In the present paper, effects of electroacupuncture (EA) of 3 points of the Heart Meridian and other 3 points of the Lung Meridian on changes of electrocardiogram (ECG), small intestinal electrogram (SIG) and electroe...In the present paper, effects of electroacupuncture (EA) of 3 points of the Heart Meridian and other 3 points of the Lung Meridian on changes of electrocardiogram (ECG), small intestinal electrogram (SIG) and electroencephalogram (EEG) in intravenous drip of pituitrin induced myocardial ischemia rabbits. The three points of the Heart Meridian are "Shenmen" (HT 7), "Lingdao" (HT 4) and one point between HT 7 and HT 4, the 3 points of the Lung Meridian are "Taiyuan"(LU 9), Lieque (LU 7) and one point between LU 9 and LU 7. These points are punctured with filiform needles and stimulated electrically by setting the parameters being frequency of 2.5 Hz, dense sparse waves and duration of 10 min. Results display that the regulative effect of EA of the Heart Meridian is superior to that of EA of the Lung Meridian on the three indexes, showing a closer correlation between the whole Heart Meridian and activities of ECG, SIG and EEG.展开更多
Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evalu...Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）展开更多
Background Clinical observations have shown that the complex fractionated atrial electrogram （CFAE） associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investiga...Background Clinical observations have shown that the complex fractionated atrial electrogram （CFAE） associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investigate the impact of CFAE ablation on vagal modulation to atria and vulnerability to develop atrial fibrillation （AF）. Methods Ten adult mongrel dogs were involved. Cervical sympathovagal trunks were decentralized and sympathetic effects were blocked. CFAE was color tagged on the atrial 3-dimensional image and ablated during AF induced by S1S2 programmed stimulation plus sympathovagal trunk stimulation. Atrial effective refractory period （ERP） and vulnerability window （VW） of AF were measured on baseline and at vagal stimulation at 4 atrium sites. Serial tissue sections from ablative and control specimens received hematoxylin and eosin staining for microscopic examination. Results Most CFAE areas were localized at the right superior pulmonary quadrant, distal coronary sinus （CS~） quadrant, and proximal coronary sinus （CSp） quadrant （21.74%, separately）. Sinus rhythm cycle length （SCL） shortening did not decrease significantly after ablation at the sites, including right atrial appendage, left atrial appendage, CSd, and CSp （P 〉0.05）. ERP shortening during vagal stimulation significantly decreased after ablation （P 〈0.01）; the VW to vagal stimulation significantly decreased after ablation （P 〈0.05）. The architecture of individual ganglia altered after ablation. Conclusions CFAE has an autonomic basis in dogs. The decreased SCL and ERP shortening to vagal stimulation after CFAE ablation demonstrate that CFAE ablation attenuates vagal modulation to the atria, thereby suppressing AF mediated by enhanced vagal activity. CFAE ablation could suppress AF mediated by enhanced vagal activity.展开更多
Background Ablation of complex fractionated atrial electrograms （CFAE） is an important adjunctive therapy in atrial fibrillation （AF）. The present study was to elucidate the substrate underlying CFAE. Methods Nine...Background Ablation of complex fractionated atrial electrograms （CFAE） is an important adjunctive therapy in atrial fibrillation （AF）. The present study was to elucidate the substrate underlying CFAE. Methods Nine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation, CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin （HE） and the general neural marker protein gene product 9.5 （PGP9.5）. We compared the characteristics of the myocardium and the ganglionated plexus （GPs） distribution between the CFAE and non-CFAE sites. Results The myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue （（61.7±24,3）% vs, （34.1±9,2）%, P 〈0,01 ）, G Ps in the CFAE site were more abundant than in non-CFAE sites （（34.45±37.46） bundles/cm2 vs, （6.73± 8.22） bundles/cm2, P〈0.01）. Conclusion The heterogeneity Of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.展开更多
Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. O...Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. Our study aimed to study the use of intramyocardial electrograms combined with other noninvasive methods for the monitoring of acute rejection after human heart transplantation. Methods Permanent pacemakers were implanted in 58 patients undergoing heart transplantations. Intramyocardial electrograms （IMEG） were recorded periodically and the results were compared with those from EMBs. The R wave amplitude of the IMEG was used as the index value, the average R wave amplitude at the third week following transplantation was considered as the baseline, and a reduction of 〉20% compared with the baseline was regarded as a positive result. EMB was performed in cases of positive IMEG results and also at other times. Other noninvasive methods were used to help the diagnosis. Acute rejection （AR） was defined as International Society of Heart-Lung Transplantation grade IliA or higher. Results We obtained 1231 IMEG records and 127 EMBs. Of the total 127 EMBs, 53 were positive, in which there were 42 IMEG positive results and 11 negative, while in the rest 74 negative EMBs, there were 9 IMEG positive results and 65 negative. The sensitivity of IMEG for the diagnosis of AR was 79.2%, and the specificity was 87.8%. The positive predictive value was 82.4% and the negative predictive value was 85.5%. Of the total of 1231 IMEG records, 51 were positive and 1180 were negative. Excluding 11 proved by EMB to be false negative, if the other 1169 were considered as no evidence of rejection, through the other noninvasive methods, AR diagnosed by this noninvasive monitoring strategy, the sensitivity was 79.2%, and the specificity was 99.2%. The positive predictive value was 82.4% and the negative predictive value was 99.1%. Conclusions IMEG can be used as a noninvasive method for monitoring AR following heart transplantation. It is a continuous, safe and inexpensive method, and could reduce the need for EMB combined with other noninvasive methods without reducing the detection of rejection. Chin Med J 2009; 122（2）： 136-139展开更多
Objective To analyze the unipolar electrogram from successful and unsuccessful ablation sites of focal atrial tachycardia (AT), and to evaluate its value in the identification of successful targets.Methods Fifteen con...Objective To analyze the unipolar electrogram from successful and unsuccessful ablation sites of focal atrial tachycardia (AT), and to evaluate its value in the identification of successful targets.Methods Fifteen consecutive patients with focal AT were referred for radiofrequency catheter ablation (RFCA). Both unipolar (from the tip electrode of ablating catheter) and bipolar (from the distal pair of electrode of ablating catheter) electrograms were used to identify the ablation targets of focal AT.Results Successful ablation was echieved in 14 patients. Radiofrequency energy was delivered at a total of 27 sites. The bipolar electrograms associated with successful ablation sites showed earlier atrial deflection relative to P wave onset (36 ms±15 ms vs 30 ms±11 ms, P <0.05) than the electrograms associated with failed ablation sites. At the 14 successful ablation sites, the unipolar electrograms displayed a completely negative atrial wave (“QS” morphology ) beginning with intrinsic deflection. However, at the 13 unsuccessful ablation sites,a “rS” morphology of atrial wave was shown on the unipolar electrogram.Conclusion The “QS” morphology of the atrial wave on unipolar electrograms appears to represent a reliable marker for identifying the successful ablation targets of focal AT, with a high sensitivity and specificity .展开更多
Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-limina...Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-liminating DF gradient and restoring sinus rhythm. Clinical groups have applied the traditional FFT-based approach to generate the three-dimensional dominant frequency (3D DF) maps during electro-physiology (EP) procedures but literature is restricted on using alternative spectral estimation tech-niques that can have a better frequency resolution that FFT-based spectral estimation.展开更多
文摘In the present paper, effects of electroacupuncture (EA) of 3 points of the Heart Meridian and other 3 points of the Lung Meridian on changes of electrocardiogram (ECG), small intestinal electrogram (SIG) and electroencephalogram (EEG) in intravenous drip of pituitrin induced myocardial ischemia rabbits. The three points of the Heart Meridian are "Shenmen" (HT 7), "Lingdao" (HT 4) and one point between HT 7 and HT 4, the 3 points of the Lung Meridian are "Taiyuan"(LU 9), Lieque (LU 7) and one point between LU 9 and LU 7. These points are punctured with filiform needles and stimulated electrically by setting the parameters being frequency of 2.5 Hz, dense sparse waves and duration of 10 min. Results display that the regulative effect of EA of the Heart Meridian is superior to that of EA of the Lung Meridian on the three indexes, showing a closer correlation between the whole Heart Meridian and activities of ECG, SIG and EEG.
文摘Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）
基金This study was supported by the grants from National Natural Science Foundation of China （No. 30770866, 30971272）.
文摘Background Clinical observations have shown that the complex fractionated atrial electrogram （CFAE） associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investigate the impact of CFAE ablation on vagal modulation to atria and vulnerability to develop atrial fibrillation （AF）. Methods Ten adult mongrel dogs were involved. Cervical sympathovagal trunks were decentralized and sympathetic effects were blocked. CFAE was color tagged on the atrial 3-dimensional image and ablated during AF induced by S1S2 programmed stimulation plus sympathovagal trunk stimulation. Atrial effective refractory period （ERP） and vulnerability window （VW） of AF were measured on baseline and at vagal stimulation at 4 atrium sites. Serial tissue sections from ablative and control specimens received hematoxylin and eosin staining for microscopic examination. Results Most CFAE areas were localized at the right superior pulmonary quadrant, distal coronary sinus （CS~） quadrant, and proximal coronary sinus （CSp） quadrant （21.74%, separately）. Sinus rhythm cycle length （SCL） shortening did not decrease significantly after ablation at the sites, including right atrial appendage, left atrial appendage, CSd, and CSp （P 〉0.05）. ERP shortening during vagal stimulation significantly decreased after ablation （P 〈0.01）; the VW to vagal stimulation significantly decreased after ablation （P 〈0.05）. The architecture of individual ganglia altered after ablation. Conclusions CFAE has an autonomic basis in dogs. The decreased SCL and ERP shortening to vagal stimulation after CFAE ablation demonstrate that CFAE ablation attenuates vagal modulation to the atria, thereby suppressing AF mediated by enhanced vagal activity. CFAE ablation could suppress AF mediated by enhanced vagal activity.
基金The study was supported by a grant from the National Natural Science Foundation of China （NSFC） （No. 30971272）.
文摘Background Ablation of complex fractionated atrial electrograms （CFAE） is an important adjunctive therapy in atrial fibrillation （AF）. The present study was to elucidate the substrate underlying CFAE. Methods Nine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation, CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin （HE） and the general neural marker protein gene product 9.5 （PGP9.5）. We compared the characteristics of the myocardium and the ganglionated plexus （GPs） distribution between the CFAE and non-CFAE sites. Results The myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue （（61.7±24,3）% vs, （34.1±9,2）%, P 〈0,01 ）, G Ps in the CFAE site were more abundant than in non-CFAE sites （（34.45±37.46） bundles/cm2 vs, （6.73± 8.22） bundles/cm2, P〈0.01）. Conclusion The heterogeneity Of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.
文摘Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. Our study aimed to study the use of intramyocardial electrograms combined with other noninvasive methods for the monitoring of acute rejection after human heart transplantation. Methods Permanent pacemakers were implanted in 58 patients undergoing heart transplantations. Intramyocardial electrograms （IMEG） were recorded periodically and the results were compared with those from EMBs. The R wave amplitude of the IMEG was used as the index value, the average R wave amplitude at the third week following transplantation was considered as the baseline, and a reduction of 〉20% compared with the baseline was regarded as a positive result. EMB was performed in cases of positive IMEG results and also at other times. Other noninvasive methods were used to help the diagnosis. Acute rejection （AR） was defined as International Society of Heart-Lung Transplantation grade IliA or higher. Results We obtained 1231 IMEG records and 127 EMBs. Of the total 127 EMBs, 53 were positive, in which there were 42 IMEG positive results and 11 negative, while in the rest 74 negative EMBs, there were 9 IMEG positive results and 65 negative. The sensitivity of IMEG for the diagnosis of AR was 79.2%, and the specificity was 87.8%. The positive predictive value was 82.4% and the negative predictive value was 85.5%. Of the total of 1231 IMEG records, 51 were positive and 1180 were negative. Excluding 11 proved by EMB to be false negative, if the other 1169 were considered as no evidence of rejection, through the other noninvasive methods, AR diagnosed by this noninvasive monitoring strategy, the sensitivity was 79.2%, and the specificity was 99.2%. The positive predictive value was 82.4% and the negative predictive value was 99.1%. Conclusions IMEG can be used as a noninvasive method for monitoring AR following heart transplantation. It is a continuous, safe and inexpensive method, and could reduce the need for EMB combined with other noninvasive methods without reducing the detection of rejection. Chin Med J 2009; 122（2）： 136-139
文摘Objective To analyze the unipolar electrogram from successful and unsuccessful ablation sites of focal atrial tachycardia (AT), and to evaluate its value in the identification of successful targets.Methods Fifteen consecutive patients with focal AT were referred for radiofrequency catheter ablation (RFCA). Both unipolar (from the tip electrode of ablating catheter) and bipolar (from the distal pair of electrode of ablating catheter) electrograms were used to identify the ablation targets of focal AT.Results Successful ablation was echieved in 14 patients. Radiofrequency energy was delivered at a total of 27 sites. The bipolar electrograms associated with successful ablation sites showed earlier atrial deflection relative to P wave onset (36 ms±15 ms vs 30 ms±11 ms, P <0.05) than the electrograms associated with failed ablation sites. At the 14 successful ablation sites, the unipolar electrograms displayed a completely negative atrial wave (“QS” morphology ) beginning with intrinsic deflection. However, at the 13 unsuccessful ablation sites,a “rS” morphology of atrial wave was shown on the unipolar electrogram.Conclusion The “QS” morphology of the atrial wave on unipolar electrograms appears to represent a reliable marker for identifying the successful ablation targets of focal AT, with a high sensitivity and specificity .
文摘Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-liminating DF gradient and restoring sinus rhythm. Clinical groups have applied the traditional FFT-based approach to generate the three-dimensional dominant frequency (3D DF) maps during electro-physiology (EP) procedures but literature is restricted on using alternative spectral estimation tech-niques that can have a better frequency resolution that FFT-based spectral estimation.
