Progress of clinical research in arrhythmias and pacing 2023 / 中国介入心脏病学杂志

Reviewing important clinical trials in the field of arrhythmia in 2023,involving atrial fibrillation,pacing,and other aspects.Both the CIRDA-DOSE study and the EARLY-AF study affirmed the efficacy of cryoballoon ablation in treating atrial fibrillation,alter its progression to persistent atrial fibrillation.The MANIFEST-PF study examined the success rate and safety of pulse field ablation in atrial fibrillation,and the ADVENT study also confirmed its safety and effectiveness not inferior to conventional thermal ablation.In the LBBAP study,LBBAP reduced the occurrence of sustained VT/VF and new-onset atrial fibrillation compared to BVP.For patients with a high right ventricular pacing burden and reduced ejection fraction in pacemakers or ICDs,the BUDAPEST CRT upgrade study affirmed the benefits of upgrading to CRT-D.The DANPACE Ⅱ study showed that minimizing atrial pacing in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation.The IDE study demonstrated the safety of Aveir DR dual-chamber leadless pacemaker at 3 months post-operation,providing reliable atrial pacing and atrioventricular synchrony.The iSUSI study is a registry study of subcutaneous implantable cardioverter-defibrillators,finding similar inappropriate and appropriate shock rates in patients with and without heart failure.

Feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers for patients with infective endocarditis after lead removal and before permanent pacemaker implantation / 中华心血管病杂志

Objective: To analyze the feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers (AFLEP) for patients with infective endocarditis after lead removal and before permanent pacemaker implantation. Methods: A total of 44 pacemaker-dependent patients, who underwent lead removal due to infective endocarditis in our center from January 2015 to January 2020, were included. According to AFLEP or temporary pacemaker option during the transition period, patients were divided into AFLEP group or temporary pacemaker group. Information including age, sex, comorbidities, indications and types of cardial implantable electionic device (CIED) implantation, lead age, duration of temporary pacemaker or AFLEP use, and perioperative complications were collected through Haitai Medical Record System. The incidence of pacemaker perception, abnormal pacing function, lead perforation, lead dislocation, lead vegetation, cardiac tamponade, pulmonary embolism, death and newly infection of implanted pacemaker were compared between the two groups. Pneumothorax, hematoma and the incidence of deep vein thrombosis were also analyzed. Results: Among the 44 patients, 24 were in the AFLEP group and 20 in the temporary pacemaker group. Age was younger in the AFLEP group than in the temporary pacemaker group (57.5(45.5, 66.0) years vs. 67.0(57.3, 71.8) years, P=0.023). Male, prevalence of hypertension, diabetes mellitus, chronic renal dysfunction and old myocardial infarction were similar between the two groups (all P>0.05). Lead duration was 11.0(8.0,13.0) years in the AFLEP group and 8.5(7.0,13.0) years in the temporary pacemaker group(P=0.292). Lead vegetation diameter was (8.2±2.4)mm in the AFLEP group and (9.1±3.0)mm in the temporary pacemaker group. Lead removal was successful in all patients. The follow-up time in the AFLEP group was 23.0(20.5, 25.5) months, and the temporary pacemaker group was 17.0(14.5, 18.5) months. In the temporary pacemaker group, there were 2 cases (10.0%) of lead dislocation, 2 cases (10.0%) of sensory dysfunction, 2 cases (10.0%) of pacing dysfunction, and 2 cases (10.0%) of death. In the AFLEP group, there were 2 cases of abnormal pacing function, which improved after adjusting the output voltage of the pacemaker, there was no lead dislocation, abnormal perception and death. Femoral vein access was used in 8 patients (40.0%) in the temporary pacemaker group, and 4 patients developed lower extremity deep venous thrombosis. There was no deep venous thrombosis in the AFLEP group. The transition treatment time was significantly longer in the AFLEP group than in the temporary pacemaker group (19.5(16.0, 25.8) days vs. 14.0(12.0, 16.8) days, P=0.001). During the follow-up period, there were no reinfections with newly implanted pacemakers in the AFLEP group, and reinfection occurred in 2 patients (10.0%) in the temporary pacemaker group. Conclusions: Bridge therapy with AFLEP for patients with infective endocarditis after lead removal and before permanent pacemaker implantation is feasible and safe. Compared with temporary pacemaker, AFLEP is safer in the implantation process and more stable with lower lead dislocation rate, less sensory and pacing dysfunction.

Comparison of efficacy and safety of temporary pacing using active-fixation rersus traditional leads after extraction of infected leads / 中国介入心脏病学杂志

Objective To evaluate the efficacy and safety of the new active-fitation right ventricular lead temporary-permanent pacemaker (TPPM) rersus the traditional temporary transvenous pacing system .Methods Between January 2011 and June 2013, 234 patients had their infected leads removed at our center. A total of 105 (44.9%) patients were pacemaker dependent. Thirty-five patients underwent TPPM implantation and 70 patients had implanted with traditional temporary transvenous pacing system. For traditional temporary pacing, the quadrupole catheter was implanted into the right ventricle through the femoral vein to connect the temporary pacemaker. In TPPM, an active-fixation electrode was implanted into the right ventricular septum through the subclavian and internal jugular veins to connect to the reused permanent pacemaker. parameters from the pacemakers,time for the procedure,the occurance of complications and rates of infection and mortality during the 2 years of follow up were compared between the 2 groups. Results There were more patients with infectious endocarditis in the TPPM group than in the traditional temporary pacing group(22.9% vs. 5.7%,P=0.019). Therefore,the electrode retention time in the TPPM group was longer[2(2,7)d vs.2(2,3)d,P=0.032]and the hospital stay was slightly prolonged[15(14,21)d vs.17(15,25)d,P=0.05]compared with the traditional temporary pacing group.The pacing threshold in the TPPM group was lower than that in the traditional temporary pacing group[(0.7±0.2)V vs.(1.0±0.3)V, P=0.035)].There was no difference in X-ray exposure time between the groups[(24.7±15.4)min vs.(27.5±17.7)min,P=0.242].There were no complications related to bridging in the TPPM group, but 11 patients in the traditional temporary pacing group had developed complications (P=0.009). Conclusions TPPM is effective and safer as compared to traditional temporary pacing for pacemaker-dependent patients with device infection. The operation time does not increase in patients with TPPM implantation.

Population characteristics and impact on heart rate variability, heart rate and blood pressure of passive smoking / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the basic characteristics of passive smoking population, and the impact of passive smoking on heart rate variability, heart rate and blood pressure.</p><p><b>METHODS</b>Eighty-six passive smokers [mean age: (52.4 ± 7.6) years] were recruited from patients and their relatives who visited cardiovascular outpatient department and excluded structural heart disease between June 2010 and June 2012, 80 normal subjects who were not exposed to smoking served as controls. Questionnaire survey, 24 hours ambulatory electrocardiogram examination and blood pressure measurement were performed in all recruited subjects.</p><p><b>RESULTS</b>(1) Non-marriage rate [18.60% (16/86) vs. 3.75% (3/80), P < 0.01] was significantly higher while education level were significantly lower in passive smoking group than in control group. Passive smokers were more likely service industry workers [29.07% (25/86) vs. 15.00% (12/80), P < 0.05] and had longer daily working time [(7.56 ± 1.24) h vs. (6.02 ± 0.96) h, P < 0.01], and were less likely to be professional technology industry employers [20.93% (18/86) vs. 36.25% (29/80), P < 0.05] and managers [13.95% (12/86) vs. 38.75% (31/80), P < 0.01] compared to controls. The main place of passive smoking was workplace (67.44%, 58/86), entertainment venues (63.95%,55/86), restaurants (48.84%, 42/86). (2) Standard of the normal sinus RR intervals (SDNN), the normal consecutive sinus RR interval difference between the root-mean-square (rMSSD) and adjacent the difference between the RR interval>50 ms the number of share the percentage (PNN50) were significantly lower in passive smoking group than in the control group (all P < 0.05). Every 5 min average of the standard deviation of sinus RR cycle (SDNN index) and 24 h every 5 min sinus RR interval mean standard deviation (SDANN) were similar between the 2 groups (all P > 0.05). Ultra-low-frequency power (VLF), low frequency power (LF), high frequency power (HF) and LF/HF were significantly lower in passive smoking group than in the control group (all P < 0.01). (3) Heart rate and diastolic blood pressure were significantly higher in passive smoking group than in control group (all P < 0.05) while systolic blood pressure was similar between the 2 groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Marriage status, education level, profession and daily working time are independent determinants for passive smoking. Passive smoking mainly occurred in the workplace, entertainment venues and restaurants. Passive smoking is linked with reduced heart rate variability, increased 24 h average heart rate and diastolic blood pressure.</p>

A novel deletion-frameshift mutation in the S1 region of HERG gene in a Chinese family with long QT syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The congenital Long QT syndrome (LQTS) is a hereditary cardiac channelopathy that is characterized by a prolonged QT interval, syncope, ventricular arrhythmias, and sudden death. The chromosome 7-linked type 2 congenital LQTS (LQT2) is caused by gene mutations in the human ether-a-go-go-related gene (HERG).</p><p><b>METHODS</b>A Chinese family diagnosed with LQTS were screened for KCNQ1, HERG and SCN5A, using polymerase chain reaction (PCR), direct sequencing, and clong sequencing. We also investigated the mRNA expression of the HERG gene.</p><p><b>RESULTS</b>We identified a novel I414fs + 98X mutation in the HERG gene. The deletion mutation of 14-bp in the first transmembrane segment (S1) introduced premature termination codons (PTCs) at the end of exon 6. This mutation would result in a serious phenotype if the truncated proteins co-assembled with normal subunit to form the defective channels. But only the proband was symptomatic.</p><p><b>CONCLUSIONS</b>We found that the mRNA level of the HERG gene was significantly lower in I414fs + 98X carriers than in noncarriers. We found a novel I414fs + 98X mutation. The mRNA level supports that NMD mechanism might regulate the novel mutation.</p>

Re-evaluation of transvenous lead extraction with modified standard technique: a prospective study in 229 patients / 华中科技大学学报（医学）（英德文版）

As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients (median, 66 years) who underwent lead extraction due to infection and lead malfunction were registered and followed up prospectively with respect to clinical features, reasons for lead extraction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted transvenously by using special tools from 229 patients (male, 72.1%). Vegetations ≥1 cm were detected in six patients. Locking Stylets were applied for 398 (90.5%) leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 (45.9%) leads due to lead adhesion, and the mean implant duration of the 202 leads was longer than the other 238 leads (48.9±22.6 vs. 26.6±17.8 months; P <0.01). In addition, modified isolation and snare techniques were used for 56 leads (12.7%). Minor and major procedure-related complications occurred in three (1.3%) and four (1.7%) cases respectively, including one death (0.4%). Severe lead residue occurred in one case. Complete procedural success rate was 96.1% (423/440), and clinical success rate was 98.9% (435/440). The median follow-up period was 18 (1-76) months. No infection- and procedure-related death occurred in our series. Our data demonstrated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.

Types and risk factors of arrhythmia on young patients with acute coronary syndrome in Henan province / 中华心血管病杂志

<p><b>OBJECTIVE</b>The types and risk factors of arrhythmia were analyzed on acute coronary syndrome (ACS) patients under the age of 44 years who were hospitalized in Henan province between September 2009 to June 2012.</p><p><b>METHODS</b>Medical records of eligible patients were obtained from the information system of the First Affiliated Hospital of Zhengzhou University teleconsultation information center. Middle aged and elderly ACS patients who were hospitalized at the same period served as controls. Data on arrhythmia types, blood pressure, thyroid disease, respiratory sleep apnea syndrome, smoking history, history of alcohol consumption, eating habits, family history of early-onset arrhythmia, laboratory tests were analyzed.</p><p><b>RESULTS</b>(1) Arrhythmia was detected in 110 out of young ACS patients (55%), which was significantly lower than that in the elderly ACS patients (71.05%, P < 0.01). (2) The top three arrhythmias in young ACS patients were: sinus tachycardia (30.50%), the premature ventricular contractions (19.00%), atrial flutter/atrial fibrillation (16.50%). Incidence of sinus tachycardia, atrial flutter/atrial fibrillation were significantly higher while incidence of ventricular tachycardia, ventricular fibrillation, paroxysmal supraventricular tachycardia were significantly lower in young ACS patients than in middle-aged ACS patients (all P < 0.05). The incidence of sinus tachycardia was higher while incidence of ventricular premature accelerated ventricular spontaneous cardiac rhythm, ventricular tachycardia, ventricular fibrillation, non-paroxysmal supraventricular tachycardia, atrial flutter/atrial fibrillation, paroxysmal supraventricular tachycardia, sinus bradycardia, nodal escape, atrioventricular block were significantly lower in young ACS patients than in elderly ACS patients (all P < 0.05). (3) Body mass index, incidence of smoking, coronary three-vessel disease, drinking, eating salty foods, thyroid dysfunction, sleep apnea were significantly higher in youth ACS patients with arrhythmia than in young ACS patients without arrhythmia (all P < 0. 05). (4) Logistic regression analysis found that number of diseased coronary vessels (OR = 24.293), smoking (OR = 1.112) and alcohol consumption (OR = 1.039) were independent risk factor for developing arrhythmia in young ACS patients from Henan province.</p><p><b>CONCLUSIONS</b>The main types of arrhythmia are sinus tachycardia, premature ventricular contractions, atrial flutter/atrial fibrillation and the major risk factors related to the arrhythmia are number of diseased coronary vessels, smoking and alcohol consumption in young ACS patients from Henan province.</p>

Re-evaluation of transvenous lead extraction with modified standard technique: A prospective study in 229 patients / 华中科技大学学报（医学）（英德文版）

As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients (median, 66 years) who underwent lead extraction due to infection and lead malfunction were registered and followed up prospectively with respect to clinical features, reasons for lead extraction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted transvenously by using special tools from 229 patients (male, 72.1%). Vegetations ≥1 cm were detected in six patients. Locking Stylets were applied for 398 (90.5%) leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 (45.9%) leads due to lead adhesion, and the mean implant duration of the 202 leads was longer than the other 238 leads (48.9±22.6 vs. 26.6±17.8 months; P <0.01). In addition, modified isolation and snare techniques were used for 56 leads (12.7%). Minor and major procedure-related complications occurred in three (1.3%) and four (1.7%) cases respectively, including one death (0.4%). Severe lead residue occurred in one case. Complete procedural success rate was 96.1% (423/440), and clinical success rate was 98.9% (435/440). The median follow-up period was 18 (1-76) months. No infection- and procedure-related death occurred in our series. Our data demonstrated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.

Effect of the smoking cessation services in the out-patient department for patients with coronary heart disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effects and clinical prognosis of out-patient department-based smoking cessation services for coronary heart disease (CHD) patients.</p><p><b>METHODS</b>A total of 140 smoking patients diagnosed with coronary heart disease in our cardiovascular department were randomly divided into the intensive smoking cessation clinic follow-up group (intervention group, patients were informed on the importance and methods to quit smoking at the first visit and reminded for that at months interval for 6 months, n = 70) and the conventional treatment group (control group, n = 70). After 6 months, the smoking status, cardiovascular event rates, drug usage, out-patient medical costs and quality of life were compared between the two groups.</p><p><b>RESULTS</b>Age, gender, concomitant diseases, drug usage were similar between the two groups at baseline (all P > 0.05). After 6 months, smoking quit rate [34.2% (24/70) vs. 5.7% (4/70), P < 0.01], drug use rates: lipid-lowering drugs [95.3% (67/70) vs. 80.4% (56/70)], β blockers [82.4% (57/70) vs. 41.3% (28/70)], and ACEI/ARB [61.4% (43/70) vs. 34.4% (24/70)] were significantly higher in the intervention group than in the control group, while total cardiovascular event rates [21.4% (15/70) vs. 47.1% (33/70), P < 0.01] and out-patient medical costs (3789.3 RMB vs. 4984.2 RMB, P < 0.01) were significantly lower in the intervention group than in the control group. The quality of life scores derived from MYO health survey questionnaire was significantly higher in the intervention group than in the control group (P < 0.01). The top three reasons responsible for continuous smoking for all patients failed to quit smoking were: (1) others smoked more than me and still alive and healthy [90.3% (56/62)]; (2) smoking helped me to keep relaxed and reduce trouble in daily work and life [70.9% (44/62)]; (3) smoking was essential while chatting and drinking with friends [66.1% (41/62)]. The overall satisfactory rate to this smoking cessation program was 42.8% and the satisfactory rate was up to 50.0% by patients.</p><p><b>CONCLUSIONS</b>Intensive outpatient smoking cessation follow-up program can significantly improve the smoking cessation rates, the guideline drug use rate and the quality of life while reduce medical costs for coronary heart disease patients.</p>

Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques.</p><p><b>METHODS</b>Of 200 patients referred for lead extraction from January 2007 to June 2011, 24 (12.0%) involved CS leads (24 CS leads). We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction.</p><p><b>RESULTS</b>Complete procedural success was achieved in 23 patients (95.8%), and the clinical success in 24 patients (100.0%). The leading indication for CS lead extraction was infection (66.7%). Mean implant duration was (29.5 ± 20.2) months (range, 3 - 78 months). Sixteen CS leads (66.6%) were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads (16.7%), which had longer implant duration than other leads ((62.5 ± 12.3) vs. (22.9 ± 14.1) months, P < 0.05). Another 4 CS (16.7%) leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes (range, 3 - 61 minutes) per CS lead, which had significant correlation with implant duration (r = 0.8, P < 0.001). Sixteen patients (66.6%) were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months (range, 8 - 61 months), three patients died due to sudden cardiac death (26 months), heart failure (45 and 57 months, respectively).</p><p><b>CONCLUSION</b>The modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.</p>

Diagnostic value of DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery / 中华神经医学杂志

Objective To investigate the diagnostic value of aortocranial DSA in collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotid artery. Methods Twenty-three elderly patients with serious stenosis or occlusion of the internal carotid artery, admitted to our hospital from August 2008 to July 2010, were chosen; their DSA findings and prognoses were retrospectively analyzed. Results Of these 23 patients, the collateral circulation was seen in 18(78.3%), including compensations from anterior communicating artery (n=16), posterior communicating artery (n=6), anterior together with posterior communicating artery (n=3), anterior choroidal artery (n=5),meningina artery between anterior cerebral artery and posterior cerebral artery (n=5), meningina artery between posterior cerebral artery and middle cerebral artery (n=4), ophthalmic artery (n=15), blood vessel between posterior cerebral artery and superior cerebellar artery (n=3), and blood vessel among superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery (n=2); after conservative treatment and long time follow-up (1 to 22 months with a mean of 11.2 moths),disappearance of clinical symptoms and no recurrence were found in these 18 patients. Five patients were noted without compensatory collateral circulation: the 2 paralysis patients could not take care of themselves even with the improvement of myodynamia from grade 0 to grade Ⅲ; the 2 patients with disturbance of consciousness showed no recovery and died from lung infection; the left 1 patient was having aphasia. Conclusion DSA can accurately define ways and compensative ability of collateral circulation in elderly patients with serious stenosis or occlusion of the internal carotidartery, which can put forward reliable evidences for their treatments and prognoses.

Coronary characteristics of young smokers with coronary heart disease and the effects of tobacco control on smoking cessation / 中华心血管病杂志

<p><b>OBJECTIVE</b>Coronary features of young smokers and non-smokers with coronary heart disease were compared and the effect of tobacco control education was analyzed.</p><p><b>METHODS</b>A total of 160 young patients (14 - 35 years old) diagnosed with coronary heart disease by coronary angiography were included in this study, patients were followed up for 3 months. There were 118 smokers and 42 non-smokers, smokers were further divided to psychological counseling intervention group (68 cases) and control group (50 cases), non-smokers were also divided into psychological counseling intervention group (22 cases) and control group (20 cases).</p><p><b>RESULTS</b>Incidence of single-vessel lesion (50.84% vs. 66.67%) was significantly lower, acute coronary syndrome (75.42% vs. 50.00%), double-vessel lesions (24.58% vs. 19.05%), three-vessel lesions (11.86% vs. 4.74%) as well as coronary artery ectasias (12.71% vs. 9.52%) was significantly higher in smokers than in non-smokers. Gensini scores (61.94 ± 40.35 vs. 45.08 ± 28.97) was significantly higher in smokers than in non-smokers (all P < 0.05). At the end 3-months follow up, smoking cessation rate was significantly higher in psychological counseling intervention group than in control group (61.76% vs. 30.00%, P < 0.05). New smokers was zero in psychological counseling intervention group and 1 in control group among previous non-smokers.</p><p><b>CONCLUSION</b>Smoking is linked with severe coronary artery lesion in young patients with coronary heart disease and psychological counseling intervention could significantly increase the short-term successful smoking cessation rate in these patients.</p>

Electrophysiological characterization and efficacy of radiofrequency ablation of focal atrial tachycardia originating from the left atrial appendage / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the electrophysiological characteristics and efficacy of radiofrequency catheter ablation (RFA) of focal atrial tachycardia (AT) originating from the left atrial appendage (LAA).</p><p><b>METHODS</b>Electrophysiologic study and RFA were performed in 9 patients (4 female) with focal AT originating from the LAA. Atrial appendage angiography was performed to identify the origin of AT. P waves were classified as negative, positive, isoelectric, or biphasic.</p><p><b>RESULTS</b>The mean age was (21 +/- 9) years. AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing. A characteristic P-wave morphology and endocardial activation pattern were observed. Positive P-wave in inferior leads was seen in all patients, upright or biphasic (+/-) component P wave was observed in lead V1, isoelectric component or an upright component P wave with low amplitude ( < 0.1 mV) was seen in lead V2-V6. Earliest endocardial activity occurred at the distal coronary sinus (CS) in all patients. The earliest endocardial activation at the successful RFA site occurred (36.7 +/- 7.9) ms before the onset of P wave. RFA was successful in all 9 patients immediately post procedure. AT reoccurred in 2 patients within 1 month post RFA and AT disappeared post the 2nd-RFA. AT reoccurred in 1 patient and terminated after the 3rd RFA. At the final follow-up (12 +/ 5) months, all 9 patients were free of arrhythmias without antiarrhythmic drugs.</p><p><b>CONCLUSIONS</b>The LAA is an uncommon site of origin for focal AT. The characteristic P wave and activation timing are suggestive for focal AT originating from the LAA. LAA focal ablation is safe and effective for patients with focal AT originating from the LAA.</p>

Assessment of left ventricular systolic synchronicity by quantitative tissue velocity imaging in patients with left ventricular noncompaction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess left ventricular systolic synchronicity by quantitative tissue velocity imaging (QTVI) in patients with left ventricular noncompaction (LVNC).</p><p><b>METHODS</b>Eighteen LVNC patients and 30 healthy controls were included. Two-dimensional echocardiography, QTVI was applied on parasternal long axis view, apical two-chamber and four-chamber view. Tissue velocity curve was obtained from the middle and basal segments of left ventricular posterior, lateral, septal, anterior, inferior and anteroseptal walls. Time interval from the beginning of QRS complex to the peak systolic velocity (Q-Ts) and the maximal difference in Ts among all 12 LV segments (Max-DeltaTs) was calculated.</p><p><b>RESULTS</b>Q-Ts from basal and middle segments of left ventricular inferior, lateral and posterior walls was significantly prolonged in LVNC patients compared to controls (P < 0.001). Max-DeltaTs was also significantly increased in LVNC patients [(161.9 +/- 93.2) ms] than that in controls [(61.2 +/- 27.4) ms, P < 0.001].</p><p><b>CONCLUSIONS</b>There was significant left ventricular asynchronies in patients with LVNC and delayed systolic contraction occurred mostly in the basal and middle segments of left ventricular inferior, posterior and lateral walls.</p>

Clinical characteristics and treatment of a Chinese family with congenital short QT syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the clinical characteristics and therapeutic efficacy of a Chinese family with congenital short QT Syndrome (SQTs).</p><p><b>METHODS</b>Fourteen family members including the proband were screened with routine clinical examination, serum electrolyte, serum myocardial enzymes, electrocardiography (ECG), Holter recording, treadmill exercise test, echocardiography and chest radiograph. High risk patient received intracardiac electrophysiological study (EPS).</p><p><b>RESULTS</b>Among the fourteen family members, 4 members died of sudden cardiac death at young ages, 4 members including the proband and his two daughters and one son were diagnosed as SQTs with structurally intact hearts. Initial ECG in these subjects revealed sinus rhythm with a high peaked T wave, QTc interval </= 320 ms and QT/QTp < 80%. The proband was a 45-year-old man presented with occasional dizziness and family history of sudden cardiac death. Polymorphic ventricular tachyarrhythmias and ventricular fibrillation as well as syncope were induced in this patient during programmed stimulation (S1 = 400 ms, S2 = 250 ms, S3 = 140 ms) from right ventricular outflow tract and a dual chamber Implantable Cardioverter Defibrillator (ICD) was implanted and the patient remained asymptomatic during the 6 months follow up.</p><p><b>CONCLUSIONS</b>SQTs could be presented as an inherited disorder with increased risk for arrhythmias and sudden cardiac death. ICD implantation is the first-choice therapy for high risk patients.</p>

Expression of water channel aquaporin-4 following status epilepticus in rats / 中华神经医学杂志

Objective To investigate the expression of water channel aquapoin-4 (AQP4) and its relationship to brain edema formation after status epilepticus (SE) in rats. Methods Fifty-four Sprague-Dawley rats (weighing 250～300 g) were randomly divided into 9 groups (n=6 in each group): the control group and the post-SE 6, 12, 24, 48, 72, 96, 120, 168 h groups. SE models were established with Lithium-pilocarpine. Immunohistochemistry and semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) were used to assess AQP4 protein and mRNA expression following SE. Results AQP4 expression significantly increased at 24 h, reached to a peak level at 48 h, lasted for 3 d and then began to decline, but still existed at day 7 (P＜0.05 vs control group). The time-dependent change displayed an obvious positive correlation with the process of brain edema after SE (r=0.73, P＜0.05).Conclusion The time-related change of AQP4 expression after SE has a positive correlation with brain edema, indicating that AQP4 may play an important role in the formation of brain edema following SE.

Effection of observation Xinnaoxin capsules in treatment of chronic cerebral circulatory insufficiency / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of Xinnaoxin capsules in patients with chronic cerebral circulatory insufficiency.</p><p><b>METHOD</b>Patients with chronic cerebral circulatory insufficiency were divided randomly into two groups: a Xinnaoxin capsules group (n = 60, treated by Xinnaoxin capsules for four 4 weeks), a control group (n = 58, treated by Nimodiping for four weeks). The transcranial doppler (TCD) was used to determined mean velocity (Vm) and auto-viscometer measured hemorheological indices before and after being treated.</p><p><b>RESULT</b>After 4 weeks treatment, the hemorheological indices and mean velocity were obviously improve in Xinnaoxin capsules group (P <0.05), there is significant difference between the effective rate of two groups (88.3%, 70.7%).</p><p><b>CONCLUSION</b>Our study suggest that Xinnaoxin capsules have therapeutic function on chronic cerebral circulatory insufficiency.</p>

Quality of life of epilepsy patients in Zhuang populations in Guangxi Guixi area / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the quality of life (QOL) and its influence factors in epilepsy patients in Zhuang population in Guangxi Guixi area.</p><p><b>METHODS</b>Totally 78 epilepsy patients in Zhuang populations and 60 healthy controls were enrolled, and their QOL was assessed with Quality of Life in Epilepsy Inventory-31 (QOLIE-31). The QOLIE-31 scores of patients between different sexes, anti-epileptic drugs (AEDs) usage, duration of seizure, and seizure types were compared.</p><p><b>RESULTS</b>QOL score was significantly lower in epileptic group (53.9 +/- 8.0) compared with control group (77.0 +/- 7.1) (P < 0.01). No difference was found in QOLIE-31 scores of patients between men and women (P > 0.05). Patients with single AED, shorter duration of seizure, and tonic-clonic seizure had higher QOLIE-31 scores than those with multiple AEDs, longer duration of seizure, and other seizure types (P < 0.01, P < 0.05, P < 0.01, respectively).</p><p><b>CONCLUSIONS</b>QOL is lower in epilepsy patients than normal people in Zhuang populations in Guangxi Guixi area. Medication and seizure type affects the QOL in patients with epilepsy.</p>

Electrophysiological characteristics of peri-cingulum atrial tachycardia and its treatment with radiofrequency ablation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of atrial tachycardia originating from the atrioventricular cingulum.</p><p><b>METHOD</b>The electrophysiological mechanism, ablation site graph and nerve distribution of 16 cases of atrial tachycardia originating from the atrioventricular cingulum or adjacent atrial muscle which were proved by electrophysiological monitoring and radiofrequency ablation.</p><p><b>RESULTS</b>Atrial tachycardia from peri-cingulum represented 23.2% of atrial tachycardia treated by radiofrequency ablation during the same period. The ratio of left to right atrioventricular cingulum was 3:16. There was no difference of the surface ECG characteristics and electrophysiological mechanism between the atrial tachycardia originating from atrioventricular cingulum and that from other positions. Both A and V components were recorded at all the successful ablation sites. The ratio of amplitude of A to V was between 2:3 and 6:1. Atrial potential in the target site was 20-46 (38.6 +/- 6.7) ms earlier than P'wave in surface ECG. The success rate of ablation was 87.5% and the recurrent rate 7.1%.</p><p><b>CONCLUSIONS</b>Peri-cingulum atrial tachycardia accounts for a certain proportion in all atrial tachycardia. The exciting sites originating from right cingulum are more common than those from left cingulum. Its electrophysiological mechanism has no difference from other positions. Cingulum mapping and ablation have important practical meanings.</p>