Effectiveness of Baduanjin Exercise on Quality of Life and Psychological Health in Postoperative Patients With Breast Cancer: A Systematic Review and Meta-analysis.

BACKGROUND: Baduanjin exercise is a traditional Chinese Qigong exercise. This study aimed to investigate the effects of Baduanjin exercise on the quality of life and psychological status of postoperative patients with breast cancer. METHODS: A systematic review and meta-analysis were conducted. Eight databases were searched from inception to December 15, 2021, restricting the language to English and Chinese. RevMan5.3 software was employed for data analysis. This study was registered in PROSPERO, number CRD 42020222132. RESULTS: A total of 7 randomized controlled trials (RCTs) with 450 postoperative breast cancer patients with or without Baduanjin exercise were collected. Compared with the group without Baduanjin, those who practiced Baduanjin showed significant improvement in quality of life (WMD = 5.70, 95% CI 3.11-8.29, P < .0001). Subgroup analysis showed significant improvement in physical (WMD = 1.83, 95% CI 1.13-2.53, P < .00001) and functional well-being (WMD = 1.58, 95% CI 0.77-2.39, P = .0001), which were measured by the functional assessment of cancer therapy-breast (FACT-B). Subgroup analysis also showed that role-physical (WMD = 11.49, 95% CI 8.86-14.13, P < .00001) and vitality (WMD = 8.58, 95% CI 5.60-11.56, P < .00001) were significantly increased, as measured by a 36-item Short Form survey (SF-36). In terms of psychological health, Baduanjin exercise reduced patients' anxiety (WMD = -8.02, 95% CI -9.27 to -6.78, P < .00001) and depression (WMD = -4.45, 95% CI -5.62 to -3.28, P < .00001). CONCLUSIONS: Baduanjin is an effective exercise, which can significantly improve the quality of life and psychological health of breast cancer patients after operation.

Comparison of efficacy and safety of His-Purkinje system pacing versus cardiac resynchronisation therapy in patients with pacing-induced cardiomyopathy: protocol for a randomised controlled trial.

INTRODUCTION: Recent studies have shown that the His-Purkinje system pacing (HPSP) can achieve electrocardiomechanical synchronisation, and thus improve cardiac function. For patients with pacing-induced cardiomyopathy (PICM) who should be treated with pacemaker upgrade, the HPSP is a viable alternative to cardiac resynchronisation therapy (CRT). However, no randomised controlled trial has been performed to evaluate the efficacy and safety of HPSP in patients with PICM. The present study compared the efficacy and safety of HPSP with that of traditional CRT in the treatment of patients with PICM. METHODS AND ANALYSIS: This study is a single-centre, randomised controlled non-inferiority trial. This trial was carried out at the cardiac centre of Beijing Anzhen Hospital. A total of 46 patients with PICM who needed pacemaker upgrade treatment between January 2022 and December 2023 will be enrolled in this study. Patients will be randomised into an investigational group (HPSP) and a control group (CRT) at a 1:1 ratio. The primary outcome is the duration of QRS complex (QRS width), and the secondary outcomes are NT-proBNP (N terminal pro B type natriuretic peptide), C reactive protein, the number of antibiotics used, left ventricular ejection fraction, end systolic volume, end diastolic volume, the hospitalisation duration, the incidence of postoperative infection, pacemaker parameters (threshold, sensing and impedance), the 6-minute walking test, and quality of life (36-Item Short Form Survey scale), all-cause mortality, cardiovascular death, heart failure-related rehospitalisation rate, other rehospitalisation rates, major complication rates and procedure costs. ETHICS AND DISSEMINATION: This study has been approved by the Beijing Anzhen Hospital Medical Ethics Committee (No. 2020043X). TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR2000034265).

New method and electrophysiological characteristics of LA posterior wall isolation in persistent atrial fibrillation.

BACKGROUND: Left atrial posterior wall isolation (PWI) is commonly used with persistent atrial fibrillation (AF) ablation. However, potentials are often still recorded in the posterior wall after pulmonary vein isolation (PVI), roof linear ablation, and bottom linear ablation in clinical practice. We aimed to explore the methodological approach and electrophysiological characteristics of PWI. METHODS: A total of 36 patients who attended our center with long-standing persistent AF were retrospectively analyzed. After routine PVI and roof and bottom linear ablation, complete PWI was confirmed in sinus rhythm by voltage mapping and high-output pacing. Otherwise, activation mapping and voltage mapping were used to guide ablation on the line or inside the posterior wall until bidirectional block was achieved. RESULTS: The first-pass success rate of PWI was 39%. In the remaining 61% of patients with posterior wall electrograms, activation mapping in sinus rhythm showed that the earliest activation point was not on the ablation line but in a relatively dispersed focal area, possibly related to epicardial muscular sleeve insertion. Voltage mapping revealed a focal high-voltage area in the posterior wall matching the relatively dispersed earliest activation site, in which an average of five points of ablation achieved complete PWI without serious esophageal injury. The middle zone contained 80% of the additional posterior wall ablation points. CONCLUSIONS: PWI was performed safely and effectively with an average of five additional ablation points in the posterior wall in 61% of patients under the guidance of voltage mapping.

Cardiac resynchronization therapy in heart failure patients: tough road but clear future.

Cardiac resynchronization therapy (CRT) based on biventricular pacing (BVP) is an invaluable intervention currently used in heart failure (HF) patients. The therapy involves electromechanical dyssynchrony, which can not only improve heart function and quality of life but also reduce hospitalization and mortality rates. However, approximately 30% to 40% of patients remain unresponsive to conventional BVP in clinical practice. In the recent years, extensive research has been employed to find a more physiological approach to cardiac resynchronization. The His-Purkinje system pacing (HPSP) including His bundle pacing (HBP) and left bundle branch area pacing (LBBaP) may potentially be the future of CRT. These technologies present various advantages including offering an almost real physiological pacing, less complicated procedures, and economic feasibility. Additionally, other methods, such as isolated left-ventricular pacing and multipoint pacing, may in the future be important but non-mainstream alternatives to CRT because currently, there is no strong evidence to support their effectiveness. This article reviews the current situation and latest progress in CRT, explores the existing technology, and highlights future prospects in the development of CRT.

Zero-fluoroscopy transseptal puncture guided by right atrial electroanatomical mapping combined with intracardiac echocardiography: A single-center experience.

BACKGROUND: Right atrial electroanatomical mapping may be combined with SoundStar 3D diagnostic ultrasound catheter (EAM-ICE) as a zero-fluoroscopy procedure for radiofrequency catheter ablation (RFCA). We aimed to evaluate the efficiency and safety of zero-fluoroscopy transseptal puncture guided by EAM-ICE and fluoroscopy combined with intracardiac echocardiography (F-ICE) in patients with paroxysmal atrial fibrillation (PAF). HYPOTHESIS: Zero-fluoroscopy transseptal puncture is an effective and safe procedure. METHODS: This study had a prospective design. A total of 57 patients with PAF were enrolled and assigned to two groups. Twenty-seven patients were enrolled in the EAM-ICE group, and 30 patients were enrolled in the F-ICE group. RESULTS: There were no statistically significant differences in baseline patient characteristics between groups. Transseptal puncture was successful in all patients (57/57, 100%). Total procedure time and duration of transseptal puncture were lower in the F-ICE group (199.4 ± 26.0 minutes vs 150.7 ± 22.1 minutes, P = 0.000; 118.4 ± 19.7 vs 70.5 ± 13.5 minutes, P = 0.000). There was no use of fluoroscopy in the EAM-ICE group (0 mGy vs 70.5 ± 13.5 mGy); the duration of fluoroscopy in the EAM-ICE group was negligible (0 minutes vs 5.4 ± 1.9 minutes). No procedural complication occurred in either group. CONCLUSIONS: EAM-ICE guided zero-fluoroscopy transseptal puncture is an effective and safe procedure.