Cell and gene therapy for arrhythmias： Repair of cardiac conduction damage

在 sinoatrial 节点(圣)产生的行动潜力 heart.Subsequently 统治一个健康的人的节奏和率，这些行动潜力在一个心罐头原因 arrhythmias.For 例子经由它推动产生或繁殖的传导系统 .Abnormalities 宣传到整个心，心房与心室的节点的圣机能障碍或传导块能导致当前与另外的手传导损坏可以引起的植入的电子 pacemaker.On 被对待的严肃的

Cardiac arrhythmia and heart failure： From bench to bedside

Cardiac arrhythmia is an abnormal rate and/or rhythm of a heart due to its abnormal electrical impulse origination and/or propagation.Various etiologies can cause arrhythnuas.Heart failure(HF)is a clinical syndrome due to an impaired heart that can not pump sufficient blood to meet the systemic metabolic needs.The common causes of HF include myocardial infarction,hypertension,valvular heart disease,and cardiomyopathy.

Hyperpolarization-activated Cyclic nucleotide-gated Channel and Cardiac Biological Pacemaker:Part Ⅰ

Hyperpolarization-activated cyclic-nucleotide-gated (HCN) channels in the heart modulate cardiac automaticity via the hyperpolarization-activated cation current ( named Ⅰf, Ⅰh, or Ⅰq). Recent studies have unveiled the molecular identity of HCN (HCN1-4) channels. HCN isoforms are unevenly expressed in the heart, even in the sinoatrial node. Features of HCN currents have been characterized in cardiac and other types of cells or in cell lines transfected with the HCN isoforms. The factors modulating Ih and the physiological significance of HCN channels in the heart have been extensively investigated in recent years. The hypothesis for transplanting and/or creating biological pacemakers to replace diseased sinoatrial and/or atrioventricular nodes has been postulated and tested in animal models. Local overexpression of HCN2 channels in the left atrium or in the left conductive bundle branch of the left ventricle via gene delivery induced significant Ⅰh and escape rhythms during vagal stimulation in canines. In addition, implantation of human mesenchymal stem cells with overexpression of HCN2 channels to the canine left ventricular wall was associated with formation of spontaneous escape rhythms of left-sided origin during vagal-stimulation-induced sinus arrest. This preliminary data suggest that the use of HCN channels may hold great promise in,the development of biological pacemakers.

Hyperpolarization-activated Cyclic nucleotide-gated Channel and Cardiac Biological Pacemaker:Part Ⅱ

Abstract Hyperpolarization-activated cyclic-nucleotide-gated ( HCN) channels in the heart modulate cardiac automaticity via the hyperpolarization-activated cation current (named If, Ih, or Iq). Recent studies have unveiled the molecular identity of HCN (HCN 1-4) channels. HCN isoforms are unevenly expressed in the heart, even in the sinoatrial node. Features of HCN currents have been characterized in cardiac and other types of cells or in cell lines transfected with the HCN isoforms. The factors modulating Ih and the physiological significance of HCN channels in the heart have been extensively investigated in recent years. The hypothesis for transplanting and/or creating biological pacemakers to replace diseased sinoatrial and/or atrioventricular nodes has been postulated and tested in animal models. Local overexpression of HCN2 channels in the left atrium or in the left conductive bundle branch of the left ventricle via gene delivery induced significant Ih and escape rhythms during vagal stimulation in canines. In addition, implantation of human mesenchymal stem cells with overexpression of HCN2 channels to the canine left ventricular wall was associated with formation of spontaneous escape rhythms of left-sided origin during vagal-stimulation-induced sinus arrest. This preliminary data suggest that the use of HCN channels may hold great promise in the development of biological pacemakers.

IN VIVO CHARACTERIZATION OF ATTACHMENT SAFETY BETWEEN CARDIAC PACING LEAD AND CANINE HEART MUSCLE

在 vivo，拧紧犬的心的电极并且在铅心肌层接口上分配外部刺激的实验被执行评估铅 / 心肌层坚持安全。电极特殊被设计招待紧张计量器的一个测量单位。我们在自然的心与外部刺激跳动并且跳动下面从 12 条狗获得了铅 / 心相互作用数据。从尖锐阶段和拔出踱步的皮带的长期的阶段记录的数据与对方相比。电极 / 心相互作用被心敲击引起并且由肺呼吸影响了。这个过程导致了可容忍的损坏到皮带或心肌层。当外部刺激的频率增加，相互作用减少。皮带是更可能的在更高的刺激频率下面从心肌层被分开。在植入地点的一样，更安全的踱步铅 / 心肌层附件能比在尖锐测试在长期的测试被认识到。

经静脉拔除心内膜导线:目前认识和建议(2011年修订版)

1经静脉拔除心内膜导线发展简介 随着电子技术的发展,心内植入型电子装置(cardiac implantable electronic device,CIED),包括起搏器与植入型心律转复除颤器( implantable cardioverter defibrillator,ICD)的植入量日益增加,相关的临床问题也随之增多,例如CIED的感染、导线故障、静脉血栓形成等。特别是感染,轻者为局部囊袋肿胀、化脓、破溃,严重者甚至导致菌血症、血栓性静脉炎、心内膜炎等严重并发症,拔除心内膜导线和取出脉冲发生器是唯一有效的根治感染的方法。

主编寄语

心律学科近年来的发展成果日新月异,极大地推动了相关学科和临床医学的进步。学科自身的发展不仅切实保障了患者的安全,提高了临床质量,并且对于延长人口寿命和保障生活质量也起了重要的作用。 心律学科作为第一届中国国际继续医学教育大会的重要组成部分,“2009-2010心律学科年度进展报告”(蓝皮书)完美发布成为心律学科发展进程中华关的瞬间。由心律学科的专家教授共同打造的蓝皮书,体现了“普及与提高合作与发展”的主题。 “2010-2011心律学科年度进展报告”将继续延续前一本的主题,向着更完美的方向发展一本次“蓝皮书”涵盖心律学科发展中的诸多专题,揭示“心房颤动”、 “心脏性猝死”、 “心脏再同步治疗”等学科热点的国内外发展动态。同时, “蓝皮书”充分展现了我国大陆地区心律学科发展的水平及现状,包括心律失常发病情况、治疗机构现状、医卫人员分布、继续教育情况等,并将近期正在执行的临床指南作为重要内容进行发布。

计算机模型和仿真在心脏病研究中的应用(待续)

随着计算机性能的提高，计算机模型被广泛应用于研究心肌细胞电生理与新陈代谢的内在机制，其在探索各种心脏病的诱因与疗法中也具有独特的应用价值。虽然计算机模型只是对真实存在系统的近似描述,但是一个成熟的心脏模型不仅能够模拟系统中各种生理过程，而且能够预测整个系统在非正常甚至疾病状态下的动态反应。本文简述了计算机心脏模型的发展历史和最新进展，并列举了其在一些心脏疾病研究中的应用。因篇幅所限，本文仅讨论单细胞的情况，有关二维多细胞组织和三维心脏模型的综述请参考相关文献。

计算机模型和仿真在心脏病研究中的应用(续前)

在细胞层面，离子通道的改变通常对应于遗传性心律失常综合征，例如长QT综合征（long Q-T syndrome, LQTS）和Brugada综合征（Brugada syndrome，BrS），主要体现在编码心肌细胞离子通道的基因发生突变。Clancy和Rudy模拟了SCN 5 0A基因的KPQ基因突变（获得功能的基因突变）所导致的LQTS，模拟结果显示，基因突变导致的钠电流失活门多肽的改变中断钠电流失活，从而引起后期钠电流的产生。这导致了电动势时程的延长和QT间期的延长，从而形成LQTS。