Background::Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic obstructive cardiomyopathy (HOCM). Data regarding the correlations of thyroid dysfunction and the incidence of AF in HOC...Background::Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic obstructive cardiomyopathy (HOCM). Data regarding the correlations of thyroid dysfunction and the incidence of AF in HOCM are quite limited. This study aimed to reveal the correlations between different thyroid status and the corresponding incidence of AF in a large HOCM cohort.Methods::A total of 806 HOCM patients with complete information on thyroid function tests and comprehensive cardiac evaluations were recruited. The participants were divided into the AF group (n = 159) and non-AF group (n = 647) according to established medical history and results of Holter monitoring. The thyroid status of the study population and the corresponding incidence of AF were assessed and analyzed.Results::Hypothyroidism accounted for the greatest proportion of thyroid dysfunction in HOCM patients. The incidence of AF significantly increased in individuals with both overt ( P = 0.022) and subclinical ( P = 0.007) hypothyroidism. Compared with participants in the non-AF group, those with positive AF episodes presented with lower free triiodothyronine (FT3) (2.86 ± 0.52 pg/mL vs. 3.01 ± 0.42 pg/mL, P = 0.001), higher free thyroxine (FT4) (1.24 ± 0.25 ng/dL vs. 1.15 ± 0.16 ng/dL, P < 0.001), and remarkably increased levels of thyrotropin (TSH) (12.6% vs. 5.3%, P = 0.001). Multivariable analyses demonstrated that the concentrations of FT3 (odds ratio [OR] = 0.470, 95% confidence interval [CI]: 0.272-0.813, P = 0.007) and FT4 (OR = 17.992, 95% CI: 5.750-56.296, P < 0.001), as well as TSH levels above normal ranges (OR = 2.276, 95% CI: 1.113-4.652, P = 0.024) were independently associated with the occurrence of AF in the large HOCM cohort. Conclusions::This study indicated a strong link between low thyroid function and the presence of AF in HOCM. Hypothyroidism (both overt and subclinical states) seems to be valuable for assessing the incidence of AF in patients with HOCM.展开更多
Background The transseptal puncture technique has been widely used in therapeutic left atrium catheterization. But this technique may lead to some life-threatening complications. It can not be used widely because it i...Background The transseptal puncture technique has been widely used in therapeutic left atrium catheterization. But this technique may lead to some life-threatening complications. It can not be used widely because it is restricted by economy and deferring the transseptal puncture procedure. The aim of this study was to introduce a simple and safe transseptal puncture procedure. Methods The distal of coronary sinus （CS） electrode was positioned close to the lateral margin of heart, which was about at 3 o＇clock at left anterior oblique （LAO） 30° referred to whole cardiac profile. It was then used as the marker for the level of fossa ovalis at posterior-anterior projection to guide the pull of transseptal needle. The midpoint between the distal CS and the posterior margin of heart at right anterior oblique （RAO） 45° view was considered as the location of fossa ovalis. Once the puncture was succeeded, the guidewire was introduced to the left superior pulmonary vein via puncture sheath after the needle was retrieved. The end of outer sheath was introduced into left atrium with the protection of guidewire. It was applied in 539 patients （316 male, 223 female; （53±16） years old） who underwent catheter ablation of atrial fibrillation or left-sided atrioventricular accessory pathway. Results This transseptal approach reached 100.0% success and was succeeded in 98.9% with the first attempt. The first attempt puncture was aborted due to greater patients. However, the second attempts were all tamponade and embolism occurred. Conclusion The atrial septum puncture approach guidewire for protection when sending outer sheath resistance to needle advancement or smaller needle curve in six succeeded after the needle curve was reshaped. There was no using the location of distal CS electrode as important marker and the into left atrium is reliable and safe.展开更多
Background N-terminal pro β-type natriuretic peptide （NT pro BNP） has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicti...Background N-terminal pro β-type natriuretic peptide （NT pro BNP） has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicting the clinical response to cardiac resynchronization therapy （CRT）. Methods A total of 44 patients with chronic heart failure （34 male and 10 female, mean age of （58±13） years, New York Heart Association （NYHA） class 3.3±0.5, QRS duration （150±14） milliseconds） who underwent successful implantation of a CRT system were enrolled in this study. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of NT pro BNP were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored at each clinical visit after CRT implantation. Receiver operating characteristic analysis and a paired ttest were performed to analyze the data. Results After a mean of （16.3±5.5） months of follow-up, 11 nonresponders were identified. CRT resulted in a significant reduction in NT pro BNP （（1.70±1.28） vs （1.07±0.88） pmol/ml, P 〈0.001） in responders. Percentage change in NT pro BNP level （△BNP%） was a statistically significant predictor of long term clinical improvement at 3 months of follow-up. Conclusions △BNP% from baseline to 3 months of follow-up is a predictor of long term response to CRT. NT pro BNP may be a simple method for monitoring the effects of CRT.展开更多
Background P-wave dispersion （PWD） is a useful predictor of paroxysmal atrial fibrillation （AF）. The effect of cardiac resynchronization therapy （CRT） on PWD and the prognostic implications of the improvement in...Background P-wave dispersion （PWD） is a useful predictor of paroxysmal atrial fibrillation （AF）. The effect of cardiac resynchronization therapy （CRT） on PWD and the prognostic implications of the improvement in PWD remain undefined. The aim of the study was to explore the clinical significance of the improvement of PWD after CRT. Methods Electrocardiographic studies were performed before and three months after CRT in 81 patients （57 men and 24 women; age （60.5±11.2） years） with standard CRT indication but no history of AF. A significant improvement of PWD （PWD responder） was defined as a relative decrease 〉20% from baseline PWD. The primary endpoints were new-onset AF detected by electrocardiogram （ECG） or CRT. Results After （30.6±7.5） months of follow-up, PWD responders （n=43） had a significantly lower incidence of AF than did PWD nonresponders, 12% vs. 29% （P 〈0.001）. In Cox proportional hazard analysis, PWD responders was the only predictor of lower risk of new-onset AF （HR 0.33, 95% confidence interval 0.12-0.96, P=0.033）. Conclusion Improvement of P-wave dispersion after CRT was associated with a lower incidence of AF, which may be related to the significant improvement in left ventricular systolic function and the reverse modeling of the left atrium.展开更多
目的探讨房室折返性心动过速(AVRT)患者射频消融(RFCA)术后复发率、复发原因。方法回顾分析2017年1月至2019年10月间收治的323例AVRT患者的临床资料、首次射频消融术资料、随访结果和复发患者二次射频消融术资料。结果 323例患者中男性1...目的探讨房室折返性心动过速(AVRT)患者射频消融(RFCA)术后复发率、复发原因。方法回顾分析2017年1月至2019年10月间收治的323例AVRT患者的临床资料、首次射频消融术资料、随访结果和复发患者二次射频消融术资料。结果 323例患者中男性196(60.9%)例,年龄(40.2±14.3)岁,术中即刻成功率99.7%,随访(20.0±12.7)个月,复发21(6.5%)例。复发患者的旁道分布:左侧游离壁10例、右侧游离壁7例、前间隔2例、后间隔2例。术中使用三维标测的复发率低于传统标测复发率(2.8%vs 9.5%,P=0.015),与复发组相比未复发组V/A融合时限短[(74.3±3.6)ms vs (80.7±3.1)ms,P<0.05],逆传A波更提前[(24.2±2.8)ms vs (17.3±3.9)ms,P<0.05],靶点心室电位提前QRS波时间更长[(25.4±2.3)ms vs (22.2±1.4)ms,P<0.05],消融反应时间更短[(4.4±1.8)s vs (8.9±3.5)s,P<0.05]。左侧旁道患者术中采用主动脉逆行途径的复发率低于穿间隔途径(1.8%vs 7.1%,P<0.05)。多因素回归分析显示,术中是否使用三维标测、消融反应时间、逆传A波提前程度是复发的影响因素。复发患者中有20例接受了二次消融手术均消融成功,随访(12.2±8.0)个月未见复发。结论导管消融术治疗AVRT成功率高,复发率较低。术中是否使用三维标测、消融反应时间、逆传A波提前程度是复发的影响因素。展开更多
Background The impact of home monitoring system in the early detection of ventricular arrhythmia and inappropriate shock in daily work is not clear. The aim of this study was to investigate the impact of home monitori...Background The impact of home monitoring system in the early detection of ventricular arrhythmia and inappropriate shock in daily work is not clear. The aim of this study was to investigate the impact of home monitoring system on the early detection of ventricular arrhythmia and inappropriate shock in daily clinical practice. Methods Cases of implantable cardioverter defibrillator （ICD） implantation with or without the home monitoring system from June 2010 to October 2011 at our center were reviewed. Follow-up was scheduled after implantation. Data relating to the home monitoring ICD were retrieved using a remote transmitter system. Data relating to the other devices were obtained during scheduled follow-up or unscheduled visits. Results Our study involved 69 patients （mean age （68.4＋17.6） years, 64.3% males, 26 in the home monitoring group vs. 43 in the non-home monitoring group）. In all, 561 ventricular arrhythmia episodes were detected in 17 patients （39.5%） in the non-home monitoring group： 495 episodes were ventricular tachycardia and 66 episodes were ventricular fibrillation; among these, 476 episodes of ventricular tachycardia and 45 episodes of ventricular fibrillation were appropriately diagnosed （96.1% and 68.2%, respectively）. In the home monitoring group, 389 ventricular arrhythmia episodes were transmitted by the home monitoring system in nine patients （34.6%）： 348 ventricular tachycardia episodes and 41 ventricular fibrillation episodes. Device detection was appropriate in 348 ventricular tachycardia episodes （100.0%） and 36 ventricular fibrillation episodes （87.8%）. The home monitoring group showed a higher appropriate detection rate of ventricular tachycardia （P 〈0.01） and ventricular fibrillation （P=0.02）. The proportion of inappropriate shock was comparable in the two groups （6/11 in the non-home monitoring group vs. 1/7 in the home monitoring group; m=0.08）. Conclusions The home monitoring ICD was able to provide information relating to inappropriate detection and shock earlier than conventional devices. It proved to be a reliable tool and has a strong potential to provide greater reaction time in the case of inappropriate shock.展开更多
基金supported by grants from the Fundamental Research Funds for the Central Universities(No.3332019045)the National Key R&D Program of China(No.2017YFC1307800).
文摘Background::Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic obstructive cardiomyopathy (HOCM). Data regarding the correlations of thyroid dysfunction and the incidence of AF in HOCM are quite limited. This study aimed to reveal the correlations between different thyroid status and the corresponding incidence of AF in a large HOCM cohort.Methods::A total of 806 HOCM patients with complete information on thyroid function tests and comprehensive cardiac evaluations were recruited. The participants were divided into the AF group (n = 159) and non-AF group (n = 647) according to established medical history and results of Holter monitoring. The thyroid status of the study population and the corresponding incidence of AF were assessed and analyzed.Results::Hypothyroidism accounted for the greatest proportion of thyroid dysfunction in HOCM patients. The incidence of AF significantly increased in individuals with both overt ( P = 0.022) and subclinical ( P = 0.007) hypothyroidism. Compared with participants in the non-AF group, those with positive AF episodes presented with lower free triiodothyronine (FT3) (2.86 ± 0.52 pg/mL vs. 3.01 ± 0.42 pg/mL, P = 0.001), higher free thyroxine (FT4) (1.24 ± 0.25 ng/dL vs. 1.15 ± 0.16 ng/dL, P < 0.001), and remarkably increased levels of thyrotropin (TSH) (12.6% vs. 5.3%, P = 0.001). Multivariable analyses demonstrated that the concentrations of FT3 (odds ratio [OR] = 0.470, 95% confidence interval [CI]: 0.272-0.813, P = 0.007) and FT4 (OR = 17.992, 95% CI: 5.750-56.296, P < 0.001), as well as TSH levels above normal ranges (OR = 2.276, 95% CI: 1.113-4.652, P = 0.024) were independently associated with the occurrence of AF in the large HOCM cohort. Conclusions::This study indicated a strong link between low thyroid function and the presence of AF in HOCM. Hypothyroidism (both overt and subclinical states) seems to be valuable for assessing the incidence of AF in patients with HOCM.
文摘Background The transseptal puncture technique has been widely used in therapeutic left atrium catheterization. But this technique may lead to some life-threatening complications. It can not be used widely because it is restricted by economy and deferring the transseptal puncture procedure. The aim of this study was to introduce a simple and safe transseptal puncture procedure. Methods The distal of coronary sinus （CS） electrode was positioned close to the lateral margin of heart, which was about at 3 o＇clock at left anterior oblique （LAO） 30° referred to whole cardiac profile. It was then used as the marker for the level of fossa ovalis at posterior-anterior projection to guide the pull of transseptal needle. The midpoint between the distal CS and the posterior margin of heart at right anterior oblique （RAO） 45° view was considered as the location of fossa ovalis. Once the puncture was succeeded, the guidewire was introduced to the left superior pulmonary vein via puncture sheath after the needle was retrieved. The end of outer sheath was introduced into left atrium with the protection of guidewire. It was applied in 539 patients （316 male, 223 female; （53±16） years old） who underwent catheter ablation of atrial fibrillation or left-sided atrioventricular accessory pathway. Results This transseptal approach reached 100.0% success and was succeeded in 98.9% with the first attempt. The first attempt puncture was aborted due to greater patients. However, the second attempts were all tamponade and embolism occurred. Conclusion The atrial septum puncture approach guidewire for protection when sending outer sheath resistance to needle advancement or smaller needle curve in six succeeded after the needle curve was reshaped. There was no using the location of distal CS electrode as important marker and the into left atrium is reliable and safe.
基金This project was supported by a grant from the National Natural Science Foundation of China （No. 30770860）.
文摘Background N-terminal pro β-type natriuretic peptide （NT pro BNP） has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicting the clinical response to cardiac resynchronization therapy （CRT）. Methods A total of 44 patients with chronic heart failure （34 male and 10 female, mean age of （58±13） years, New York Heart Association （NYHA） class 3.3±0.5, QRS duration （150±14） milliseconds） who underwent successful implantation of a CRT system were enrolled in this study. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of NT pro BNP were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored at each clinical visit after CRT implantation. Receiver operating characteristic analysis and a paired ttest were performed to analyze the data. Results After a mean of （16.3±5.5） months of follow-up, 11 nonresponders were identified. CRT resulted in a significant reduction in NT pro BNP （（1.70±1.28） vs （1.07±0.88） pmol/ml, P 〈0.001） in responders. Percentage change in NT pro BNP level （△BNP%） was a statistically significant predictor of long term clinical improvement at 3 months of follow-up. Conclusions △BNP% from baseline to 3 months of follow-up is a predictor of long term response to CRT. NT pro BNP may be a simple method for monitoring the effects of CRT.
文摘Background P-wave dispersion （PWD） is a useful predictor of paroxysmal atrial fibrillation （AF）. The effect of cardiac resynchronization therapy （CRT） on PWD and the prognostic implications of the improvement in PWD remain undefined. The aim of the study was to explore the clinical significance of the improvement of PWD after CRT. Methods Electrocardiographic studies were performed before and three months after CRT in 81 patients （57 men and 24 women; age （60.5±11.2） years） with standard CRT indication but no history of AF. A significant improvement of PWD （PWD responder） was defined as a relative decrease 〉20% from baseline PWD. The primary endpoints were new-onset AF detected by electrocardiogram （ECG） or CRT. Results After （30.6±7.5） months of follow-up, PWD responders （n=43） had a significantly lower incidence of AF than did PWD nonresponders, 12% vs. 29% （P 〈0.001）. In Cox proportional hazard analysis, PWD responders was the only predictor of lower risk of new-onset AF （HR 0.33, 95% confidence interval 0.12-0.96, P=0.033）. Conclusion Improvement of P-wave dispersion after CRT was associated with a lower incidence of AF, which may be related to the significant improvement in left ventricular systolic function and the reverse modeling of the left atrium.
文摘目的探讨房室折返性心动过速(AVRT)患者射频消融(RFCA)术后复发率、复发原因。方法回顾分析2017年1月至2019年10月间收治的323例AVRT患者的临床资料、首次射频消融术资料、随访结果和复发患者二次射频消融术资料。结果 323例患者中男性196(60.9%)例,年龄(40.2±14.3)岁,术中即刻成功率99.7%,随访(20.0±12.7)个月,复发21(6.5%)例。复发患者的旁道分布:左侧游离壁10例、右侧游离壁7例、前间隔2例、后间隔2例。术中使用三维标测的复发率低于传统标测复发率(2.8%vs 9.5%,P=0.015),与复发组相比未复发组V/A融合时限短[(74.3±3.6)ms vs (80.7±3.1)ms,P<0.05],逆传A波更提前[(24.2±2.8)ms vs (17.3±3.9)ms,P<0.05],靶点心室电位提前QRS波时间更长[(25.4±2.3)ms vs (22.2±1.4)ms,P<0.05],消融反应时间更短[(4.4±1.8)s vs (8.9±3.5)s,P<0.05]。左侧旁道患者术中采用主动脉逆行途径的复发率低于穿间隔途径(1.8%vs 7.1%,P<0.05)。多因素回归分析显示,术中是否使用三维标测、消融反应时间、逆传A波提前程度是复发的影响因素。复发患者中有20例接受了二次消融手术均消融成功,随访(12.2±8.0)个月未见复发。结论导管消融术治疗AVRT成功率高,复发率较低。术中是否使用三维标测、消融反应时间、逆传A波提前程度是复发的影响因素。
文摘Background The impact of home monitoring system in the early detection of ventricular arrhythmia and inappropriate shock in daily work is not clear. The aim of this study was to investigate the impact of home monitoring system on the early detection of ventricular arrhythmia and inappropriate shock in daily clinical practice. Methods Cases of implantable cardioverter defibrillator （ICD） implantation with or without the home monitoring system from June 2010 to October 2011 at our center were reviewed. Follow-up was scheduled after implantation. Data relating to the home monitoring ICD were retrieved using a remote transmitter system. Data relating to the other devices were obtained during scheduled follow-up or unscheduled visits. Results Our study involved 69 patients （mean age （68.4＋17.6） years, 64.3% males, 26 in the home monitoring group vs. 43 in the non-home monitoring group）. In all, 561 ventricular arrhythmia episodes were detected in 17 patients （39.5%） in the non-home monitoring group： 495 episodes were ventricular tachycardia and 66 episodes were ventricular fibrillation; among these, 476 episodes of ventricular tachycardia and 45 episodes of ventricular fibrillation were appropriately diagnosed （96.1% and 68.2%, respectively）. In the home monitoring group, 389 ventricular arrhythmia episodes were transmitted by the home monitoring system in nine patients （34.6%）： 348 ventricular tachycardia episodes and 41 ventricular fibrillation episodes. Device detection was appropriate in 348 ventricular tachycardia episodes （100.0%） and 36 ventricular fibrillation episodes （87.8%）. The home monitoring group showed a higher appropriate detection rate of ventricular tachycardia （P 〈0.01） and ventricular fibrillation （P=0.02）. The proportion of inappropriate shock was comparable in the two groups （6/11 in the non-home monitoring group vs. 1/7 in the home monitoring group; m=0.08）. Conclusions The home monitoring ICD was able to provide information relating to inappropriate detection and shock earlier than conventional devices. It proved to be a reliable tool and has a strong potential to provide greater reaction time in the case of inappropriate shock.
