéuticos prometedores.

ABSTRACT Objective: To report a case of complete congenital atrioventricular block and to review the literature on diagnosis and treatment. Materials and methods: Case report of a 27-year-old pregnant woman who came to a high complexity general hospital with a 33-week singleton gestation and a diagnosis of complete atrioventricular block and secondary dilated cardiomyopathy. Response to initial prenatal management with beta-mimetic therapy was poor, and the woman had to be taken to Cesarean section. The newborn required implantation of a ventricular pacemaker on the first day of life, with excellent results at 1-year follow-up. A review of the literature published in Medline, Lilacs and SciELO databases was conducted using the terms "foetal complete atrioventricular block", "congenital complete heart block," limited to articles published between 2000 and 2016 in Spanish and English. Results: Overall, 21 publications were retrieved: seven case reports, ten reviews of the literatura and four cohort studies. Diagnosis is based on the foetal echocardiographic scan to determine the PR interval and the atrioventricular ratio, and to detect intracardiac abnormalities, including valvular regurgitation, myocardial/valvular hyperechogenicity, endocardial fibroelastosis, premature atrial contractions, and pericardial effusion. In terms of prenatal treatment, corticosteroids and beta-mimetics are the most widely used medications. Treatment of severe neonatal refractory bradyarrhythmia may require pacemaker implantation as definitive management. Conclusion: Congenital third-degree AV bock requires early diagnosis and timely treatment, because associated perinatal morbidity and mortality are high. Studies with better methodological quality are needed in order to endorse other promising therapeutic options and approaches.

Therapeutic Observation of Acupoint Application plus Chinese Herbal Medicine for Bradyarrhythmias Due to Yang Deficiency and Blood Stagnation / 上海针灸杂志

Objective To observe the clinical efficacy of acupoint application plus intake of Chinese herbal medication in treating bradyarrhythmias due to yang deficiency and blood stagnation.Method A total of 110 patients with bradyarrhythmias due to yang deficiency and blood stagnation were randomized into a treatment group and a control group, 55 cases each. The treatment group was intervened by acupoint application at Neiguan (PC 6), Danzhong (CV 17) and Geshu (BL 17) plus Chinese herbal medication, while the control group was treated with oral administration of Theophylline sustained-release tablets. The treatment was given once a day, 2 weeks as a treatment course. The dynamic electrocardiogram (ECG) was observed before the treatment and after 2 treatment courses, and the clinical efficacies were compared between the two groups.Result The total effective rate regarding the Chinese medicine syndromes and signs was 94.5% in the treatment group versus 83.6% in the control group, and the difference was statistically significant (P0.05). The average and lowest heart rates were significantly changed after the treatment in both groups (P<0.05). After the treatment, the average and lowest heart rates in the treatment group were significantly different from those in the control group (P<0.05).Conclusion Acupoint application plus intake of Chinese herbal medication can effectively boost the heart rate of patients with bradyarrhythmias, and improve the discomforts.

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences.

Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

Application of cardiac pacemaker in laparoscopic cholecystectomy—an analysis of 215 cases / 中华消化内镜杂志

ObjectiveTo evaluate the influence of electrotome on permanent and temporary cardiac pacemaker in laparoscopic cholecystectomy ( LC),and the application of cardiac pacemaker to the cases of cholecystolithiasis combined with bradyarrhythmia.MethodsClinical data of 215 patients with permanent or temporary cardiac pacemaker who underwent were studied for the preoperative and postoperative variation of pacemaker function,and for the influence of electricity coagulation during the operation on cardiac pacemaker function.ResultsLC was successfully completed in all 215 patients.The function of cardiac pacemaker was not obviously interfered during the operation,and the parameters of cardiac pacemaker did not remarkably change after the operation.ConclusionCardiac pacemaker is slightly interfered when electrotome and electrocoagulation were used in LC; LC is feasible and safe for patients with bradyarrhythmia by placement of cardiac pacemaker.

Anti-bradyarrhythmia Efficacy of Cilostazol:An Experimental Study / 中国药房

OBJECTIVE:To study the effect and mechanism of cilostazol in experimental anti-bradyarrhythmia.MET-HODS:Bradyarrhythmia model of mice was induced using verapamil hydrochloride and nicotine,respectively.The electrocardiograms at different time and the heart rates of the model mice after intragastric administration of different dosages of cilostazol were recorded.The in vivo His' bundle electrogram(HBE)recordings in rabbits were obtained after intragastric administration of different dosage of cilostazol for detection of A-H interval and H-V interval,which were compared with control group(normal saline group).RESULTS:Verapamil hydrochloride and nicotine markedly slowed down the heart rates of mice,but cilostazol significantly sped up the heart rates in mice(P

Prevalence of sleep-disordered breathing in elderly patients with cardiac pacemaker: a case-control study / 老年心脏病学杂志（英文版）

Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients' sleep apnea-hypopnea index.Methods Forty-four elderly patients (＞60 years) with cardiac pacemaker and their 44 controls matched for gender, age, body mass index and cardiovascular morbidity were studied using polysomnography or portable sleep monitoring device. Results Prevalence of sleep-disordered breathing (apnea-hypopnea index ≥5/h) was 44.7% and the mean apnea-hypopnea index was 8.2 ±4.1/h in the cardiac pacemaker group, which were significantly higher than those in control subjects (25% and 4.6±2.4/h, respectively, P＜0.01 and P＜0.05). The mean apnea-hypopnea index of patients with DDD or AAI pacemaker was significantly lower than that of patients with VVI pacemaker. Conclusions Sleep-disordered breathing was more common in patients who had their cardiac pacemaker implanted due to bradyarrhythmias than in their matched controls. Compared with VVI pacing, DDD or AAI pacing may be more beneficial to patients with bradyarrhythmias and sleep-disordered breathing.

Application of temporary cardiac pacemaker in perioperative period of laparoscopic cholecystectomy / 中国微创外科杂志

Objective To evaluate the safety of temporary cardiac pacemaker during perioperative period of laparoscopic cholecystectomy (LC) in patients with bradyarrhythmia. Methods Temporary cardiac pacemakers were installed preoperatively in 34 elderly patients with bradyarrhythmia for LC. On operation the ultrasonic harmonic scalpel, instead of electrotome, was used to perform dissection and coagulation. Results LC was completed successfully in all the 34 patients without surgery-related complications or perioperative serious cardiovascular diseases. Conclusions Utilization of temporary cardiac pacemaker and ultrasonic harmonic scalpel may considerably enhance the perioperative safety and reduce the incidence of cardiovascular complications in elderly patients with bradyarrhythmia.

Indications of Temporary Cardiac Pacing during Perioperative Period of Non-Cardiac Operations / 中国微创外科杂志

Objective To evaluate the indications of temporary cardiac pacing during perioperative period of non-cardiac operations.Methods Temporary cardiac pacemakers were installed preoperatively in 102 patients with bradyarrhythmia.The patients were divided into paced and no-paced groups according to the ECG monitoring during perioperative period.Clinical data were compared between the two groups.Results Totally 37 patients needed pacing during perioperative period.They were older than the no-paced patients [(61?17)y vs(52?14)y,t=2.885,P=0.005].In the paced group,more patients had history of myocardial infarction [54%(20/37)vs 14%(9/65),?2=18.733,P=0.000],cardiomyopathy [8%(3/37)vs 0%(0/65),P=0.045],and syncope [11%(4/37)vs 0%(0/65),P=0.030],abnormal findings in Holter [97%(36/37)vs 48%(31/65),?2=25.741,P=0.000] and UCG [97%(36/37)vs 45%(29/65),?2=26.076,P=0.000].Conclusions Temporary cardiac pacemaker can enhance the perioperative safety and reduce the incidence of cardiovascular complications in patients with bradyarrhythmia.Overall assessments of clinical setting were needed before implantation.The indications for temporary cardiac pacing include bradyarrhythmia with myocardium disorder,which is confirmed by UCG,advanced age,as well as history of syncope.Positive result of atropine test is not one of the significant indications.