Postprocedural Outcomes and Risk Factors for Arrhythmias Following Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect: A Single-center Retrospective Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Currently, transcatheter closure of perimembranous ventricular septal defect (pmVSD) is a widely accepted therapeutic modality. However, arrhythmias, especially postprocedural heart blocks, are a concern and outcomes are not very clear. This study explored the outcomes and risk factors of arrhythmias associated with transcatheter device closure of pmVSD.</p><p><b>METHODS</b>A total of 395 patients diagnosed with pmVSD who successfully underwent transcatheter intervention between January 2010 and December 2015 in our center were retrospectively reviewed. Electrocardiographic data before and after the procedure were collected and analyzed. We first evaluated the potential risk factors including gender, age, weight, inlet and outlet diameters of defect, subaortic rim length, occluder size, corrected occluder size into body surface area, fluoroscopy time, presence of aneurysm, and deployment position. We compared the potential risk factors between arrhythmia and nonarrhythmia groups using univariate analysis, followed by logistic analysis for independent risk factors.</p><p><b>RESULTS</b>Various arrhythmias were detected in 95 cases (24.1%) following transcatheter closure procedure. Logistic regression analysis revealed that eccentric (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.2-7.2) and large occluders (OR 2.0, 95% CI: 1.6-2.5), as well as long fluoroscopy time (OR 1.1, 95% CI: 1.1-1.2), were correlated with postprocedural arrhythmia. During 35.5 months (range: 9-80 months) of follow-up, most of the patients (74 out of 95) reverted to normal heart rhythm.</p><p><b>CONCLUSIONS</b>The mid-term outcome of patients with arrhythmias after transcatheter closure of pmVSD was satisfactory as most of the patients recovered normal rhythm. Eccentric, large device and long fluoroscopy time increase the risk of arrhythmias after transcatheter closure of pmVSD.</p>

Clinical analysis of radiofrequency transcatheter ablation for treatment of tachyarrhythmia in 261 children / 中华实用儿科临床杂志

Objective To investigate the efficacy and safety of radiofrequency catheter ablation(RFCA) treatment for children with tachyarrhythmia of various types.Methods Two hundred and sixty-one cases with tachyarrhythmia who received RFCA at Shandong Provincial Hospital Affiliated to Shandong University from Aug.2000 to Dec.2012 were selected.All electrocardiogram(ECG) and echocardiography data were obtained.All of the 261 patients underwent electrophysiological study and RFCA.The clinical data of the pediatric patients with tachyarrhythmia after RFCA in Shandong Provincial Hospital Affiliated to Shandong University were retrospectively analyzed and the curative effect and the complication rate of RFCA treatment for children with tachyarrhythmia of various types were investigated.Results (1)Among the 261 cases,4 cases had tachyarrhythmia associated with tachycardia induced cardiomyopathy,and 1 case had tachycardia associated with heart failure.(2)One hundred and forty-six cases had atrioventricular reentrant tachycardia(AVRT) ;74 cases had atrioventricular nodal reentrant tachycardia(AVNRT) ;32 cases had idiopathic ventricular tachycardia(IVT) ;6 cases had atrial tachycardia(AT) ;and 3 cases had atrial flutter(AF).Ten children with tachyarrhythmia associated with organic heart disease received RFCA successfully.(3) The average operation time was (101.23 ±51.37) minutes and the average X-ray exposure time was(21.85 ± 17.10) minutes.(4)The total successful rate of RFCA was 98.08％ (256/261 cases),1 case(0.38％) suffered from pneumothorax after operation,and recovered after treatment.There was no serious complications nor deaths of all the patients.(5) Twenty-two cases recurred,and the total recurrence rate was 8.43％ (22/261 cases),time to relapse was 3 days to 5 years,and the average time was 7 months.There were 9 cases in IVT(9/32 cases,28.13％),7 cases in AVRT(7/146 cases,4.79％),4 cases in AVNRT(4/74 cases,5.41％),2 cases in AT(2/6 cases,33.33％).Eighteen cases received successful RFCA for second time,and 4 cases had good effect after drug control.Conclusions (1) RFCA in pediatric patients of tachyarrhythmia is relatively convenient,and this therapy can be performed safely and effectively that can cure certain tachyarrhythmia.(2) AVRT is the common type of tachyarrhythmia in children,followed by AVNRT,IVT,AT and AF.(3) The total recurrence rate of RFCA in children is low,but is relatively high in IVT and AT.(4) The success rate of RFCA is the same in children combined organic heart disease.

Mechanism of conditioned immune response in curing bronchial asthma in mice / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand the mechanism of effect of conditioned immune response in curing bronchial asthma.</p><p><b>METHODS</b>An experimental asthma modal was produced on healthy BALB/C mice (female, 4 - 6 weeks old) by sensitization and stimulation with ovalbumin (OV A). Totally 105 mice were divided into 7 groups randomly with 15 in each and treated differently: in group CIR(1), noise was used as conditioned stimulus (CS) and budesonide and salbutamol as unconditioned stimulus (UCS) respectively, a conditioned immune response model of mice with asthma was established by the combination of CS and UCS 7 times (7 days), then the mice were given CS only, and the combination were given once a week for 20 weeks. In group CIR(2) saccharin (SAC) was taken as CS, and the other treatments were the same as the group CIR(1). In the group of conventional therapy, the mice were given inhalation of nebulized budesonide and salbutamol only for 20 weeks. In the group of lower dose conventional therapy, the mice were given nebulized inhalation of budesonide and salbutamol for the first 7 days, then once a week for 20 weeks. In the noise group the mice were given noise only everyday for 20 weeks. In SAC group the mice were treated with SAC only everyday for 20 weeks. In the blank control group the mice were treated with placebo for 20 weeks. The mice in all the groups were stimulated with OVA once a day. The mice in the healthy control group were given PBS inhalation for 20 weeks. After 20 weeks therapy, the bronchoalveolar lavage fluid (BALF) was taken for eosinophils (EOS) counting. The spleens were taken to obtain CD4(+)T lymphocytes and the expression of neuronal acetylcholine receptor alpha 7 (nAChRalpha7), IL-4, IFN-gamma and IL-17 were detected by flow cytometry.</p><p><b>RESULTS</b>(1) The percent of EOS of groups CIR(1), CIR(2), conventional therapy and healthy control was much lower than that of blank control (P < 0.01), and there was no significant difference among groups CIR(1), CIR(2) and conventional therapy (P > 0.05). (2) The expression of nAChRalpha7, IL-4 and IL-17 of groups CIR(1), CIR(2), conventional therapy and healthy control was much lower than that in blank control group, IFN-gamma was much higher (P < 0.01), and no significant difference was found among groups CIR(1), CIR(2) and conventional therapy (P > 0.05). There was a positive correlation between nAChRalpha7 and IL-4 (r = 0.76, P < 0.01), nAChRalpha7 and IL-17 (r = 0.46, P < 0.01). There was a negative correlation between nAChRalpha7 and IFN-gamma (r = 0.69, P < 0.01). (3) In the groups treated with lower dose of conventional therapy, noise, SAC and blank control, the epithelial tissue of airway were much thicker, the lumens were much narrower, and inflammatory cells and collagen fibers were much more than in the healthy control group, and after therapy, the inflammation in groups CIR(1), CIR(2) and conventional therapy was significantly improved.</p><p><b>CONCLUSION</b>The conditioned immune response models established by both noise and SAC as CS and budesonide and salbutamol as UCS can downregulate nAChRalpha7 on CD4(+)T lymphocytes, regulate the function of CD4(+)T lymphocytes, and achieve the same therapeutic efficacy in treatment of asthma.</p>