Heart rate control in chronic heart failure patients received cardiovascular implantable electronic device therapy: effects of optimized medication / 中华心血管病杂志

Objective@#To investigate the heart rate control situation of chronic heart failure (CHF) patients who received cardiovascular implantable electronic device (CIED) therapy, and to assess the heart rate control efficacy by optimized medication adjustment.@*Methods@#We performed a perspective study in heart failure with reduced left ventricular ejection fraction (HFrEF) patients who received CIED according to guideline recommendations, patients were enrolled from January 2012 to January 2017. Resting heart rate (RHR) recorded by electrocardiogram after 10 minutes' rest and medication usage within 1 month were recorded at baseline. RHR less than 70 beats per minute (bpm) was regarded as well controlled. β-receptor blockers and (or) ivabradine would be added in patients whose RHR were over 70 bpm. RHR after optimized medication adjustment was recorded during follow-up period.@*Results@#One hundred and fifty patients were included in this study with average RHR (80.6±11.9) bpm. RHR was<70 bpm in 27.3% (41/150) patients at baseline and β-receptor blockers was underused in 80.7% patients (88/109) whose RHR was>70 bpm. The overall RHR decreased to (73.1±10.4) bpm and percent of patients with RHR<70 bpm increased to 70.0% (105/150) after up-titration of β-receptor blockers compared to baseline (χ2=52.958, P<0.001). Ivabradine was added in the rest 45 patients and RHR was<70 bpm in 43 out of 45 patients after ivabradine use. The overall RHR decreased to (67.1±2.7) bpm and percent of RHR<70 bpm significantly increased to 98.7% (148/150) (χ2=44.504, P<0.001 vs. up-titration of β-receptor blockers only).@*Conclusion@#RHR in CHF patients who received CIED therapy is not ideally controlled in this patient cohort, individual up-titration ofβ-receptor blockers and ivabradine use may help to optimize RHR in these patients.

Influence of high frequency electrosurgical equipment application in cardiac impalntable elect ornic device implantation pro cedure on the rate of pocket hematoma / 中国介入心脏病学杂志

Objective To investigate the influence of high frequency electrosurgical equipment ( HFEE) application in cardiac implantable electronic device ( CIED) implantation procedure on the rate of pocket hematoma .Methods Patients who received CIED implantation in General Hospital of Shenyang Military Region were analyzed retrospectively .HFEE was applied during CIED implantation procedure in every patient who was classified into HFEE group .Other patients without HFEE application were classified as the control group . Patients with or without bleeding tendency were sub-classified into the bleeding tendency subgroup or non-bleeding tendency subgroup respectively .Bleeding tendency subgroup was further divided into heparin bridging group and direct implantation group .The occurance rate of CIED pocket hematoma was recorded in all groups .Results A total of 3884 patients were enrolled .There were 3115 patients in the HFEE group and 769 patients in the control group .The baseline data of two groups was similar.The overall rate of CIED pocket hematoma in the total patient population during perioperative period were 2.2%(86/3884), and the rate of long term pocket infection or rupture in patients with CIED pocket hematoma was 10.5%(9/8).In the HFEE group, the rate of pocket hematoma was lower than that in the control group (1.5%vs.5.2%, P<0.001).The rates of CIED pocket hematoma in respective subgroups in the HFEE group including the bleeding tendency subgroup ( 1.8% vs.11.5%, P=0.004 ) , the non-bleeding tendency subgroup ( 1.4% vs.4.7%, P<0.001 ) and the heparin bridging group ( 2.0% vs. 11.5%, P=0.046 ) were markedly decreased as compared with the corresponding subgroups in the control group.In the control group , the rate of CIED pocket hematoma in the bleeding tendency subgroup was higher than that in the non-bleeding tendency subgroup (11.5%vs.4.7%, P=0.0046).In HFEE group, there was no significant difference in the rate of CIED pocket hematoma between bleeding tendency subgroup and non-bleeding tendency subgroup; and there was also no significant difference in the rate of CIED pocket hematoma between the heparin bridging group and the direct implantation group .Conclusion Application of HFEE in CIED implantation procedure could reduce the incidence of pocket hematoma , and there was no significant difference in the incidence of pocket hematoma in patients with or without oral anticoagulation or antiplatelet agents.

Age, estimated glomerular filtration rate and ejection fraction score predicts contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease: insight from the TRACK-D study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The occurrence of contrast induced acute kidney injury (CIAKI) has a pronounced impact on morbidity and mortality. The aim of the present study was to appraise the diagnostic efficacy of age, estimated glomerular filtration rate (eGFR) and ejection fraction (AGEF) score (age/EF(%)+1 (if eGFR was <60 ml × min(-1)× 1.73 m(-2))) as an predictor of CIAKI in patients with diabetes mellitus (DM) and concomitant chronic kidney disease (CKD).</p><p><b>METHODS</b>The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography. CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl (44.2 mmol/L) or 25% above baseline at 72 hours after exposure to the contrast medium. Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles. The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic (ROC) analysis.</p><p><b>RESULTS</b>The AGEF score ranged from 0.49 to 3.09. The AGEF score tertiles were defined as follows: AGEFlow ≤ 0.92 (n = 1 006); 0.92 <AGEFmid ≤ 1.16 (n = 1 000), and ACEFhigh >1.16 (n = 992). The incidence of CIAKI was significantly different in patients with low, middle and high AGEF scores (AGEFlow = 1.1%, AGEFmid = 2.3% and AGEFhigh = 5.8%, P < 0.001). By multivariate analysis, AGEF score was an independent predictor of CIAKI (odds ratio = 4.96, 95% CI: 2.32-10.58, P < 0.01). ROC analysis showed that the area under the curve was 0.70 (95% CI: 0.648-0.753, P < 0.001).</p><p><b>CONCLUSION</b>The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography. (Clinical Trial identifier: NCT00786136).</p>

Exploration of Methods for Testing Effectiveness of Indoor Air Purifying Sets / 环境与健康杂志

[Objective] To explore more scientific and reasonable methods for testing the effectiveness of indoorair purifying sets, so as to obtain scientific and constant experimental data from every laboratories. [Methods] Theindoor air purifying sets were classified on the basis of their working mechanisms. Several kinds of current popularmethods for testing the purifying effectiveness and their characters were compared each other and analyzed. The in-fluencing factors and limited conditions of 3 determining models under special conditions established on the basis ofbalance model of pollutants release were explored and studied. [Results] Several current popular methods for testingthe purifying effectiveness were crude, which couldn't accurately reflact the purifying effectiveness of tested indoorair purifying sets. To ensure the experimental operation simple and strict and to obtain scientific testing data, the ex-perimental process should be controlled and transfered to a model suitable for simple volatile matter or other modelseasily operated under the control of its influencing factors. [Conclusion]The establishments of accurate testing meth-ods and accurate expressions of testing results were the sufficient and essential conditions for accurate evaluation ontesting objectives.

The mechanism and re-ablation of recurrent atrial arrhythmias after ablation of atrial fibrillation using electroanatomic mapping system and double LASSO technique / 中国介入心脏病学杂志

Objective To investigate the possible mechanism and re-ablation of recurrent atrial arrhythmias after atrial fibrillation(AF) ablation by utilizing the Carto system and double LASSO technique.Methods A total of 77 AF patients were enrolled and among them,56 with paroxysmal AF and 21 with persistent AF.Eight-F Swartz long sheaths were positioned in the left atrium by transseptal technique.One to two LASSO catheters were placed in the ipsilateral pulmonary veins(PV).The anatomy of the left atrium and PV was established using the Carto system.PV selective venography was carried out to identify the PV ostium.Continuous circular lesions(CCL) were made at the left atrium at 0.5 to 1.0 cm outside the PV ostium.Irrigated radiofrequecy energy was delivered in all the patients.The end point of the CCL was defined as absence of all PV spikes documented with LASSO catheters within the ipsilateral PVs.Results A repeat ablation was performed in 14 patients who experienced highly symptomatic atrial tachyarrhythmia.During the repeat procedures,conduction gaps in the previous CCL were found in 13 out of the 14 patients,and a typical atrial flutter was found in the other patient which was eliminated by ablation of the tricuspid isthmus.During the second procedure,pulmonary vein tachycardia was demonstrated in 7 patients.The pulmonary vein tachycardia activated the LA via the conduction gaps.All conduction gaps were successfully ablated by irrigated RF applications.After the second procedure,12 out of the 14 patients were free of AF during 3 to 30 months of follow-up.Conclusion Continuous circular lesions(CCL) in the left atrium utilizing the Carto system and double LASSO technique had a high success.In patients with recurrent atrial tachyarrhythmia after CCLs,recovered PV conduction is a main cause for the recurrence.

Effect of chronic atrial fibrillation on atrial tissue and atrial myocytes in humans / 解放军医学杂志

Objective To investigate the changes in atrial tissue and atrial myocytes as a result of chronic atrial fibrillation (AF) in humans. Methods Twenty patients with rheumatic heart disease were divided into chronic atrial fibrillation group (n=10) and non-fibrillation group (n=10). Tissue specimens harvested from the atrial appendage were studied with light and electron microscopy. Results The content of atrial connective tissue in the fibrillation group (26.7?7.2) was significantly higher than that in non-fibrillation group (12.4?5.9) (P

Relationship between intracellular calcium concentration of atrial myocytes and atrial fibrillation in humans / 解放军医学杂志

Objective To study the relationship between intracellular calcium concentration of atrial myocytes and atrial fibrillation (AF) in humans. Methods Atrial myocytes were isolated from right atrial appendages of rheumatic heart disease (RHD) patients with or without AF, and also isolated from that of congenital heart disease (CHD) patients with sinus rhythm. Intracellular Ca 2+ concentration was measured with the fluoresent Ca 2+ indicator Fluo-3 and laser scanning confocal microscopy. Results Intracellular Ca 2+ concentration of RHD patients with AF was significantly higher than that of non-AF RHD patients [(517?98) nmol/L vs (262?65) nmol/L, P