2016—2021年湖北省冠心病介入诊疗技术应用趋势分析

目的分析2016—2021年湖北省冠心病介入诊疗技术的应用趋势,为冠心病防治提供资料。方法应用国家心血管疾病介入诊疗管理信息网,采集2016—2021年湖北省开展经皮冠状动脉介入治疗(PCI)的医院数量、患者基本情况、手术路径、病变血管和罪犯血管分布、急诊手术等数据,分析6年间的变化趋势。结果2016—2021年湖北省PCI总量从28459例增长至34474例,增长率为21.1%,但逐年增速放缓;患者均以男性和急性冠状动脉综合征为主;并发症发生率从0.16%降至0.11%(P=0.652),手术相关死亡率从0.17%增至0.34%(P<0.001);PCI路径以桡动脉为主,从90.6%增长至97.9%(P<0.001);冠状动脉病变以单支血管病变为主,左前降支最常见,左主干病变占比最少;ST段抬高型心肌梗死行直接PCI的医院总数和县级医院数量均显著增长,且县级医院占比呈逐年增长趋势(P=0.039);到达医院距手术时间呈下降趋势(P=0.029)。结论2016—2021年湖北省冠心病介入的疾病谱未发生明显变化,但PCI技术应用数量和质量均在增长,提示该地区的PCI技术应用更加普及,水平稳步提升。

安徽省近五年畜禽粪尿土地承载力时空变化特征

为了解安徽省畜禽养殖的动态变化及环境风险,为农业产业结构调整提供参考,以《畜禽养殖业源产排污系数手册》中的相关参数为基础,采用2015—2019年安徽省及地方统计年鉴数据,测算了安徽省各地市畜禽粪尿和氮磷总量以及耕地负荷,评估了近5年安徽省畜禽养殖污染的环境风险,并估算了各地市畜禽养殖发展潜力。结果表明:(1)安徽省畜禽养殖总体平稳,2014—2017年全省畜禽粪尿总量分别为4182.59、4226.62、4216.65、4224.14万吨,但2018年安徽省畜禽养殖规模大幅降低,畜禽粪尿产量较上一年大幅减少了31.58%,且各地市间差异较大,总体为皖南地区少皖北地区多。(2)安徽省畜禽养殖污染物耕地负荷总体上处于较低水平,畜禽粪尿氮、磷产量与作物生长对粪肥氮、磷需求量的比值均在0.5以下,表明安徽省畜禽养殖规模仍有较大的发展空间,尤其是淮北、马鞍山、芜湖、铜陵等地。(3)各地市间畜禽粪尿、氮、磷耕地负荷差异均较大,2014年黄山市粪污负荷、氮磷负荷均最高,马鞍山市均最低,但到2018年时为阜阳市粪污、氮、磷负荷最高,芜湖均最低。(4)2018末,安徽省畜禽养殖发展潜力为5014.79万头猪单位,但地区间的分布极不均衡,亳州、阜阳、宿州和滁州市是区内畜禽养殖进一步扩容的主体,而铜陵、池州和黄山市的发展潜力较低。

超极化激活的环核苷酸门控阳离子通道在心血管系统中作用的研究进展

超极化激活的环核苷酸门控阳离子(HCN)通道为超极化激活的阳离子通道,受电压和环核苷酸双重调节。近期科学家利用低温电磁仪探索了HCN通道的某些特殊结构,为研究相关的离子通道特性提供了理论依据。HCN通道及其亚型在心脏中的分布具有一定的种属特异性,病理状态下各亚型的异常分布常常引起各类心律失常,另外HCN基因突变亦参与病态窦房结的形成。诱导多能干细胞作为一种新兴的具有潜在发展前景的干细胞,将为研究HCN基因突变及其参与心脏离子通道病变的病理生理和分子学变化提供良好的模型,且有利于针对HCN通道的特异性药物和生物起搏器的研发。

Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation

Background The effects of anxiety and depression on the recurrence of persistent atrial fibrillation （AF） after circumferential pulmonary vein ablation （CPVA） are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown. Methods One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA （CPVA group） and 103 treated with anti-arrhythmics drugs （medicine group）, were enrolled. The Zung Self-Rating Anxiety Scale （SAS）, and Zung Self-Rating Depression Scale （SDS） were assessed before and 12 months after treatment in all patients. Results The scores of SAS （40.33±7.90 vs. 49.76±9.52, P 〈0.01） and SDS （42.33±8.73 vs. 48.17±8.77, P 〈0.01） decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group （17 patients）, the scores of SAS and SDS were significantly lower in the non-recurrent group （26 patients） at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA. Conclusions Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.

Serum uric acid levels correlate with atrial fibrillation in patients with chronic systolic heart failure

Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure （CHF）. The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF. Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients＇ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic （ROC） curves. Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level （HR, 1.084; 95% CI, 1.017-1.144; P 〈0.001）, diuretics （HR, 1.549; 95% CI, 1.246-1.854; P 〈0.001）, and New York Heart Association （NYHA） （HR, 1.237; 95% CI, 1.168-1.306; P 〈0.001） function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant （Wald Z2, 1494.88; P 〈0.001 for AF）; 58.8% （95% CI, 57.7%-60.0%） of the observed results were concordant with the separate model. Conclusion Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.

Effect of transplanted mesenchymal stem cells from rats of different ages on the improvement of heart function after acute myocardial infarction

Background Mesenchymal stem cells （MSCs） transplantation is of therapeutic potential after ischemic injury in both experimental and clinical studies. Clinically, elderly patients are more vulnerable to acute myocardial infarction （AMI）. But little is known about the characteristics of young donor-derived MSCs transplanted to old patients with AMI. The present study was designed to investigate the effect of transplanted MSCs from rats of different ages on the improvement of heart function after AMI. Methods MSCs from Sprague-Dawley （SD） rats were isolated and cultured in vitro. The apoptosis characteristics of MSCs were observed under conditions of ischemia and anoxia. SD rats underwent MI received intramyocardial injection of MSCs from young donor rats （n=-8）, old donor rats （n=-8）, respectively. AMI control group received equal volume physiological saline. Immunofluorescence was used to observe the differentiation of the grafted cells into cardiomyocytes Four weeks after cell transplantation, reverse transcriptase-polymerase chain reaction （RT-PCR） and immunohistochemistry for vascular endothelial growth factor （VEGF）, VIII-factor immunohistochemistry for vessel density, TUNEL, caspase-3 for cardiomyocyte apoptosis, echocardiography and hemodynamic detection for heart function were performed. Results The apoptosis rate of the old donor-derived MSCs group was significantly higher than that of the young donor-derived MSCs group under conditions of ischemia and anoxia （P 〈0.05）. Engrafted MSCs survived, proliferated and differentiated into myocardium-like cells. VEGF gene expression and capillary density in the old donor-derived group were lower than those in the young donor-derived group but higher than those in the control group （P 〈0.05）. The transplantation of old donor-derived MSCs attenuated apoptosis of cadiomyocytes in the peri-infract region compared with the control group and the effect was elevated in young donor-derived MSCs （P 〈0.05）. The heart functions （left ventricle ejection fraction （LVEF）, left ventricle fractional shortening （LVFS）） were improved more significantly in the old donor-derived MSCs group than in the control group and the heart function in the young donor-derived MSCs group further improved （P 〈0.05）. Conclusions Young donor-derived MSCs can improve heart function significantly through angiogenesis and decreasing cardiomyocyte apoptosis when transplanted to the infarcted area.

Comparison of coronary plaque composition among patients with acute coronary syndrome and stable coronary artery disease

Background The identification of vulnerable plaques before rupture is an important clinical goal. The purpose of the present study was to assess the difference in plaque composition among patients with acute coronary syndrome （ACS） and stable coronary artery disease （SCAD） by intravascular ultrasound virtual histologic analysis. Methods One hundred and thirty-nine patients were divided into ACS group and SCAD group according to clinical presentation. A total of 229 de novo lesions with 〉50% stenosis in native coronary arteries with diameters 〉2.5 mm were studied with intravascular ultrasonography. Geometric and compositional data were obtained using intravascular ultrasound virtual histology software. Results There were no significant differences in overall lesions for fibrous （（52.0±11.9）% vs （54.3±8.5）%, P〉0.05）, fibrolipidic （（12.3±10.1）% vs （13.8±9.5）%,P〈0.05）, calcium （（14.0±9.1）% vs （19.3±13.1）%, P〉0.05）, or necrotic core （（22.0±11.1）% vs （19.7±5.4）%, P〉0.05） percentages in ACS and SCAD patients, respectively. There were also no significant differences in culprit lesions for fibrous （（46.4±12.0）% vs （53.6±8.8）%, P〉0.05）, fibrolipidic （（9.1±9.0）% vs （12.9±9.7）%, P〉0.05）, calcium （（16.6±9.7）% vs （21.8±26.3）%, P〉0.05）, or necrotic core （（28.0±12.6）% vs （20.6±5.2）%, P〉0.05） percentages in ACS and SCAD patients, respectively. High density lipoprotein-cholesterol levels 〉1.04 mmol/L were associated with more fibrolipidic （（14.5±10.4）% vs （7.1±6.5）%, P〈0.05） and less necrotic core （（20.6±9.7）% vs （27.9±12.6）%,P〈0.05） percentages in the cohort with ACS. Conclusions In this study, coronary plaque composition assessed by intravascular ultrasound virtual histologic analysis was not significantly different between ACS and SCAD patients. The anatomic relationship of the specific plaque components to the lumen of the vessel was more important than the quantitative information of plaque composition for plaque stability.

Anticoagulation therapy in Chinese patients with non-valvular atrial fibrillation： a prospective, multi-center, randomized, controlled study

Background Non-valvular atrial fibrillation is associated with an increased risk of ischemic stroke; however, the appropriate intensity of anticoagulation therapy for Chinese patients has not been determined. The purpose of this study was to compare the safety and the efficacy of standard-intensity warfarin therapy, low-intensity warfarin therapy, and aspirin therapy for the prevention of ischemic events in Chinese patients with non-valvular atrial fibrillation （NVAF）. Methods A total of 786 patients from 75 Chinese hospitals were enrolled in this study and randomized into three therapy groups： standard-intensity warfarin （international normalized ratio （INR） 2.1 to 2.5） group, low-intensity warfarin （INR 1.6 to 2.0） group and aspirin （200 mg per day） group. All patients were evaluated by physicians at 1,3, 6, 9, 12, 15, 18, 21 and 24 months after randomization to obtain a patient questionnaire, physical examination and related laboratory tests. Results The annual event rates of ischemic stroke, transient ischemic attack （TIA） or systemic thromboembolism were 2.6%, 3.1% and 6.9% in the standard-intensity warfarin, low-intensity warfarin and aspirin groups, respectively （P=0.027）. Thromboembolic event rates in both warfarin groups were significantly lower than that in the aspirin group （P=0.018, P=0.044）, and there was no significant difference between the two warfarin groups. Severe hemorrhagic events occurred in 15 patients, 7 （2.6%） in the standard-intensity warfarin group, 7 （2.4%） in the low-intensity warfarin group and 1 （0.4%） in the aspirin group. The severe hemorrhagic event rates in the warfarin groups were higher than that in the aspirin group, but the difference did not reach statistical significance （P=0.101）. The mild hemorrhagic and total hemorrhagic event rates in the warfarin groups （whether in the standard-intensity warfarin group or low-intensity warfarin group） were much higher than that in the aspirin group with the annual event rates of total hemorrhages of 10.2%, 7.6% and 2.2%, respectively, in the 3 groups （P=0.001）. Furthermore, there was no significant difference in all cause mortality among the three study groups. Conclusion In Chinese patients with NVAF, the warfarin therapy （INR 1.6-2.5） for the prevention of thromboembolic events was superior to aspirin.

Effect of nifekalant on acute electrical remodelling in rapid atrial pacing canine model

Background Nifekalant may prevent atrial fibrillation （AF） and possibly be useful in treatment of atrial tachyarrhythmia in patients with severe heart failure. This study investigated the electophysiologic effect of nifekalant on the acute atrial remodeling in rapid atrial pacing （RAP） model of canine. Methods Twelve mongrel dogs subjected to rapid stimulation （400 beats/min） at left atrial appendage （LAA） for 24 hours, were randomized into the control group （rapid pacing only, n=6） and the nifekalant group （intravenous nifekalant therapy immediately after RAP, n=6）. Atrial electrophysiological parameters were measured in right atrium, coronary sinus, LAA, posterior wall of left atrium （PWLA） and left superior pulmonary vein （LSPV）, before and after the RAP. Results In the control group, the effective refractory periods （ERP） were shortened greatly at all sites, paced dogs had substantially shorter ERPs in the high right atrium, LAA, and LSPV, but fewer changes in the PWLA, the coefficient variation of ERP （COV ERP） was increased significantly. After rapid atrial stimulation, the inducibility of AF increased significantly [induction number： pre-RAP vs post-RAP, 1.00 ± 0.89 vs 8.17 ± 2.79, P〈0.01; duration of AF： pre-RAP vs post-RAP, （450.34± 362.59） ms vs （9975.77±4376.99） ms, P〈0.01]. In the nifekalant group, although the ERPs were prolonged at all sites compared with those in pre-RAP state, only the value at LSPV differed significantly from that in pre-RAP state [pre-RAP vs post-RAP, （102.50±5.24） ms vs （132.51 ±5.20） ms, P〈0.01]; the COV ERP did not change statistically in this group. The inducibility of AF slightly increased but insignificantly after pacing [induction number： pre-RAP vs post-RAP, 0.83 ±0.75 vs 1.67±0.82, P=0.19; duration of AF： pre-RAP vs post-RAP, （378.67±317.88） ms vs （1124.08± 1109.77） ms, P=0.06]. Conduction time values did not alter significantly in either of the two groups after RAP. Condusions In canine RAP model, nifekalant inhibited ERP shortening and ERP heterogeneity increasing, decreased AF induction. Nifekalant can reverse acute electrical remodeling effect in this model.

Linear ablation of left atrium for the treatment of atrial fibrillation guided by double Lasso catheters and three dimensional electroanatomical mapping

Background Linear ablation of left atrium （LA） guided by three dimensional （3-D） electroanatomical mapping （Carto） has been used in many centres worldwide for the treatment of atrial fibrillation （AF） instead of pure anatomical approaches. There were little data about linear ablation of LA guided by Carto and double Lasso catheters in China. We report the results of linear ablation of LA guided by both Carto and double Lasso catheters. Methods After the anatomical model of LA and all pulmonary veins （PVs） had been established, circumferential ablations of the left pulmonary vein antrum and the right pulmonary vein antrum were performed with 2 circumferential mapping catheters （Lasso） placed within the ipsilateral superior and inferior PVs. The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials （PVPs）. Oral amiodarone or propafenone was taken for at least 3 months by patients with persistent AF, permanent AF or those whose PVPs had not been isolated completely. The recurrence of atrial tachyarrhythmias was observed 3 months after the procedure. Results There were 106 patients （mean age, 51.4±9.9 years）. Seventy-eight patients had paroxysmal AF, 12 persistent AF and 16 permanent AF. Onset of atrial fibrillation occurred in 52 patients during ablation procedure. Thirty-two patients restored to sinus rhythm eventually after the procedure. Abolishment or dissociation of PVPs was accomplished during the procedure in 94 patients （88.7%）. The duration of procedure and exposure to X-ray were （213±45） minutes and （32.5± 12.8） minutes, respectively. Among the 87 patients followed up for over 3 months, 62 were free of atrial tachyarrhythmias （including 8 patients who were still taking oral amiodarone）. The success rate was 71.3% in the first procedure. Two patients had pericardial effusion treated by pericardial puncture and effusion drainage. No pulmonary vein stenosis, atrioesophageal fistula, stroke or procedural death occurred. Conclusions Combination of double Lasso catheters with 3-D electroanatomical mapping to guide the linear ablation of left atrium procedure can confirm the isolation of PVPs.

Chinese Medicine Shensong Yangxin Capsule(参松养心胶囊)Ameliorates Myocardial Microcirculation Dysfunction in Rabbits with Chronic Myocardial Infarction

Objective:To investigate the effect of Chinese compound Shensong Yangxin Capsule(参松养心胶囊,SSYX)on myocardial microcirculation in myocardial-infarcted rabbits.Methods:Myocardial infarction(MI)was established in rabbits by ligation of the left circumflex coronary.Thirty rabbits were randomly divided into the control group,the MI group(model),and the MI treated with SSYX group(MI+SSYX)by a random number table method.After 4 weeks of administration,low-energy real-time myocardial contrast echocardiography(RT-MCE)was conducted to assess the microcirculatory perfusion.Immunofluorescence double staining was used to detect the capillary density.The endothelial ultrastructure was observed with a transmission electron microscope.The m RNA expression levels of vascular endothelial growth factor(VEGF),endothelin 1(ET-1),prostaglandin I2(PGI2)and endothelial nitric oxide synthase(e NOS)were measured by real-time quantitative polymerase chain reaction(Real-time PCR).The plasmic levels of ET-1,thromboxane A2(TXA2),nitric oxide(NO)and von willebrand factor(v WF)were examined with enzyme-linked immunosorbent assays(ELISA).Results:SSYX significantly improved the myocardial blood volume,myocardial micro bubble velocity,and myocardial inflow according to the examination of RT-MCE,and it visibly ameliorated the capillary endothelial structure.Furthermore,compared with the MI group,the plasma levels of TXA2,ET-1 and v WF contents significantly decreased in the MI+SSYX group,and the ET-1 mRNA expression levels of myocardium in the border zone significantly decreased,and the VEGF,PGI2 and e NOS m RNA expression levels significantly increased(all P<0.05).Conclusions:SSYX has favorable advantages in ameliorating the impaired myocardial microcirculation following MI.The mechanisms of the effect are related to the ability of SSYX in balancing the endothelial-derived vasodilators and vasoconstrictors,and up-regulating the expression of VEGF and e NOS.

Mitral isthmus ablation in patients with prosthetic mitral valves

Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mitral valves （MVs） was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium （LA） mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan. Results During the study period, a consecutive of 19 patients （male/female=12/7, mean age of （48±6） years） with prosthetic MVs （16 with metal valves, 3 with biologic valves） entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages （（2.0±1.0） vs. （3.1±1.3） mV, P=-0.002）, more fragmented potentials （19/19 vs. 20/15, P 〈0.001 ）, and higher impedance （（132±34） vs. （110±20） Ω, P=0.004）. After initial ablation, more residual gaps along the MI lesions were found in study group （2.4±0.4 vs. 1.7±0.3, P 〈0.001）. The mean length of MI （（6.2±3.3） vs. （7.1±2.3） cm, P=-0.25） was comparable between 2 groups, but the MI in study group was much thicker （（3.1±1.8） vs. （2.1±1.07） cm, P=0.01） and all were found as pouch type （19/19 vs. 2/35, P 〈0.001）. The follow-up results were comparable （65.1% vs. 72.3%, P=-0.30）. Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.

ADAMTS-1 expression in rat myocardium after ischemic preconditioning： age-associated differences

Background It has been found that cardiac protection afforded by ischemic preconditioning （IPC） is significantly reduced in the senescent myocardium. ADAMTS-1 （a disintesrin and metalloprotease with thrombospondin type 1 motifs） has been shown to inhibit angiogenesis in a variety of in vitro and in vivo assays. The aim of this study was to investigate the age-associated differences in ADAMTS-1 protein expression in rat myocardium after ischemic preconditioning. Methods Sixty-four young （4 months） and old （24 months） male Sprague-Dawley rats were randomly assigned to an IPC group （40 rats） or a sham group （rats）. A model of delayed IPC was induced and rats were sacrificed and myocardial samples were harvested from the ischemic-reperfused region for immunohistochemical detection of ADAMTS-1 at serial time points after IPC. A model of myocardial infarction was produced by ligation of the left anterior descending coronary artery in additional sets of young and old rats after sham or IPC procedures, then age-associated myocardial infarction survival after IPC was calculated. Results ADAMTS-1 expression increased significantly in old rats compared to young rats （P 〈0.05）. The mean densities of ADAMTS-1 protein at 0, 6, 12, and 24 hours in young-IPC group after IPC were 0.05＋0.01, 0.13±0.03, 0.16±0.04, and 0.12±0.03 vs. 0.07±0.03, 0.20±0.03, 0.24±0.05, and 0.21±0.04 in old-IPC group. IPC resulted in diminished survival rates （5/35 vs. 6/14, old-IPC group vs shortening （（13.9±2.8）% vs. （18.3±2.3）%, P 〈0.05） and old-sham group, P 〈0.05）, reduced left ventricular fractiona increased the myocardial infarction size （（37.9±3.2）% vs （32.8±5.1）%, P 〈0.05） in the older rats. Conclusions Cardioprotection with IPC is attenuated in the older heart. ADAMTS-1 expression induced by IPC is greater in old rats. Over-expression of anti-angiogenic factors might be a potential mechanism behind reduced protection after IPC associated with aging.

Interventricular septum motion abnormalities:unexpected echocardiographic changes of Brugada syndrome

Background There remains controversy about whether Brugada syndrome （BS） has structural heart changes. We occasionally noted that a patient with BS had a quite unusual regional wall motion abnormality at the basal segment of the interventricular septum （IVS） during echocardiographic examination. The unexpected finding promoted us to reexamine our patients with BS by echocardiographic interrogation in the present study. Methods Patients with BS （n=11）, patients with complete right bundle branch block （RBBB） （n=11）, and control subjects （n=11） were enrolled in this study. Two-dimensional echocardiography （2DE） was performed to obtain parasternal left ventricular long axis view on which M-mode scanning line was adjusted to be perpendicular to the basal segment of IVS for delineation of the segmental motion curve, with a simultaneously electrocardiographic tracing. Results 2DE revealed a rapid swing motion shifting toward the right ventricle of the IVS basal segment at early systole in 73% （8/11） patients with BS, which was further confirmed on the M-mode curve evidenced by an early systolic notch toward the right ventricle. The position of the notch corresponded to C-point on the mitral motion curve, lasting for （53±5） ms. There were no similar changes both in patients with RBBB and in the control subjects. Conclusion IVS basal motion abnormalities at early-systolic phase may be the novel finding of BS.

Prognosis investigation in patients with chronic heart failure and pericardial effusion

Background Researchers still do not reach the consensus on the incidence, characters and the prognostic value of pericardial effusion （PE） in patients with chronic heart failure （CHF）. This study is to investigate the incidence, characters and the prognostic value of pericardial effusion （PE） in patients with CHF.

Sinus node, phrenic nerve and electrical connections between superior vena cava and right atrium： lessons learned from a prospective study

Background When performing superior vena cava isolation, the major concerns are inadvertent ablation on sinus node and right phrenic nerve. However, little is known about the spatial relationship of electrical connections between superior vena cava and right atrium with the sinus node and phrenic nerve locations among individual patients.Methods We studied 87 patients （male/female 60/27, mean age of （51±9） years） with atrial fibrillation. Before superior vena cava isolation, the sinus node site was defined by right atrium activation mapping during sinus rhythm and the right phrenic nerve site was localized via pacing manoeuvre. Superior vena cava was isolated by ablation at the electrical connection under the guidance of circular mapping catheter. The sites of sinus node, phrenic nerve and electrical connections were noted. Continuous variables were compared using Student＇s t test. A P value 〈0.05 was considered statistically significant.Results Right atrium activation mapping revealed that the sinus node located at the anterior lateral segment of superior vena cava-right atrium junction in all patients. In 82 patients with detectable diaphragmatic stimulations, the phrenic nerve sites were predominantly at the lateral segment （70/82） with anterior lateral and anterior segments for a few patients. A total of 165 electrical connections were located among all 87 patients, and this averaged 1.8±0.6 （1-3） per patient. The anterior septum （72 patients （43.6%））, the anterior wall （40 （24.2%））, and the posterior septum （35 （35.4%）） of superior vena cava-right atrium junction were the electrical connection regular sites. Superior vena cava was isolated in all patients. Two patients developed sinus bradycardia, with 3 mild superior vena cava stenosis and 2 phrenic nerve palsy.Conclusions The sinus node, phrenic nerve and electrical connection sites were distributed along the superior vena cava-right atrium junctions at expected locations for most patients. The electrical connections were separated from the sinus node and phrenic nerve sites. With the activation mapping of right atrium and pacing along superior vena cava-right atrium junctions, the sinus node and phrenic nerve were localized and superior vena cava isolated in most patients.

Multi-link Vision and MiniVision stent registry in Asian patients with coronary artery disease:a prospective,multi-center study

Background Recent studies have showed that the fine mesh stents are associated with a significant reduction in both clinical and angiographic re-stenosis of the coronary arteries. To maintain a very satisfactory radio-opacity using the stents, Guidant of the USA has designed a new type of bare metal stents （BMS）-Multi-link （ML） Vision / ML MiniVision stents. The clinical outcomes of Asian patients with coronary artery disease （CAD） after implanting the Multi-link Vision or MiniVision stent were investigated in this study. Methods An observational, prospective, multi-center, non-randomized post marketing registry was conducted to demonstrate the efficacy of the BMS- ML Vision / ML MiniVision stents. The primary end point of the registry was clinical target lesion revascularization （TLR） at a 6-month follow-up. The major secondary end points included the rate of major adverse cardiac events （MACE） and serious adverse events （SAE） in hospital and at 6 months; and the rate of clinical TLR as a function of the type of angina. A total of 429 Asian people with 449 lesions from 14 centers were selected for this study, The average reference diameter of the lesions was （3.0±0.5） mm, and the mean length was （15.7±5.0） mm. Results The successful rate of the procedure was 99.3%. Twenty-five percent of the lesions were treated by direct stenting without pre-dilation. Eighty-six percent of the lesions were implanted with ML Vision stent. After the 6-month follow-up, the rate of clinical TLR was 1.4%. The MACE, SAE and target vessel revascularization （TVR） were 6.8%, 3.5% and 1.4% respectively. Conclusion The current registry showed the excellent 6-month clinical outcomes of ML Vision/ML MiniVision stents in Asian patients with CAD.