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1.
Ultrasound Med Biol ; 2018 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-30509784

RESUMO

The study described here aimed to evaluate left ventricular (LV) systolic mechanical synchronization during permanent selective His bundle pacing (SHBP) using 3-D speckle-tracking echocardiography post-operatively and 6 mo after pacemaker implantation in 62 patients randomly assigned to SHBP (n = 32) or right ventricular apical pacing (RVAP, n = 30). A standard apex four-chamber view was exposed and was transformed into full-volume mode under 3-D echocardiography. Three-dimensional speckle-tracking echocardiography was analyzed offline. The primary endpoint was LV mechanical synchronization post-operatively and during the 6-mo follow-up. Significant LV dyssynchrony was detected while evaluating the maximum time difference and standard deviation of 16-segment systolic time to peak 3-D strain at 1 wk and 6 mo. The pacing thresholds were significantly higher in the SHBP than in the RVAP group throughout follow-up. The R-wave amplitude was significantly lower in the SHBP group than with RVAP. The pacing parameters during SHBP were as stable as during conventional RVAP during the mid-term follow-up. In conclusion, 3-D speckle-tracking echocardiography is feasible and provides a more convenient method for evaluating LV synchrony.

2.
Sci Rep ; 8(1): 17829, 2018 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-30546024

RESUMO

Precise prevalence of atrial fibrillation (AF) and the associated risk factors in southern China are rarely reported. This large population-based follow-up study, the Guangzhou Heart Study, was conducted from 2015 to 2017 to fill up this gap. Permanent residents aged 35 years and above in Guangzhou city were enrolled and demographic factors of participants were collected by a structured questionnaire. Examinations of physical, electrocardiographic and biochemical indicators were performed following a standard operation procedure designed prior to the field investigation. Descriptive statistics were used to evaluate basic characteristics of the study participants, and multivariate logistic regression model was performed to assess the AF prevalence-related factors. The detailed study design, the baseline characteristics and the prevalence of AF were reported here. In total, 12,013 residents were enrolled, and the percentage of participants from rural and urban areas was 53.92% and 46.08%, respectively. In total, 90.57% participants aged 40-79 years old and the proportion of women was more than men (64.98% vs. 35.02%). Overall, the prevalence of AF among the participants was 1.46%. Increasing age, male sex and widowed marital status were associated with higher AF prevalence (P-value < 0.05). The prevalence of AF increased with age and climbed to approximately 5% in residents aged 80 years and over. Residents with abnormal higher blood level of total cholesterol tended to have a lower AF prevalence but a higher prevalence of AF was observed in female participants with lower level of high density lipoprotein cholesterol land higher level uric acid (all P-value < 0.05). Personal illness such as hypertension, diabetes mellitus, dyslipidemia, myocardial infarction, heart failure, stroke and transient ischemic were significantly linked to the attack of AF (all P-value < 0.05). This study will be rich resource for investigating environmental exposure and individual genetic diathesis of AF and other common cardiovascular diseases in Chinese population.


Assuntos
Fibrilação Atrial/epidemiologia , Modelos Biológicos , População Rural , População Urbana , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/fisiopatologia , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais
3.
JACC Clin Electrophysiol ; 4(11): 1460-1470, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30466853

RESUMO

OBJECTIVES: This study aimed to evaluate the electrophysiological mechanisms of post-surgical atrial tachycardias (ATs) during mapping with an automated high-resolution mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts). BACKGROUND: Mapping and ablation of post-operative ATs following previous open-heart surgery is often challenging because the potential mechanisms remain incompletely understood. METHODS: Fifty-one consecutive patients underwent mapping and ablation of post-surgical ATs. RESULTS: A total of 64 ATs were identified, and the mechanism was macro re-entry in 58 of 63 (92.1%) ATs, focal in 4 ATs, localized micro re-entry in 1 AT, and undetermined in 1 AT. Of 11 patients who underwent surgical repair of congenital heart disease, 6 (54.5%) had peri-tricuspid re-entrant AT, 5 had either right atrial (RA) free-wall incisional ATs or figure-8 re-entrant ATs, with an isthmus between the tricuspid annulus and the RA free-wall incision or between the incisions, and none had left atrial (LA) or focal ATs. In 32 patients with valve replacement and 8 who underwent valvuloplasty, peri-tricuspid ATs were observed in 14 (43.4%) and 6 (75%) patients, RA free wall or septal incisions-related ATs were seen in 7 and 2 patients, and LA macro re-entrant ATs were observed in 12 patients and 1 patient, respectively. A macro pseudo re-entry pattern was identified in 8 of 51 patients (15.7%). All these activations could be easily excluded by manually moving the window of interest, except in 2 cases with a figure-8 re-entrant configuration. CONCLUSIONS: RA macro re-entrant ATs predominate, irrespective of the types of initial surgical procedures, but LA ATs occur more frequently in patients with valve replacement. Pseudo re-entry atrial activation is common and easily recognized by adjusting the mapping window.

4.
Heart Rhythm ; 2018 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-30248458

RESUMO

BACKGROUND: Ablation of para-Hisian ventricular arrhythmias (PH-VAs) is challenging because of the close relationship of the origin site and His bundle. Using pacing techniques to differentiate the near-field from far-field His activations, thereby avoiding atrioventricular block, has been reported in patients with para-Hisian accessory pathways. OBJECTIVES: We applied the same pacing technique and 3-dimensional mapping to guide radiofrequency (RF) ablation in patients with right-sided PH-VAs and investigated the clinical outcome of such cases. METHODS: Fourteen patients with right-sided PH-VAs were included in this study. The earliest activation sites were confirmed in the right ventricle on the 3-dimensional map. Pacing with different outputs was performed at the largest His potential site (P1) and the earliest activation site (P2). If the minimum His bundle-right bundle branch-captured output at P2 was higher than that at P1, RF ablation was performed at the site. RESULTS: All the patients in this study had monomorphic premature ventricular contractions (PVCs) with a mean QRS duration of 118.3 ± 8.1 ms. A His-right bundle branch potential with an amplitude of 0.05 ± 0.02 mV was recorded at P2, with a mean distance of 5.97 ± 1.84 mm away from P1. PVCs were successfully eliminated in 13 of 14 patients (92.9%). One patient exhibited persistent right bundle branch block after ablation, and 1 recurrence of ablated PVCs occurred during a median follow-up period of 15 months. CONCLUSION: Using a simple pacing technique to evaluate the safety of RF energy application led to a high success rate of RF catheter ablation of right-sided PH-VAs without atrioventricular block.

5.
Clin Cardiol ; 41(3): 354-359, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29577347

RESUMO

BACKGROUND: Electrocardiographic (ECG) characteristics of true right ventricular outflow tract (RVOT) septal pacing have not been clearly demonstrated. HYPOTHESIS: We hypothesized that ECG parameters would help operators differentiate true RVOT septum from non-septal septum. METHODS: We analyzed 151 patients who underwent pacemaker implantation with a ventricular lead in the RVOT. Transthoracic echocardiographic (TTE) determination of pacing sites was applied in all patients after implantation. A 12-lead ECG was recorded during forced ventricular pacing. RESULTS: According to TTE orientation, pacing at the RVOT septum was achieved in 94 patients (62.3%). Compared with nonseptal pacing, septal pacing had significantly shorter QRS duration (139.2 ± 18.5 ms vs 155.5 ± 14.7 ms; P < 0.001). More frequent negative or isoelectric QRS vector in lead I (76% vs 32%; P < 0.001), lead II/III R-wave amplitude ratio < 1 (52% vs 25%; P = 0.001), and aVR/aVL QS-wave amplitude ratio < 1 (59% vs 32%; P = 0.001) were observed in septal pacing. Transitional zone (TZ) score (3.8 ± 0.96 vs 4.2 ± 0.90; P = 0.004) and TZ index (0.3 ± 0.5 vs 0.6 ± 0.7; P = 0.008) were significantly lower in septal pacing than in nonseptal pacing, respectively. In multivariate analysis, paced QRS duration and negative or isoelectric QRS vector in lead I independently predicted RVOT septal pacing (P < 0.001). At ROC curve analysis, paced QRS duration ≤145 ms identified RVOT septal pacing with 85.1% sensitivity and 78.9% specificity. CONCLUSIONS: This study reveals the heterogeneity of lead placement within the RVOT. Narrower paced QRS duration and negative or isoelectric QRS vector in lead I independently predict RVOT septal pacing.


Assuntos
Fibrilação Atrial/terapia , Estimulação Cardíaca Artificial/métodos , Ecocardiografia/métodos , Eletrocardiografia , Função Ventricular Direita/fisiologia , Septo Interventricular/diagnóstico por imagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento
7.
PLoS One ; 12(1): e0169863, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28122031

RESUMO

AIMS: To summarize our experience of radiofrequency catheter ablation (RFCA) for recurrent drug-refractory ventricular tachycardias (VTs) due to arrhythmogenic right ventricular cardiomyopathy (ARVC) in our center over the past 11 years and its related factors. METHODS AND RESULTS: We reviewed 48 adults (mean age 39.9 ± 12.9 years, range: 14 to 65) who met the present ARVC diagnostic criteria and accepted RFCA for VTs from December 2004 to April 2016. The patients received a total of 70 procedures using two ablation approaches, the endocardial approach in 52 RFCAs, and the combined epicardial and endocardial approach (the combined approach) in 18 RFCAs. Kaplan-Meier survival analysis showed that the combined approach achieved better acute procedural success (p = 0.003) and better long-term outcomes (p = 0.028) than the endocardial approach. Patients who obtained acute procedural success with non-inducibility had better long-term outcomes (p < 0.001). COX regression of multivariate analysis showed that procedural success was the only factor that benefited long-term outcome, irrespective of the endocardial or the combined approach (p = 0.001). The rate of sudden cardiac death (SCD) in patients without procedural success was significantly higher than that in patients with procedural success (p = 0.005). All patients without implantable cardioverter defibrillator (ICD) implantation who had successful final RFCA survived. CONCLUSIONS: The combined approach resulted in better procedural success and long-term VT-free survival compared with the endocardial approach in ARVC patients with recurrent VTs. Acute procedural success with non-inducibility was strongly related to better long-term VT-free survival and reduced SCD, irrespective of whether this was achieved by the endocardial approach or the combined approach.


Assuntos
Displasia Arritmogênica Ventricular Direita/complicações , Ablação por Cateter , Taquicardia Ventricular/cirurgia , Adolescente , Adulto , Idoso , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis , Mapeamento Epicárdico , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Taquicardia Ventricular/etiologia , Resultado do Tratamento , Adulto Jovem
10.
Heart Rhythm ; 13(7): 1460-7, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26961304

RESUMO

BACKGROUND: In patients with idiopathic left ventricular tachycardia (ILVT), the arrhythmogenic substrate is poorly understood. OBJECTIVE: The purpose of this study was to elucidate the ILVT characteristics and outcome of radiofrequency catheter ablation in patients with ILVT. METHODS: Twenty-four patients with ILVT and 15 patients with left accessory pathways (control) underwent high-density mapping of the left His-Purkinje system during sinus rhythm (SR) using 3-dimensional electroanatomic mapping. RESULTS: Fragmented antegrade Purkinje potential (FAP) was represented at the left ventricular septum slightly inferoposterior to the left posterior fascicle (LPF) in 23 patients with ILVT. In control subjects, no FAPs could be recorded at the same region, FAPs were identified at the proximal portion of the LPF (4 patients) and at the distal LPF (1 patient). The finding of any FAPs in ILVT patients was significantly higher than that in control patients (23/24 vs 5/15, P < .01). Radiofrequency ablation at the area of FAP resulted in successful ablation in 23 patients with ILVT. No ILVT recurred during follow-up of 16.3 ± 7.2 months. CONCLUSION: In patients with ILVT, FAP located at the left ventricular septum slightly inferoposterior to the LPF is a novel finding using 3-dimensional electroanatomic mapping. The FAP may represent an arrhythmogenic substrate in ILVT and may be used for guiding successful ablation.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ventrículos do Coração , Taquicardia Ventricular , Adolescente , Adulto , Ablação por Cateter/métodos , Ecocardiografia Tridimensional/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Avaliação de Processos e Resultados (Cuidados de Saúde) , Ramos Subendocárdicos , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia
11.
Int J Cardiovasc Imaging ; 32(5): 721-8, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26797500

RESUMO

Right ventricular outflow tract (RVOT) septal pacing is commonly performed under the standard fluoroscopic positions during procedure. The aim of the prospective, randomized study was to evaluate the accuracy of the combination of standard fluoroscopic and left lateral (LL) fluoroscopic views for determination of RVOT septal position compared with standard fluoroscopic views alone. We prospectively enrolled patients who had indications for implantation of a permanent pacemaker. Patients were randomly assigned into two groups based on intraoperative fluoroscopic views as follows: LL group (three standard fluoroscopic views + LL fluoroscopic view) or standard group (three standard fluoroscopic views). Transthoracic echocardiography (TTE) determination of pacing sites was applied in all patients 3 days after pacemaker implantation. The implantation success rate of RVOT septal pacing was compared between groups. A total of 143 patients (59 males, mean age 57.6 ± 16.3 years) with symptomatic bradyarrhythmia were studied, of whom, 72 patients were randomized to LL group and 71 to standard group. TTE determination of pacing sites was compared with two groups. In the LL group, 60 patients (83 %) were achieved in RVOT septal position. In the standard group, however, the position of RVOT septum was only observed in 48 patients (68 %). The success rate of RVOT septal position in LL group was significantly higher than standard group (p = 0.029). Comparing to traditional views, combining LL view in the procedure will approve the accuracy of RVOT septal pacing site.


Assuntos
Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial , Radiografia Intervencionista/métodos , Septo Interventricular/diagnóstico por imagem , Adulto , Idoso , Bradicardia/diagnóstico por imagem , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , China , Ecocardiografia , Eletrocardiografia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia Intervencionista/efeitos adversos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Septo Interventricular/fisiopatologia
13.
Europace ; 18(9): 1357-65, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26705560

RESUMO

AIMS: Cerebrovascular complications are relatively uncommon, but severe adverse events are associated with catheter ablation of atrial fibrillation (AF). This study aimed to investigate the incidence, risk factors, and hospital outcomes of cerebrovascular events complicating AF ablation. METHODS AND RESULTS: Cerebrovascular complications occurring during the procedure or hospitalization after AF ablation were assessed. Cerebrovascular events occurred in 9 of 1946 consecutive procedures (0.46%). Seven patients (0.36% per procedure) were diagnosed with ischaemic stroke and two patients (0.1% per procedure) with intracranial haemorrhage (ICH). Six events (6/9, 66.7%) occurred during the ablation and the remainders within 24 h after the ablation. Multivariable analysis revealed that previous ischaemic stroke [odds ratio (OR) 10.549; 95% confidence interval (CI) 2.551-43.625, P = 0.001] and mechanical valve replacement (OR 3.261; 95% CI 1.337-7.953, P = 0.009) were independent predictors. In a separate model, CHA2DS2-VASc score ≥3 (OR 7.992; 95% CI 2.046-31.215, P = 0.003) and mechanical valve replacement (OR 4.104; 95% CI 1.644-10.245, P = 0.002) were significantly associated with cerebrovascular complications. All patients survived to discharge except the two cases with ICH. CONCLUSION: Cerebrovascular complications related to catheter ablation of AF are relatively infrequent and typically occur early either during the procedure or within the first 24 h after AF ablation. Previous ischaemic stroke, mechanical valve replacement, and CHA2DS2-VASc score ≥3 are independent predictors of such complications. The majority of these events are ischaemic stroke with a benign clinical outcome, while ICH may correlate with poor prognosis.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Transtornos Cerebrovasculares/epidemiologia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Biópsia , Isquemia Encefálica/epidemiologia , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/terapia , China/epidemiologia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
J Am Coll Cardiol ; 66(23): 2633-2644, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26670064

RESUMO

BACKGROUND: Idiopathic ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) have not been sufficiently clarified. OBJECTIVES: The goal of this study was to investigate the prevalence, electrocardiographic characteristics, mapping, and ablation of idiopathic VAs arising from the PSC. METHODS: Data were analyzed from 218 patients undergoing successful endocardial ablation of idiopathic VAs with a left bundle branch block morphology and inferior axis deviation. RESULTS: Twenty-four patients had VAs originating from the PSC. In the first 7 patients, initial ablation performed in the right ventricular outflow tract failed to abolish the clinical VAs but produced a small change in the QRS morphology in 3 patients. In all 24 patients, the earliest activation was eventually identified in the PSC, at which a sharp potential was observed preceding the QRS complex onset by 28.2 ± 2.9 ms. The successful ablation site was in the right cusp (RC) in 10 patients (42%), the left cusp (LC) in 8 (33%), and the anterior cusp (AC) in 6 (25%). Electrocardiographic analysis showed that RC-VAs had significantly larger R-wave amplitude in lead I and a smaller aVL/aVR ratio of Q-wave amplitude compared with AC-VAs and LC-VAs, respectively. The R-wave amplitude in inferior leads was smaller in VAs localized in the RC than in the LC but did not differ between VAs from the AC and LC. CONCLUSIONS: VAs arising from the PSC are not uncommon, and RC-VAs have unique electrocardiographic characteristics. These VAs can be successfully ablated within the PSC.


Assuntos
Arritmias Cardíacas , Bloqueio de Ramo/complicações , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/anormalidades , Taquicardia Ventricular , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , China , Ecocardiografia , Eletrocardiografia/métodos , Fenômenos Eletrofisiológicos , Mapeamento Epicárdico/métodos , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Prevalência , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Radiografia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia
15.
J Huazhong Univ Sci Technolog Med Sci ; 35(6): 858-861, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26670436

RESUMO

Lead placement for ventricular pacing variably impacts the physiological benefit of the patient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients (108 males, and 84 females, 63±21 years old) with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum (RVOTs) group had lead placement near the septum (n=97), while the right ventricular apex (RVA) group had a traditional apical placement (n=95). RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projection. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different (4.29±0.61 vs. 2.16±0.22 min; P=0.009). No differences were identified in threshold, impedance or R-wave sensing between the two groups at 1st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.


Assuntos
Septos Cardíacos/fisiopatologia , Ventrículos do Coração/fisiopatologia , Marca-Passo Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego
16.
Sci Rep ; 5: 7662, 2015 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-25563218

RESUMO

Active-fixation pacing leads allow the use of selective pacing sites. We evaluated their long-term performance versus passive-fixation leads in 199 newly implanted patients (n = 100 active and n = 99 passive). Postoperative pacing thresholds in the active group were higher than in the passive group (0.85 ± 0.31 V vs. 0.53 ± 0.21 V at baseline, P < 0.001). The active thresholds fell to 0.72 ± 0.23 V at 5 years with a significant drop at one month (0.68 ± 0.53 V, P = 0.003). The passive thresholds slightly increased to 0.72 ± 0.31 V at five years. Differences between groups were significant until three years (all P < 0.05). Active impedances were generally lower than passive impedances (600.44 ± 94.31Ω vs. 683.14 ± 110.98Ω at baseline), and both showed significant reductions at one month to 537.96 ± 147.43Ω in the active group, and after three months to 643.85 ± 82.40Ω in the passive group (both P < 0.01 vs. baseline). Impedance differences between groups were significant until four years (all P < 0.05). Adverse events included thresholds over 1 V, 5 of 6 active and 2 of 5 passive leads returned to below 1 V. One active left ventricular lead dislodged. One passive left subclavian lead insulation fracture occurred. Thus Active fixation pacing leads are stable in a five-year long-term follow up. There was no difference between active and passive leads in terms of electrical performance.


Assuntos
Ventrículos do Coração/fisiopatologia , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial , Estudos de Coortes , Eletrodos Implantados , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Limiar Sensorial
17.
Nan Fang Yi Ke Da Xue Xue Bao ; 34(10): 1551-4, 2014 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-25345961

RESUMO

UNLABELLED: Objective To compare the impact of right ventricular apical (RVA) versus right ventricular outflow tract (RVOT) pacing on left ventricular systolic synchronization. METHODS: Sixty patients were prospectively recruited and randomized into RVA group (n=30) with the right ventricle leads placed in the RVA and RVOT group (n=30) with right ventricle leads placed in the septum of the RVOT. Speckle tracking imaging was performed with 100% ventricle pacing to measure the differences in the time to maximum left ventricle (LV) radial strain. RESULTS: In RVA group, the difference in the time to 6-segment maximum LV radial strain after pacing was 105.27 ± 19.74 ms, significantly greater than that in RVOT group (41.65 ± 12.17 ms, P<0.001). The standard difference of time to 6-segment maximum LV radial strain was also significantly greater in RVA group than in RVOT group (42.71 ± 17.63 vs 17.63 ± 5.62 ms, P<0.001). CONCLUSION: Left ventricle systolic synchronizaition after RVOT pacing is superior to RVA pacing.


Assuntos
Estimulação Cardíaca Artificial/métodos , Ventrículos do Coração , Coração , Humanos , Sístole
18.
Europace ; 16(11): 1619-25, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24614573

RESUMO

AIMS: The aim of the study was to describe the complex electrophysiological features of accessory pathways (APs) in adult Ebstein's anomaly (EA). METHODS AND RESULTS: We performed a retrospective study of 17 consecutive adult EA cases with APs who underwent electrophysiological study and radiofrequency catheter ablation (RFCA) from November 2011 to May 2013. There were a total of 24 atrioventricular reentrant tachycardias (AVRTs) due to 23 APs, including 20 (87.0%) non-decremental conducting, 2 (8.7%) decremental conducting, and 1 (4.3%) nodofascicular bundle. Six (6/17 = 35.3%) patients had two APs while others had only one. Twenty-one APs (91.3%) in 15 patients were manifested and 2 APs (8.7%) in 2 patients were concealed. Six APs (26.1%) were broad, while 17 APs (73.9%) were narrow in width. Two patients suffered from duodromic tachycardias mediated by two APs. Accessory pathways were mainly located on the posterior, posteroseptal, and posterolateral tricuspid annulus (TA). Right ventriculography confirmed that all APs were located on the anatomic TA. All the patients remained free from tachycardias during 11.9 ± 6.8 months of follow-up after RFCA. For the 15 patients with manifest APs, 10 patients' electrocardiograms (ECGs) after RFCA demonstrated morphologies of right bundle branch block, while 5 patients' ECGs were normal. CONCLUSIONS: Accessory pathways in EA are predominantly right-sided, manifest and localize to the lower half of the anatomic TA. A number of APs in EA have broad widths. The incidence of multiple APs is high in these patients and RFCA is effective.


Assuntos
Feixe Acessório Atrioventricular/fisiopatologia , Anomalia de Ebstein/complicações , Taquicardia por Reentrada no Nó Atrioventricular/etiologia , Feixe Acessório Atrioventricular/cirurgia , Adolescente , Adulto , Ablação por Cateter , China , Anomalia de Ebstein/diagnóstico , Anomalia de Ebstein/fisiopatologia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Nan Fang Yi Ke Da Xue Xue Bao ; 33(8): 1229-31, 2013 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-23996773

RESUMO

OBJECTIVE: To evaluate the clinical effect of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death. METHODS: According to ACC/AHA Guideline of ICD implantation (2005), 35 patients successfully received ICD/CRT-D implantation for primary prevention of sudden cardiac death in our hospital from January 2006 to December 2009. All the patients were followed up for a mean of 2 years. RESULTS: During the follow up, 11 (31.43%) patients experienced ventricular arrhythmic episodes, for which 16 defibrillation therapies and 75 anti-tachycardia pacing (ATP) therapies were delivered without mistaken shock or death. The incidence rate of NVM was 100%, that of PVT was 66.67%, Brugada syndrome 50%, HCM 25% and DCM 16.67%. Of these episodes, the incidence of VF episodes among PVC patients was 87.5% (14 beats), ventricular tachycardia PVC was 82.28% (65 times), 5 beats in NVM patients, 4 beats in HCM and Brugada syndrome patients, and 1 beat in DCM patients. No ICD implantation-related complication was detected, and no ventricular tachycardia induced syncope occurred in these cases. All patients showed improved quality of life after the implantation. CONCLUSION: ICD implantation can prevent malignant ventricular arrhythmia episodes, especially for PVT, NVM and Brugada syndrome in high risk SCD patients, demonstrating the value of implantation of ICD as a primary prevention in high-risk SCD patients.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Prevenção Primária , Adulto , Idoso , Morte Súbita Cardíaca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Mol Med Rep ; 8(2): 493-8, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23799545

RESUMO

Aldosterone-induced myocyte apoptosis is an important component of cardiovascular disease. While the p38 mitogen-activated protein kinase (p38 MAPK) pathway has been shown to be crucial in myocyte apoptosis, whether aldosterone induces myocyte apoptosis through this pathway remains unclear. In the present study, three individual strands of p38 MAPK short hairpin RNA (ShRNA), delivered by lentiviral vectors (PGLV), were constructed and used to explore the role of p38 MAPK pathway activation in aldosterone-mediated myocyte apoptosis in cultured myocytes and normotensive rats. Aldosterone stimulation increased myocyte apoptosis, caspase-3 expression levels and p38 MAPK mRNA and protein expression levels in vitro and in vivo. PGLV-ShRNA3 transduction decreased aldosterone-mediated myocyte apoptosis and p38 MAPK mRNA and protein expression levels in vitro (all P<0.01). PGLV-ShRNA3 transduction significantly decreased aldosterone-mediated myocyte apoptosis, p38 MAPK mRNA and protein expression levels in normotensive rats (P<0.01, P<0.01 and P<0.05, respectively). Results from the present study suggest that aldosterone directly induces myocyte apoptosis through the p38 MAPK pathway and the gene silencing of p38 MAPK may protect cardiac myocytes from aldosterone-mediated apoptosis.


Assuntos
Aldosterona/farmacologia , Apoptose/efeitos dos fármacos , Apoptose/genética , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Interferência de RNA , Proteínas Quinases p38 Ativadas por Mitógeno/genética , Animais , Animais Recém-Nascidos , Caspase 3/metabolismo , Células Cultivadas , Regulação da Expressão Gênica , Vetores Genéticos/genética , Vetores Genéticos/metabolismo , Lentivirus/genética , Lentivirus/metabolismo , Masculino , Ratos , Transdução Genética , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
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