Impact of the COVID-19 pandemic on cardiac implantable electronic device implantation in China: Insights from 2 years of changing pandemic conditions.

Background: A substantial reduction in the number of cardiac implantable electronic device (CIED) implantation was reported in the early stages of the COVID-19 pandemic. None of the studies have yet explored changes in CIED implantation during the following pandemic. Objective: To explore changes in CIED implantation during the COVID-19 pandemic from 2020 to 2021. Methods: From 2019 to 2021, 177,263 patients undergone CIED implantation from 1,227 hospitals in China were included in the analysis. Generalized linear models measured the differences in CIED implantation in different periods. The relationship between changes in CIED implantation and COVID-19 cases was assessed by simple linear regression models. Results: Compared with the pre-COVID-19 period, the monthly CIED implantation decreased by 17.67% (95% CI: 16.62-18.72%, p < 0.001) in 2020. In 2021, the monthly number of CIED implantation increased by 15.60% (95% CI: 14.34-16.85%, p < 0.001) compared with 2020. For every 10-fold increase in the number of COVID-19 cases, the monthly number of pacemaker implantation decreased by 429 in 2021, while it decreased by 676 in 2020. The proportion of CIED implantation in secondary medical centers increased from 52.84% in 2019 to 56.77% in 2021 (p < 0.001). For every 10-fold increase in regional accumulated COVID-19 cases, the proportion of CIED implantation in secondary centers increased by 6.43% (95% CI: 0.47-12.39%, p = 0.036). Conclusion: The impact of the COVID-19 pandemic on the number of CIED implantation is diminishing in China. Improving the ability of secondary medical centers to undertake more operations may be a critical way to relieve the strain on healthcare resources during the epidemic.

Ablation efficacy and electrical morphology of a novel 18-hole open-irrigated catheter.

INTRODUCTION: The 6-hole open-irrigated catheter (SHOI) is increasingly used in radiofrequency (RF) ablation of arrhythmias. However, deep transmural lesions are not always achieved, and volume overload caused by irrigated ablation is another problem that should be concerned. The purpose of this study was to analyze and compare the ablation effect and electrical morphology between a novel 18-hole open-irrigated catheter (EHOI) and SHOI. METHODS AND RESULTS: The heart was exposed through a median sternotomy in 12 anesthetized dogs, and the chest cavity was filled with heparinized saline. Bipolar contact pericardial electrograms of both catheters were recorded. Lesions were created under all permutations of the following conditions: RF energy 30 and 40 W for 60 seconds, contact force at 10, 30, and 50 g, electrode orientation horizontal to the tissue, irrigation rate 10 mL/min for EHOI and 17 mL/min for SHOI. The EHOI created deeper lesions than SHOI (5.77 ± 1.37 mm vs 4.98 ± 1.22 mm at power of 30 W, P < 0.05; 7.16 ± 1.15 mm vs 6.02 ± 1.04 mm at power of 40 W, P < 0.01), and there was a trend of larger lesion volume for EHOI (312 ± 141 mm(3) vs 259 ± 108 mm(3) at power of 30 W, 536 ± 200 mm(3) vs 451 ± 180 mm(3) at power of 40 W, P > 0.05). No significant difference in electrogram morphology between 2 catheters was detected. CONCLUSIONS: The mapping electrograms of EHOI and SHOI were not significantly different. Compared with SHOI, EHOI more effectively produced deeper lesions at a lower rate of irrigation perfusion.

[Association between adipocyte fatty acid binding proteins/adiponectin and coronary artery stenosis].

OBJECTIVE: To observe the relationship between serum and monocyte-derived-macrophages secreted adipocyte fatty acid binding protein (A-FABP), adiponectin (or A-FABP/adiponectin ratio) and coronary artery disease. METHODS: Three hundred and forty subjects underwent coronary angiography (CAG) were classified into CAD group (n = 211) and non-CAD group (n = 129) according to the CAG results. The severity of coronary artery stenosis was assessed by the numbers of involved coronary artery branches and the sum of the Gensini scores. Fasting venous blood was collected from all subjects and peripheral monocytes were isolated from 20 subjects (10 selected from each group with age-, gender-, and BMI-matched). Peripheral blood monocytes were obtained and stimulated into macrophages with PMA, cell culture supernatant was collected. The concentration of serum/supernatant A-FABP and adiponectin levels were assayed by enzyme-linked immunosorbent assays. RESULTS: (1) A-FABP levels tended to be higher in CAD patients compared to non-CAD subjects [18.3(13.2, 22.8) µg/L vs. 16.4(13.5, 20.4) µg/L, P = 0.088]. The concentration of adiponectin in CAD group was significantly lower than those in non-CAD group [13.9 (9.8, 17.1) mg/L vs. 19.7 (14.5, 27.6) mg/L, P < 0.05]. (2) The A-FABP levels increased and the adiponectin levels decreased as the number of stenotic vessels increased. Gensini scores were positively correlated with serum A-FABP (r = 0.120, P = 0.043) and inversely correlated with adiponectin (r = -0.405, P = 0.007). (3) The difference in A-FABP/adiponectin ratio was more prominent between subjects with CAD and subjects without CAD [(1.51 ± 0.79) µg/mg vs. (0.89 ± 0.30) µg/mg, P < 0.01] and there was a stronger positive correlation of Gensini score to A-FABP/adiponectin ratio(r = 0.531, P = 0.000). (4) Monocyte-derived-macrophages from patients with CAD had higher A-FABP/adiponectin ratio than that in patients without CAD [(0.51 ± 0.19) µg/mg vs. (0.36 ± 0.11) µg/mg, P < 0.05]. CONCLUSIONS: Increased levels of serum A-FABP and reduced levels of adiponectin in CAD patients serves as a novel biomarker for the severity of the coronary stenosis. A-FABP/adiponectin ratio is superior to A-FABP or adiponectin alone on predicting CAD risks.

Continuous positive airway pressure versus mandibular advancement device in the treatment of obstructive sleep apnea: a systematic review and meta-analysis.

BACKGROUND: The goal of this study was to review relevant randomized controlled trials in order to determine the efficacy of continuous positive airway pressure (CPAP) versus mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). METHODS: Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane Library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios (ORs), mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. RESULTS: We included 14 RCTs, for a total of 249 patients in the CPAP group and 247 in the MAD group. Compared with MAD, CPAP significantly decreased apnea hypopnea index (AHI) (WMD: -7.08, 95%CI: -9.06∼-5.10) and the percentage of stage 1 and 2 after therapy (WMD: -3.728, 95%CI: -6.912∼-0.543). However, compared with MAD, CPAP significantly decreased the SF-36-social function score (WMD: -3.381, 95%CI: -6.607∼-0.154).There was no significant difference in Epworth sleepiness scale score after therapy between the two groups. CONCLUSION: CPAP has better therapeutic efficacy in OSA patients than MAD.

The prognostic significance of fragmented QRS in patients with left ventricular noncompaction cardiomyopathy.

BACKGROUND: Fragmented QRS complexes (fQRS) were proven to be associated with the prognosis of several heart diseases. However, no data is available regarding fQRS in left ventricular noncompaction cardiomyopathy (LVNC), in which the outcome varies greatly and a simple yet practicable prognostic predictor is needed. The purpose of this study was to determine the prognostic value of fQRS in LVNC patients. METHODS: Sixty-four LVNC patients were evaluated. Fragmented narrow QRS (f-nQRS) included single or multiple notches in the R or S wave in at least 2 contiguous electrocardiogram (ECG) leads and QRS duration < 120 ms, fragmented wide QRS (f-wQRS) included more than 2 notches and QRS duration > 120 ms. RESULTS: f-nQRS and f-wQRS was present in 24 (38%) and 7 (11%) patients respectively. During follow-up, 13 patients died and 7 patients underwent heart transplantation. Kaplan-Meier analysis revealed that compared with the non-f-nQRS group, the f-nQRS group associated with a significantly lower survival (P = 0.005). The f-wQRS group also demonstrated a substantially lower survival as compared with the non-f-wQRS group (P = 0.02). Multivariate analysis indicated f-nQRS was an independent predictor of all-cause mortality (HR: 5.33; P = 0.045). CONCLUSIONS: In LVNC patients, the presence of f-nQRS has significant prognostic value and may provide a valid method of risk stratification.

An ionic liquid supported CeO2 nanoparticles-carbon nanotubes composite-enhanced electrochemical DNA-based sensor for the detection of Pb2.

An electrochemical sensor incorporating a signal enhancement for the determination of lead (II) ions (Pb2+) was designed on the basis of the thrombin-binding aptamer (TBA) as a molecular recognition element and ionic liquid supported cerium oxide (CeO2) nanoparticles-carbon nanotubes composite modification. The composite comprises nanoparticles CeO2, multi-wall carbon nanotubes (MWNTs) and hydrophobic room temperature ionic liquid (RTIL) 1-ethyl-3-methylimidazolium tetrafluoroborate (EMIMBF4). The electrochemical sensors were fabricated by immersing the CeO2-MWNTs-EMIMBF4 modified glassy carbon electrode (GCE) into the solution of TBA probe. In the presence of Pb2+, the TBA probe could form stable G-quartet structure by the specific binding interactions between Pb2+ and TBA. The TBA-bound Pb2+ can be electrochemically reduced, which provides a readout signal for quantitative detection of Pb2+. The reduction peak current is linearly related to the concentration of Pb2+ from 1.0×10-8 M to 1.0×10-5 M with a detection limit of 5×10-9 M. This work demonstrates that the CeO2-MWNTs-EMIMBF4 nanocomposite modified GCE provides a promising platform for immobilizing the TBA probe and enhancing the sensitivity of the DNA-based sensors.

Serum adipocyte fatty acid binding proteins and adiponectin in patients with coronary artery disease: the significance of A-FABP/adiponectin ratio.

BACKGROUND: Adipocyte fatty acid binding protein (A-FABP) and adiponectin have been shown to play important roles in atherosclerosis. We investigated serum A-FABP, adiponectin and A-FABP/adiponectin ratio in patients with coronary artery disease (CAD). METHODS: A total of 340 subjects who underwent coronary angiography (CAG) were classified into CAD group (n=211) and non-CAD group (n=129) according to the CAG. Serum A-FABP and adiponectin concentrations were determined by enzyme-linked immunosorbent assays. RESULTS: CAD patients tend to have higher A-FABP concentrations than non-CAD subjects, the difference is significant only between female CAD patients and controls [22.8 (18.6-25.7) ng/ml vs 18.1 (15.6-21.8) ng/ml, P=0.008]. Serum A-FABP concentration was independently associated with Gensini scores in female subjects (P=0.018). CAD patients have significant higher serum A-FABP/adiponectin ratio [1.51 ± 0.05 vs 0.89 ± 0.03 ng/µg, P<0.01] than controls in both genders. CONCLUSIONS: Serum A-FABP is associated with CAD more closely in female than in male. The A-FABP/adiponectin ratio may be a more useful indicator for CAD than A-FABP or adiponectin alone.