Feasibility of Left Bundle Branch Area Pacing Combined with Atrioventricular Node Ablation in Atrial Fibrillation Patients with Heart Failure.

BACKGROUND: Pacemaker implantation combined with atrioventricular node ablation (AVNA) could be a practical choice for atrial fibrillation (AF) patients with heart failure (HF). Left bundle branch area pacing (LBBaP) has been widely reported. OBJECTIVES: To explore the safety and efficacy of LBBaP combined with AVNA in AF patients with HF. METHODS AND RESULTS: Fifty-six AF patients with HF attempted LBBaP and AVNA from January 2019 to December 2020. Standard LBBaP was achieved in forty-six patients, and another ten received left ventricular septal pacing (LVSP). The cardiac function indexes and pacemaker parameters were evaluated at baseline, and we conducted a 1-month and 1-year follow-up. RESULT: At the time of implantation and 1-month and 1-year follow-up, QRS duration of LVSP group was longer than that of LBBaP group. The pacemaker parameters remained stable in both the LBBaP and LVSP groups. At 1-month and 1-year follow-up after LBBaP and AVNA, left ventricular ejection fraction, left ventricular end-diastolic diameter, and NYHA classification continued to improve. Baseline left ventricular ejection fraction and QRS duration change at implantation can predict the magnitude of improvement of left ventricular ejection fraction at 1-year after LBBaP. Baseline right atrial left-right diameter, the degree of tricuspid regurgitation, and interventricular septum thickness may be the factors affecting the success of LBBaP. CONCLUSION: LBBaP combined with AVNA is safe and effective for patients with AF and HF. Baseline right atrial left-right diameter, the degree of tricuspid regurgitation, and interventricular septum thickness may be the factors affecting the success of LBBaP.

Idiopathic Ventricular Arrhythmias Originating from Different Portions of the Coronary Venous System: Prevalence, Electrocardiographic Characteristics, Catheter Ablation, and Complications.

(1) Background: To determine the prevalence, electrocardiographic characteristics, mapping, and ablation of IVAs arising from the CVS. (2) Methods: Detailed activation and pace mapping of the CVS IVAs was performed before attempted radiofrequency ablation (RFCA). (3) Results: The IVAs originating from the vicinity of the CVS represented approximately 5.27% (164/3113) of all IVAs; 94.51% (155/164) cases were accessed at the earliest identified site and 83.54% (137/164) IVAs were successfully ablated. The main coronary vein group had a relatively short procedure time, short fluoroscopy time, fewer radiofrequency lesions prior to success, and less Swartz sheath support. IVAs originating from the CVS had distinct ECG characteristics: Rs, RS or rS (with s or S) wave in lead V1 indicate the Vas arising from the proximal portion of the anterior interventricular vein (AIV) and summit-CV; Rs (with s or S) wave in leads V5−V6 indicate the Vas arising from the adjacent regions of the distal great cardiac vein 1 (DGCV1); positive wave (R, Rs or r) In lead I indicate the VAs ori"inat'ng from Summit-CV and posterior wall subgroup (including middle cardiac vein [MCV], posterior lateral vein [PLV], coronary sinus [CS]). Compared with the IVAs originating from the endocardial mitral annulus, a PdW > 45 ms, an IDT > 74 ms, and an MDI > 0.50 indicate a CVS origin of the IVAs. The common peri-procedure complications were CV dissection (6.45%, 10/155), CV rupture (1.29%, 2/155), coronary artery spasm (1.29%, 2/155), coronary artery stenosis (0.65%, 1/155), pericardial effusion (0.65%, 1/155) and tamponade (1.29%, 2/155). Stenosis of coronary arteries was not observed at the adjacent ablation site in the CVS during follow-up. (4) Conclusions: vAs arising from the CVS are not a rare phenomenon. Several ECG and procedure characteristics could help regionalize, map, and ablate the origin of IVAs from different portions of the CVS. RFCA within the CVS was relatively effective and safe.

One-Year Recording of Cardiac Arrhythmias in a Non-Infected Population with Cardiac Implantable Devices During the COVID-19 Pandemic.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) was associated with a higher risk of arrhythmia in infected patients. However, there are no reports about the effect of the ongoing pandemic on arrhythmias in the non-infected population. We measured the arrhythmia burden in a non-infected population with cardiac implantable devices. METHODS: The arrhythmia burden during the COVID-19 pandemic was compared to a 6-month interval in the pre-COVID-19 period. The COVID-19 pandemic was divided into high-risk (17 January 2020 to 16 March 2020) and low-risk periods (17 March 2020 to 17 July 2020) according to whether there were locally infected patients. Arrhythmia burdens were compared among the pre-COVID-19, high-risk, and low-risk periods. RESULTS: A total of 219 patients with 1859 episodes were included. We observed a larger proportion of patients with atrial fibrillation (AF) during the COVID-19 pandemic (38.36% vs 26.03%, p = 0.006). There was not significantly more ventricular arrhythmia during the COVID period than the pre-COVID-19 period (p > 0.05). During the high-risk period, daily frequency of non-sustained ventricular tachycardia (NSVT) (0.0172, 0.0475 vs 0.0109, 0.0164, p < 0.05), atrial tachycardia (AT) (0.0345, 0.0518 vs 0.0164, 0.0219 p < 0.05) and AF (0.0345, 0.0432 vs 0.0164, 0.0186, p < 0.05) and daily duration of NSVT (0.1982, 0.2845 vs 0.0538, 0.1640 p < 0.05) were higher and longer than those in the pre-COVID-19 period. Regression modeling showed that the impact of COVID-19 pandemic lead to an increased onset of AF (odds ratio 2.465; p < 0.01). Patients with paroxysmal AF who had undergone a previous radiofrequency ablation had a lower burden of AF (incidence 21.43% vs 55.00%, P = 0.049, daily frequency 0.0000, 0.0027 vs 0.0000, 241.7978, P = 0.020) during the pandemic. CONCLUSION: The COVID-19 pandemic contributed to a higher burden of arrhythmias in non-infected patients. Patients would experience a lower burden of AF following radiofrequency ablation treatment, and this effect persisted during the pandemic.

Effect of pemetrexed on the efficacy, toxic reaction, and survival rate of patients with EGFR-TKI resistant moderate and advanced lung cancer.

OBJECTIVE: To explore the effect of pemetrexed on the efficacy, toxic reaction, and survival rate of patients with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) resistant moderate to advanced lung cancer. METHODS: A total of 86 patients with EGFR-TKI resistant moderate and advanced lung cancer in our hospital were divided by therapeutic drugs into a control group (39 patients) and pemetrexed group (47 patients). Differences in general data, clinical efficacy, immunoglobulin expression, tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) levels, tumor markers, toxic reaction, and survival rate between the two groups were analyzed. RESULTS: Similar expression levels of carcinoembryonic antigen, IL-6, carbohydrate antigen 125, TNF-α, carbohydrate antigen 153 and immunoglobulin were found in the control group and pemetrexed group before treatment (all P>0.05). Expression levels of the above indicators in all patients decreased one month after the end of treatment, and levels of immunoglobulin, inflammatory factors, and tumor markers in the control group were higher than those in the pemetrexed group (all P<0.05). Similar incidence rates of toxic reactions were shown in the two groups (P>0.05). Twelve months after the end of treatment, one-year survival rate was significantly higher in the pemetrexed group than in the control group (χ2=3.332, P=0.042). CONCLUSION: Pemetrexed can significantly improve the clinical efficacy in patients with EGFR-TKI resistant lung cancer, decrease the expression of inflammatory factors, tumor markers, and immunoglobulin in serum, has few side effects on the body, and prolongs the long-term survival rate.

Extracorporeal membrane oxygenation (ECMO) for acute exacerbations of chronic obstructive pulmonary disease: care modalities, experience, and precautions.

PURPOSE: The aim of this study was to summarize the care modalities, experiences, and corresponding precautions of ECMO for acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: Seventy-three patients with acute exacerbations of COPD were enrolled, of whom 38 were treated with ECMO (experimental group) and 35 received conventional low-flow oxygen therapy, management of metabolic acidosis, infection control, bronchodilators for quick relief from severe spasms, and glucocorticoid-mediated suppression of inflammation (control group). The improvement in the patient's pulmonary ventilation and the incidence of complications were recorded. RESULTS: PaCO2 is lower in patients using ECMO, FEV1, FEV1/FVC, and FEV1% are significantly higher in the experimental group than in the control group, and the respiratory rate, heart rate, and CO2 saturation are significantly lower in patients in the experimental group (i.e., the experimental group) after oxygenation than in the control group, pH and O2 saturation are significantly higher in experimental group than in the control group, and the incidence of complications in experimental group is significantly higher than in the control group. CONCLUSION: ECMO significantly improves gas exchange in patients, but also increases the incidence of complications with the extension of usage, so the duration of ECMO support should be monitored and the complications should be prevented.

Catheter Ablation of Ventricular Arrhythmias Originating From the Region of DGCV-AIV via a Swartz Sheath Support Approach.

Aims: This study aimed to investigate an appropriate catheter manipulation approach for ventricular arrhythmias (VAs) originating from the left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein (DGCV-AIV). Methods: A total of 123 patients with DGCV-AIV VAs were retrospectively analyzed. All these patients underwent routine mapping and ablation by conventional approach [Non-Swartz sheath support (NS) approach] firstly. In the situation of the distal portion of the coronary venous system (CVS) not being accessed or a good target site not being obtained, the Swartz sheath support (SS) approach was attempted alternatively. If this still failed, the hydrophilic coated guidewire and left coronary angiographic catheter-guided deep engagement of Swartz sheath in GCV to support ablation catheter was performed. Results: A total of 103 VAs (103/123, 83.74%) were successfully eliminated in DGCV-AIV. By NS approach, the tip of the catheter reached DGCV in 39.84% VAs (49/123), reached target sites in 35.87% VAs (44/123), and achieved successful ablation in 30.89% VAs (38/123), which was significantly lower than by SS approach (88.61% (70/79), 84.81 % (67/79), and 75.95% (60/79), P < 0.05). There were no significant differences in complication occurrence between the NS approach and the SS approach (4/123, 3.25% vs. 7/79, 8.86%, p > 0.05). The angle between DGCV and AIV <83° indicated an inaccessible AIV by catheter tip with a predictive value of 94.5%. Width/height of coronary venous system>0.69 more favored a SS approach with a predictive value of 87%. Conclusion: For radiofrequency catheter ablation (RFCA) of VAs arising from DGCV-AIV, the SS approach facilitates the catheter tip to achieve target sites and contributes to a successful ablation.