HIP fracture is becoming a global public health issue due to increased longevity and the in-creased incidence of osteoporosis.1,2 Patients who underwent surgery experience high rates of mortality and disability, with...HIP fracture is becoming a global public health issue due to increased longevity and the in-creased incidence of osteoporosis.1,2 Patients who underwent surgery experience high rates of mortality and disability, with approximately 5% death rate before discharge and 10% death rate within 30 days after discharge.3,4 Intraoperative cardiac arrest （IOCA） complicates up to 43 per 100,000 surgeries.5 Even with resuscitation by eligible professionals in a well-equipped operating room, IOCA is still associated with 35% imme-diate mortality and 65.5% in-hospital mortality.6,7 The main causes may be related to patient conditions, preoperative complications, anesthesia or surgical procedures.7,8 Age- associated changes in cardiovascular and other systems especially increase the risk of IOCA, which may explains why geriatric patients are the majority who experience asystole during surgery.展开更多
Objective: To investigate the impacts of long-term right ventricular apical pacing on the ventricular remodeling and cardiac functions of patients with high-grade and third-degree atrioventricular blockage with normal...Objective: To investigate the impacts of long-term right ventricular apical pacing on the ventricular remodeling and cardiac functions of patients with high-grade and third-degree atrioventricular blockage with normal heart structures and cardiac functions. In addition, we provide many evidences for choosing an optimal electrode implantation site.Methods: Study participants included patients who were admitted for pacemaker replacements and revisited for examinations of implanted pacemakers at outpatient. Pacemakers were implanted to treat high-grade and third-degree atrioventricular blockage. At the time of pacemaker implantation, patients had normal cardiac functions and showed no serious heart diseases or cardiac dilatation. The durations from the implantation to follow-up were more than 5 years. The pacing rate was higher than 80%. Patients with a left ventricular ejection fraction (LVEF) < 50% and a left ventricular end-diastolic diameter (LVEDD) > 55 mm were excluded. Ventricular remodeling was defined as follows:increase of LVEDD by 10% and a reduction of LVEF by 25% for five years after implantation. Cardiac functions were evaluated according to New York Heart Association (NYHA) classification.Results:A total of 82 patients with a mean age of (66.97±13.19) years (range, 12 to 91 years old),among which 39 male and 43 female were enrolled in this study. The average duration between two assessments was 8.7 years (104.4 months). Before pacemaker implantation, the average left atrial diameter (LA), LVEDD and LVEF were 37.0 mm, 50.23 mm and 64.87%, respectively. After the implantation, these values were 39.39 mm (P=0.000163), 50.82 mm (P=0.177842) and 60.50% (P=0.000104), respectively. Four patients (4.87%) had ventricular remodeling with deteriorations of cardiac function, three of which had anterior wall myocardial infarction after implantation and one had type II diabetes. Clinical symptoms of heart failure were not found among the patients who did not exhibit ventricular remodeling. Conclusion: Through a long-period follow-up study, we found that long-term right ventricular apical pacing in patients with normal heart structure and cardiac function would not generally cause ventricular remodeling and clinical deteriorations of cardiac function. Right ventricular apical is a safe and effective site for pacing electrode wire implantation.展开更多
文摘HIP fracture is becoming a global public health issue due to increased longevity and the in-creased incidence of osteoporosis.1,2 Patients who underwent surgery experience high rates of mortality and disability, with approximately 5% death rate before discharge and 10% death rate within 30 days after discharge.3,4 Intraoperative cardiac arrest （IOCA） complicates up to 43 per 100,000 surgeries.5 Even with resuscitation by eligible professionals in a well-equipped operating room, IOCA is still associated with 35% imme-diate mortality and 65.5% in-hospital mortality.6,7 The main causes may be related to patient conditions, preoperative complications, anesthesia or surgical procedures.7,8 Age- associated changes in cardiovascular and other systems especially increase the risk of IOCA, which may explains why geriatric patients are the majority who experience asystole during surgery.
文摘Objective: To investigate the impacts of long-term right ventricular apical pacing on the ventricular remodeling and cardiac functions of patients with high-grade and third-degree atrioventricular blockage with normal heart structures and cardiac functions. In addition, we provide many evidences for choosing an optimal electrode implantation site.Methods: Study participants included patients who were admitted for pacemaker replacements and revisited for examinations of implanted pacemakers at outpatient. Pacemakers were implanted to treat high-grade and third-degree atrioventricular blockage. At the time of pacemaker implantation, patients had normal cardiac functions and showed no serious heart diseases or cardiac dilatation. The durations from the implantation to follow-up were more than 5 years. The pacing rate was higher than 80%. Patients with a left ventricular ejection fraction (LVEF) < 50% and a left ventricular end-diastolic diameter (LVEDD) > 55 mm were excluded. Ventricular remodeling was defined as follows:increase of LVEDD by 10% and a reduction of LVEF by 25% for five years after implantation. Cardiac functions were evaluated according to New York Heart Association (NYHA) classification.Results:A total of 82 patients with a mean age of (66.97±13.19) years (range, 12 to 91 years old),among which 39 male and 43 female were enrolled in this study. The average duration between two assessments was 8.7 years (104.4 months). Before pacemaker implantation, the average left atrial diameter (LA), LVEDD and LVEF were 37.0 mm, 50.23 mm and 64.87%, respectively. After the implantation, these values were 39.39 mm (P=0.000163), 50.82 mm (P=0.177842) and 60.50% (P=0.000104), respectively. Four patients (4.87%) had ventricular remodeling with deteriorations of cardiac function, three of which had anterior wall myocardial infarction after implantation and one had type II diabetes. Clinical symptoms of heart failure were not found among the patients who did not exhibit ventricular remodeling. Conclusion: Through a long-period follow-up study, we found that long-term right ventricular apical pacing in patients with normal heart structure and cardiac function would not generally cause ventricular remodeling and clinical deteriorations of cardiac function. Right ventricular apical is a safe and effective site for pacing electrode wire implantation.
