Catheter radiofrequency ablation for arrhythmias under the guidance of the Carto 3 three-dimensional mapping system in an operating room without digital subtraction angiography.

Several studies have reported the efficacy of a zero-fluoroscopy approach for catheter radiofrequency ablation of arrhythmias in a digital subtraction angiography (DSA) room. However, no reports are available on the ablation of arrhythmias in the absence of DSA in the operating room. To investigate the efficacy and safety of catheter radiofrequency ablation for arrhythmias under the guidance of a Carto 3 three-dimensional (3D) mapping system in an operating room without DSA. Patients were enrolled according to the type of arrhythmia. The Carto 3 mapping system was used to reconstruct heart models and guide the electrophysiologic examination, mapping, and ablation. The total procedure, reconstruction, electrophysiologic examination, and mapping times were recorded. Furthermore, immediate success rates and complications were also recorded. A total of 20 patients were enrolled, including 12 males. The average age was 51.3 ±â€Š17.2 (19-76) years. Nine cases of atrioventricular nodal re-entrant tachycardia, 7 cases of frequent ventricular premature contractions, 3 cases of Wolff-Parkinson-White syndrome, and 1 case of typical atrial flutter were included. All arrhythmias were successfully ablated. The procedure time was 127.0 ±â€Š21.0 (99-177) minutes, the reconstruction time was 6.5 ±â€Š2.9 (3-14) minutes, the electrophysiologic study time was 10.4 ±â€Š3.4 (6-20) minutes, and the mapping time was 11.7 ±â€Š8.3 (3-36) minutes. No complications occurred. Radiofrequency ablation of arrhythmias without DSA is effective and feasible under the guidance of the Carto 3 mapping system. However, the electrophysiology physician must have sufficient experience, and related emergency measures must be present to ensure safety.

[Impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction admitting to community hospitals without percutaneous coronary intervention capacity].

OBJECTIVE: To investigate the impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction (STEMI) admitting to community hospitals without percutaneous coronary intervention (PCI) capacity (Non-PCI hospital). METHODS: A regional collaborative network was developed, consisting of a PCI center and over 30 Non-PCI hospitals and connected by a tele-transmitted real-time 12-lead electrocardiogram system. This system enables the cardiologists on duty in PCI center to help the physicians in the Non-PCI hospitals (network hospital) to confirm the diagnosis and choose a reperfusion strategy for STEMI patients. All cardiologists in PCI center and physicians in Non-PCI hospitals were trained to follow the flowchart of reperfusion strategies for STEMI patients to shorten the reperfusion time. The mean time from door of Non-PCI hospital to needle of thrombolysis (D-to-N), the mean time from door of PCI center to balloon (D-to-B) and the mean time from the first medical contact to balloon (FMC-to-B) and the 1-year mortality were compared between the 20 months before and the 20 months after establishment of the regional collaborative network for patients with the first medical contact in three network hospitals. RESULTS: After establishment of the regional collaborative network, the mean D-to-N time was significantly shortened from (71 ± 62) min to (28 ± 9) min (P < 0.05), the rate of D-to-N below 30 min was increased from 11% (2/18) to 74% (26/35); the mean FMC-to-B and the mean D-to-B time were remarkably reduced in both complementary percutaneous coronary intervention and transfer percutaneous coronary intervention patients (all P < 0.05), the 1-year mortality post reperfusion was reduced from 15.1% (8/53) to 7.0% (10/142) (P < 0.05). CONCLUSION: The establishment of regional collaborative network could shorten the perfusion time and reduce the 1-year mortality for STEMI patients presenting to Non-PCI hospitals.

[Therapeutic effect of L-ornithine-L-aspartate on liver cirrhosis complicated by hepatic encephalopathy].

OBJECTIVE: To observe the therapeutic effects of L-ornithine-L-aspartate on liver cirrhosis complicated by hepatic encephalopathy. METHODS: Eighty-five patient with liver cirrhosis complicated by hepatic encephalopathy were divided into therapy group (n=45) and control group (n=40). Patients in the control group were treated with routine comprehensive therapy, and those in the therapy group received additional intravenous administration with 40 ml L-ornithine-L-aspartate in 250 ml 10% glucose and saline (once daily, 7 days for a treatment course). RESULTS: L-ornithine-L-aspartase significantly decreased blood ammonia and improved hepatic function (P<0.05 or 0.01). The therapeutic effects of therapy group was better than that of the control group (P<0.05), and no significant side effect was observed in L-ornithine-L-aspartate treatment. CONCLUSION: L-ornithine-L-aspartate is effective for hepatic encephalopathy and has not obvious side effect.