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.

Improvement of continuous subcutaneous insulin infusion on patients with type 2 diabetes mellitus by 3-dimensional speckle tracking echocardiography.

Three-dimensional speckle tracking echocardiography (3D-STE) was used to evaluate the improvement of continuous subcutaneous insulin infusion on the left ventricular (LV) systolic function of patients with type 2 diabetes mellitu (T2DM). We recruited T2DM patients (38 cases, diabetic group) and healthy volunteers (35 cases, control group) to collect LV full volume imaging. TomTec software was used for calculating LV global longitudinal strain (LVGLS), global circumferential strain (LVGCS), peak twist (LVTW), peak apical rotation (LVPAR), ejection fraction (LVEF), and torsion (LVT). All indices were re-tested 2 weeks later after intensive treatment of insulin pump. LVGLS, LVGCS, LVTW and LVPAR in diabetic group were significantly decreased than control group. LVGLS and LVGCS in pre-treatment diabetic group were significantly increased than post-treatment. LVGLS, LVGCS, LVTW and LVPAR had correlations among control, pre-treatment and post-treatment diabetic groups. There were no significant differences in LVEDV, LVESV, LVEF, LVT and R-R. LV systolic function of patients with T2DM complicated with microangiopathy was improved after treatment of continuous subcutaneous insulin infusion. In addition, therapeutic effect could be accurately evaluated by 3D-STE which had vital clinical application.

[Transabdominal ultrasound measurement of intravesical prostatic protrusion helps diagnosis of benign prostatic obstruction].

OBJECTIVE: To evaluate the measurement of intravesical prostatic protrusion (IPP) by transabdominal ultrasonography (TAUS) in the diagnosis of benign prostatic obstruction (BPO). METHODS: We studied the clinical data of 109 BPH patients referred for lower urinary tract symptoms (LUTS) from April 2005 to December 2006. IPP was measured by TAUS, urodynamic parameters such as Qmax and PdetQmax obtained by urodynamic studies and AG values calculated. The patients were divided into an obstruction and a non-obstruction group according to their AG values. RESULTS: IPP was found statistically different between the obstruction and non-obstruction groups (P<0.001) and positively correlated with the AG value (r=0.729, P=0.001). With the cutoff at IPP > or = 10 mm for the diagnosis of BPO, the sensitivity, specificity and accuracy of the diagnosis were 89.9%, 97.5% and 92.7%, respectively. CONCLUSION: The measurement of IPP by TAUS offers a valuable help for the diagnosis of BPO.

[Efficacy of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture technique].

OBJECTIVE: To investigate the clinical effects and safety of the technique of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture. METHODS: Eighty patients scheduled for elective operation were randomly divided into 2 equal groups to undergo axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture technique (Group U) or nerve stimulator-guided brachial plexus blocking (Group N). The main branches of brachial plexus (radial, median, ulnar, and musculocutaneous nerves) were localized by ultrasound-guided or nerve stimulator-guided techniques. In Group U 8 ml of mixed anesthetic solution containing isovolumetric 0.75% ropivacaine and 2% lidocaine was injected into the 4 main branches of brachial plexus, with a total volume of 32 ml. The ultrasonic manifestations of the brachial plexus and its surrounding tissues were observed. The values of diameter and depth of the 4 nerves and the distance of the musculocutaneous nerve to the midpoint of axillary artery were measured. The manipulation time, onset time, maintaining time, efficacy of blocking, and incidence of complication were recorded. RESULTS: The manipulation time of Group U was 5.2 +/- 2.1 min, significantly shorter than that of Group N (14.6 +/- 3.2 min, P = 0.000), The onset times of the median, radial, and ulnar nerves of Group U were 3.3 +/- 1.9 min, 3.0 +/- 1.7 min, and 3.4 +/- 1.9 min respectively, all significantly shorter than those of Group N (4.6 +/- 2.0 min, 7.3 +/- 7.4 min, and 6.4 +/- 6.1 min respectively, P < 0.01 or P < 0.05). The anesthetic success rate of Group U was 100%, significantly higher than that of Group N (77.5%, P = 0.005). The rate of accidental puncture to blood vessel of Group U was 0, significantly lower than that of Group N (40%, P = 0.000). CONCLUSION: With significantly higher anesthetic success rate, shorter manipulation time and onset time, and lower complication rate, the technique of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture is a safe and reliable blocking method in comparison with the nerve stimulator-guided method.