His-Purkinje conduction system pacing combined with atrioventricular node ablation improves quality of life in older patients with persistent atrial fibrillation refractory to multiple ablation procedures

BACKGROUND Recurrence of atrial fibrillation(AF)is common in patients with persistent AF even after multiple ablation procedures.His-Purkinje conduction system pacing(HPCSP)combined with atrioventricular node ablation(AVNA)is effective in managing patients with AF and heart failure.This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures,as well as evaluate the feasibility and safety of this therapy.METHODS Older patients(≥65 years)with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA.The success rates and complications were recorded.Pacing parameters,European Heart Rhythm Association(EHRA)scores,and Atrial Fibrillation Effect on Quality-of-Life(AFEQT)scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination.RESULTS Thirty-one patients were enrolled;of those,only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead.The success rates were 100%for HPCSP(22 cases with His bundle pacing,and 9 cases with left bundle branch pacing)and 93.3%(28/30)for AVNA,respectively.By the 6-month follow-up examination,EHRA scores improved significantly(3.00±0.73 vs.2.44±0.63,P=0.014)and AFEQT scores increased markedly(49.6±20.6 vs.70.9±14.0,P=0.001).No severe complications developed.CONCLUSIONS When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures,HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up.This therapy was proved to be safe and effective in this patient population.

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.

高效液相色普法测定兔灌胃后血清中百草枯浓度及其变化特征

目的探索建立高效液相色谱法(HPLC)在测定兔血清中百草枯浓度的可行性,并观察不同剂量百草枯灌胃后兔血清浓度的经时变化情况。方法 12只家兔按照随机数字表法分为两组,每组6只,分别灌胃给予100 mg/kg(高剂量组)和20 mg/kg(低剂量组)百草枯,于给药后1、2、5、12、24、48及72 h采集血清,血清用乙腈直接沉淀蛋白处理后进行高效液相测定。色谱柱条件:流动相为0.1 mol/L磷酸缓冲液(含12.5 mmol/L庚烷磺酸钠)-乙腈(90︰10,TFA调p H=2.8),流速为1.0 ml/min,检测波长为258 nm,柱温为30℃。结果所建立的方法在0.2~100.0 mg/L浓度范围内线性关系良好(r=0.999)。相对回收率在97.82%~101.20%之间,绝对回收率在84.37%~88.80%之间,日内和日间精密度(RSD)<5%。百草枯血药浓度时间曲线为单峰,无论是高剂量组还是低剂量组,给药2 h后其血清浓度达到峰值,之后逐渐下降,其中,高剂量组于给药后72 h后检测不出百草枯,低剂量组于药后24 h检测不出百草枯。重复测量设计的方差分析结果显示,不同时间点间、不同剂量组间的百草枯浓度及高、低剂量组随时间变化趋势差异有统计学意义。结论所建立的HPLC方法可用于测定兔血清百草枯浓度,不同剂量百草枯兔灌胃后其血清浓度和蓄积的时间与剂量有关,给药2 h后血药浓度达峰值。