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<p><b>OBJECTIVE</b>To investigate the impact of cardiac resynchronization therapy (CRT) on left ventricular systolic function evaluated by velocity vector imaging (VVI) in refractory heart failure patients and the predictive value of VVI on CRT responses.</p><p><b>METHODS</b>This study included 38 patients with medically refractory heart failure (HF) patients underwent CRT in our department from May 2007 to April 2011. Left ventricular long axis dyssynchrony indexes including time to peak of systolic velocity (Ts max-min), standard deviation of the time to peak of systolic velocity (Ts-SD) before and at 3-6 months post CRT. CRT response was defined as 15% decrease in left ventricular end-systolic volume. ROC curve and the area under the curve (AUC) were calculated.</p><p><b>RESULTS</b>Twenty-four patients were defined as responder. No significant difference was observed between responders and non-responders in medical therapy. When using Ts max-min to predict response, the AUC of ROC curves was 0.76 ± 0.07. The sensitivity and specifity was 70.8% and 77.8% respectively with Ts max-min ≥ 124.0 ms. When using Ts-SD to predict response, the AUC of ROC curves was 0.82 ± 0.07. The sensitivity and specifity was 79.2% and 71.2% respectively with Ts-SD ≥ 40.5.</p><p><b>CONCLUSION</b>Ts-SD is a useful index to predict CRT response in refractory HF patients.</p>
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Humanos , Área Sob a Curva , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Curva ROC , Volume Sistólico , Sístole , Função Ventricular EsquerdaRESUMO
Objective: To explore the guiding significance of transpulmonary thermodilution pulse-indicated continuous cardiac output (PiCCO) in treatment for patients with acute inferior wall myocardial infarction (AIMI). Methods: A total of 26 AIMI patients in intensive care unit of cardiology department in our hospital from Jul 2012 to Jan 2014 received PiCCO and ultrasonic cardiography (UCG) to monitor cardiac output (CO) and cardiac index (CI), and their correlation analysis. Results: When PiCCO placement and after placement 72h， PiCCO monitoring CI were （2.77±0.77）L•min-1•m-2, (3.17±0.39) L•min-1•m-2 respectively, there was significant difference（P＜0.01）, UCG measured CI were (2.49±0.64）L•min-1•m-2, (2.63±0.24) L•min-1•m-2, there was no significant difference（P＞0.05）; PiCCO monitoring CO were（4.78±1.06）L/min, (5.08±1.53) L/min respectively, there was significant difference（P＜0.05）, UCG measured CO were（4.51± 0.86）L/min, (4.57±0.91) L/min, there was no significant difference（P＞0.05）; and CI，CO measured by PiCCO were significantly higher than those of UCG group (P＜0.01 both) after PiCCO placement 72h. Conclusion: Pulse-indicated continuous cardiac output can offer more sensitive hemodynamic indexes compared with UCG, which possesses important treatment guiding significance in patients with acute inferior wall myocardial infarction and unstable hemodynamics.
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Objective To investigate the effect of a step-wise diversified teaching mode on cardiac electrophysiology (EP) education. Methods 64 young doctors (male:36, female:28) who studied in EP sub-specialty were enrolled. The atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) were selected as teaching content. All the doctors were randomly divided into traditional teaching group (TT) and step-wise diversified teaching group (DT) according to cross-over design protocol. In TT group, only teaching and answering the questions by teachers were given to students, for the DT group, in different stages of teaching, multiple teach-ing strategy were combined to complete teaching. T test and Chi square test were used to compare the effect of two teaching methods. Results There was no difference of basic features and time of self-studying between the two groups. In examinations, the students in DT group got higher score than TT group[DT:(92.3±9.8) and (93.1±7.8),TT:(88.3±8.6) and (87.1±10.0),P<0.05], and had better perfor-mance of learning interest, initiative, ability of finding and resolving problems, teamwork spirit and so on. Conclusion The step-wise diversified teaching mode contributes improving the quality of instruction of cardiac EP, moreover, arousing learning interest and initiative, enhancing ability of find-ing and resolving problems, teamwork spirit and so on, which is worthy of wide-popularizing in cardiac EP training.
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BackgroundPocket hematoma is one of the major complications associated with cardiovascular implantable electronic devices (CIEDs) implantation. The aim of this study is to evaluate the impact of body mass index (BMI) on the occurrence of pocket hematoma after CIEDs implantation.MethodsThe study is a retrospective review of 972 patients receiving CIEDs implantation between 2008 and 2012 in a tertiary hospital.ResultsTwenty two patients (2.2%) developed severe pocket hematoma requiring re-intervention. The hematoma rate (4.6%,n = 15) of patients with a BMI of < 23 kg/m2 was significantly higher compared with that of patients with a BMI of≥23 kg/m2 (1.1%, n = 7,P< 0.001). In multivariate regression analysis, a BMI < 23.0 kg/m2 may be associated with the development of severe pocket hema-toma. An increase of 1.0 kg/m2 in BMI was associated with lower incidence of hematoma formation (OR: 0.84; 95% CI: 0.74-0.95;P = 0.006).ConclusionBMI < 23 kg/m2 was associated with a higher incidence of pocket hematoma, requiring re-intervention. The data sup-port that great care must be taken when patients were with a lower BMI received CIEDs implantation.
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Objective: To analyze the current condition and inlfuencing factors for clinical compliance in patients with permanent pacemaker implantation and to improve the follow-up condition in relevant patients. Methods: A total of 817 patients with permanent pacemaker implantation in our hospital from 2006-01 to 2013-01 were retrospectively studied. The clinical compliance condition and inlfuencing factors were accessed for 1 year period. Results: There were 26/817 (3.18%) patients lost contact and 1 patient died. A total of 790 (96.7%) patients finished the followed-up study by 2 groups: Clinical visit group,n=440 (55.70%) and Telephone visit group,n=350 (44.30%). The education level, medical cost, residency, comprehension of arrhythmia and accompany personnel were different between 2 groups,P<0.05. The patients were with high school education or above, reimbursed medical cost, local residency, comprehension of arrhythmia and accompany personnel had the higher clinical visit rate. The overall 1 year occurrence rate of complication was 1.8% without severe event. There were 59.5% of patients optimized the pacemaker parameters during clinical visit. Conclusion: The patients with permanent pacemaker implantation had the lower rate of clinical follow-up visit which should be improved in several issues.
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AIM: To determine the effect of exogenous phosphocreatine (PCr) at different concentrations on transient outward potassium (Ito) current in rat ischemic ventricular mid-myocardial (M) cells and to explore the antiarrhythmia mechanism in the treatment of ischemic heart disease. METHODS: M cells were isolated enzymatically from left ventricular mid-myocardium of rats. Peak Ito current was recorded by patch-clamp technique in the whole-cell configuration when M cells were superfused with normal Tyrode solution,simple ischemic solution,and simulated ischemic solution containing PCr at concentrations of 5,10,20 and 30 mmol/L for 10 min. RESULTS: Peak Ito current density of M cells superfused with simple simulated ischemic solution was significantly reduced by (76.1±6.3)% (P0.05). CONCLUSION: PCr reverses the inhibition of Ito current under ischemic condition in M cells,which may be the mechanism responsible for arrhythmia prevention in ischemic heart disease. PCr at concentrations of 0～10 mmol/L exerts significant dose-effect relationship.
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ObjectiveTo observe the therapeutic effect of radiofrequency catheter ablation for idiopathic left ventricular tachycardia.To explore the relationship between surface electrocardiography and successful radiofrequency ablation location. MethodsThe electrophysiological data of surface electrocardiography and radiofrequency ablation,and the data of Holter in postorperation after 24 h and a half months,and tracking follow-up of 30 patients (23 males and 7 females)with idiopathic left ventricular tachycardia onset were retrospectively analyzed. ResultsRadiofrequency catheter ablation was successful in 29 patients(96.7%).The Holter was conducted in 29patients before and after the operation,the difference in average beats/24h before the operation(20 997 ± 10 786)and after the operation(921 ± 1 337)was statistically significant(P＜0.01).During the period of 1 to 3 months follow-up,2 patients relapsed and were all successfully re-ablated.No complication was found.The ventricular tachycardia lesions in left ventricular septum were found in 21 patients,of which 19 cases were located in a quadrant axis (-75.83 ± 19.36)°(-30 °～-90 °),and those in the left ventricular apex were in 9 cases,of which 7 cases were in the 2 quadrant axis(-102.6 ± 5.93)°(-91 °～-110 °). ConclusionRadiofrequency catheter ablation was an effeetive treatment technique for idiopathic left ventricular tachycardia with high successful rate,it could be selected as the first line treatment in patients with idiopathic left ventricular tachycardia.During idiopathic left ventricular tachycardia onset,the surface electrocardiography could help determine the initial site of ventricular tachycardia.
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<p><b>OBJECTIVE</b>Wolff-Parkinson-White syndrome (WPW) is considered to be an autosomal dominant hereditary disease, but the gene is not identified. The objective of this study was to localize the genetic loci of Wolff-Parkinson-White syndrome.</p><p><b>METHODS</b>Linkage analysis between the disease of Wolff-Parkinson-White syndrome and 3 STR (short tandem repeats) markers on 7q3 (D7S505, D7S688, and D7S483) was tested in 3 kindreds of the Wolff-Parkinson-White syndrome (101 numbers in total) by genotyping.</p><p><b>RESULTS</b>Wolff-Parkinson-White syndrome was linked to the loci above. The maximum two-point Lod score detected at D7S505 was 6.4 at a recombination fraction (theta) of 0.1; the Lod score of D7S688, D7S483 was 5.3 vs 2.5.</p><p><b>CONCLUSION</b>The gene of Wolff-Parkinson-White syndrome is located at 7q3.</p>
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Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mapeamento Cromossômico , Cromossomos Humanos Par 7 , Marcadores Genéticos , Sequências de Repetição em Tandem , Síndrome de Wolff-Parkinson-White , GenéticaRESUMO
Objective To investigate the effects of L-carnitine(L-CN)on electrophysiological changes induced by atrial ischemia in dogs.Methods Twelve dogs were divided into normal saline(NS)group and L-CN group.Atrial ischemia was induced by ligation of an atrial arterial branch of right coronary artery.Atrial effective refractory period(AERP)and conduction velocity(CV)of right atrium were measured before and after 3 hour's coronary artery ligation.Atrial wavelength(WL)and inducibility of atrial fibrillation(AF)were calculated.Histological examination was performed.Results (1)AERP and WL shortened dramatically after ligation of coronary artery in NS group;they showed no remarkable change in L-CN group.(2)There was no significant change of CV in the two groups.(3)AF was induced in 0 of 12 dogs under basic condition.(3)After ligation of the right coronary artery,AF was induced in all of the 6 dogs in NS group and 0 of 6 dogs in L-CN group.(5)Histological examination revealed that the ischemic changes occurred only in NS group.Conclusion Electrophysiological changes induced by atrial ischemia could be prevented by infusion of L-CN.
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Objectives To evaluate the safety of intravenous amiodarone in patients with atrial fibrillation and rapid ventricular response via an accessory pathway. Methods Sixteen patients with Wolff Parkinson White syndrome (W P W group) and 16 patients with concealed accessory pathway (control group) were included. The anterograde effective refractory period of accessory pathway (ERP AP ) in W P W group and the effective refractory period of atrioventricular node (ERP AVN ) in control group were measured. Then 150mg of amiodarone was injected intravenously in 10min, the ERP AP and ERP AVN were remeasured 10min later. Results After amiodarone injection, ERP AP was increased slightly ( P