Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: a prospective randomized trial.

OBJECTIVE: To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation (AF). METHODS: Patients with permanent AF who had undergone prosthetic cardiac valve replacement, who had a cardiothoracic ratio ≤ 0.5 and a left atrial diameter ≤ 50 mm for ≥ 6 months after surgery were randomly divided to receive either electrical or pharmacological cardioversion. Patients in the electrical cardioversion group were given direct-current synchronized electrical defibrillation under general anaesthesia. Patients in the pharmacological cardioversion group were given oral combination therapy with amiodarone, captopril and simvastatin for 3 months. RESULTS: A total of 115 patients received either electrical cardioversion (n = 59) or pharmacological cardioversion (n = 56); reversion to sinus rhythm occurred in 98.3% and 26.8%, respectively. Recurrence rates were similar in the two groups (3.4% and 6.7% for electrical and pharmacological cardioversion, respectively). No deaths or severe complications were reported. CONCLUSION: Electrical cardioversion has a favourable safety profile and appears to be a more effective method than pharmacological cardioversion for the treatment of permanent AF after cardiac valve replacement, once the heart has returned close to its normal size.

[Circulating endothelial cell injury in on-pump and off-pump coronary-artery bypass grafting].

OBJECTIVE: To investigate the difference in circulating endothelial cell (CECs) injuries following on-pump and off-pump coronary-artery bypass surgery. METHODS: We randomly assigned 48 patients scheduled for urgent or elective coronary artery bypass grafting into two groups to receive on-pump and off-pump procedures. Blood samples were obtained before anesthesia, at the end of operation, and on days 1 and 3 after the operation, and CECs were isolated and counted using dynabeads coated with the specific antibody of CD146. Single cell gel electrophoresis was used to observe the morphological changes of the CECs. RESULTS: In the cardiopulmonary bypass (CPB) group, the number of CECs was significantly greater than that in non-CPB group (P<0.05) at the end of surgery and 1 day after the operation. On postoperative day 3, the number CECs was similar between the two groups (P>0.05). The length of the comet tail was longer in CPB group with stronger fluorescence intensity than in the non-CPB group. CONCLUSION: Compared with of-pump coronary artery bypass grafting, on-pump coronary artery bypass grafting results in more serious CEC injury, which is closely related to the prognosis.

High risk of sudden death associated with a PRKAG2-related familial Wolff-Parkinson-White syndrome.

Familial appearance of Wolff-Parkinson-White (WPW) syndrome is rare and displays an autosomal dominant inheritance. Here we report a Chinese kindred of WPW syndrome whose unique clinical features consist of a high risk of sudden cardiac death due to atrial fibrillation, causing a rapid antegrade conduct over the accessory pathway. The mutation in the PRKAG2 gene was identified as responsible for the familial form of WPW syndrome.

Transplantation of neonatal cardiomyocytes plus fibrin sealant restores myocardial function in a rat model of myocardial infarction.

BACKGROUND: Most cardiac regenerative approaches can restore injured heart muscles. In this study, we investigated if fibrin sealant could help neonatal cardiomyocytes restore myocardial function in a rat model of myocardial infarction. METHODS: The left anterior descending artery in adult female Sprague-Dawley (SD) rats was ligated to make a myocardial infarction model. Neonatal ventricular cardiomyocytes from one-day male SD rats were isolated, labeled and cultured. The cells were injected into the infarcted area three weeks later. The animals were randomized into four recipient groups: (1) cardiomyocytes plus fibrin sealant (group CF, n = 10); (2) cardiomyocytes alone (group C, n = 10); (3) fibrin sealant recipients alone (group F, n = 10); (4) control group (n = 10). Four weeks after transplantation, echocardiography and Langerdoff model were used to assess heart function. Immunohistochemical staining and polymerase chain reaction (PCR) were performed to track the implanted cardiomyocytes and detect the sex-determining region Y gene on Y chromosome. RESULTS: Echocardiography showed the fraction shortening (FS) in groups CF, C, F and control group was (27.80 +/- 6.32)%, (22.29 +/- 4.54)%, (19.24 +/- 6.29)% and (20.36 +/- 3.29)% respectively with statistically significant differences in group CF compared with the other groups (P < 0.05). The Langendoff model revealed that the left ventricular development of peak pressure (LVDPmax, mmHg) in groups CF, C, F and control group was 104.81 +/- 17.05, 80.97 +/- 21.60, 72.07 +/- 26.17 and 71.42 +/- 17.55 respectively with statistically significant differences in group CF compared with the other groups (P < 0.05). Pathological examination and PCR indicated that transplanted cardiomyocytes in group CF survived better than those in the other groups. CONCLUSION: Transplanted neonatal cardiomyocytes plus fibrin sealant can survive in myocardial infarctioned area and improve heart function greatly in rat models.