Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains uninvestigated.Methods We reviewed clinical data from 376 patients w...Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains uninvestigated.Methods We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to 2017.CRT-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50% in absolute values at 6-month follow-up.All CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-hormonal antagonists (NHA)(defined as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term outcome.Results A total of 60 patients met criteria for super-response.One of thirteen (7.7%) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3%) in CRT-SRs with NHA (P = 0.526).However,3 of 13 (23.1%) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1%) CRT-SRs with NHA had this endpoint (P = 0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75%,P = 0.014),which was not observed in non-ischemic etiology group (2.6% vs.0,P = 1.000) during long-term follow-up.Conclusions Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF hospitalization.However,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.展开更多
Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (...Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-D).Methods We retrospectively analyzed data from 428 patients who had an ICD/CRT-D equipped with home monitoring.Baseline PR and RR interval data prior to ICD/CRT-D implantation were collected from standard 12-lead electrocardiograph,and the PR/RR was calculated.The primary endpoint was appropriate ICD/CRT-D treatment of ventricular arrhythmias (VAs),and the secondary endpoint was cardiac death.Results During a mean follow-up period of 38.8 ± 10.6 months,197 patients (46%) experienced VAs,and 47 patients (11%) experienced cardiac death.The overall PR interval was 160 ± 40 ms,and the RR interval was 866 ± 124 ms.Based on the receiver operating characteristic curve,a cut-off value of 18.5% for the PR/RR was identified to predict VAs.A PR/RR ≥ 18.5% was associated with an increased risk of VAs [hazard ratio (HR)= 2.243,95% confidence interval (CI)= 1.665–3.022,P < 0.001) and cardiac death (HR = 2.358,95%CI = 1.240–4.483,P = 0.009) in an unadjusted analysis.After adjustment in a multivariate Cox model,the relationship remained significant among PR/RR ≥ 18.5%,VAs (HR = 2.230,95%CI = 1.555–2.825,P < 0.001) and cardiac death (HR = 2.105,95%CI = 1.101–4.025,P = 0.024.Conclusions A PR/RR ≥ 18.5% at baseline can serve as a predictor of future VAs and cardiac death in ICD/CRT-D recipients.展开更多
Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation （IHVF）. Methods Data of patients with IHVF in a single center were collected. Clinical characte...Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation （IHVF）. Methods Data of patients with IHVF in a single center were collected. Clinical characteristics of patients were compared between those survived （n=112） and those died （n=94）, and those with IHVF occurred in inpatient ward and in emergency center. Multiple logistic regression analysis was used to identify factors associated with survival. Results There were 206 events in the analysis. The most common underlying disease was coronary artery disease （CAD）, especially acute myocardial infarction （AMI）. On multiple logistic regression analysis, independent predictors for failure to survive were higher NYHA class （odds ratio 1.7, 95% CI, 1.3-2.2, P〈 0.001）, lower serum potassium concentration （ [K＋] ） （odds ratio, 2.9, 95% CI, 1.9-4.3, P--0.007） and adrenaline usage （odds ratio, 25, 95% CI 11.5-55.1, P〈 0.001）. Emergency group have better NYHA class （P = 0.012）, lower [K-] （P 〈 0.001） than in inpatient ward group. Hypokalemia （serum potassium level 〈4.5 mmol/L） was found in all patients with AMI in emergency group. In AMI sub-group, 56.9% of IHVF events occurred within the first day after AMI, and decreasing within 2 weeks. Patients with fight coronary artery as infarction related artery （IRA） oRen （8/9, 88.9~,5） had bmdycardia （R-R interval 〉 ls） before the occurrence of IHVF, while those with left anterior descending artery as IRA often showed tachycardia （R-R interval 〈 0.6s） （8/12, 66.7%）. Conclusion The most common disease causing IHVF is CAD. Keeping [K＋] above 4.5mmol/1 could prevent on-setting IHVF, especially to AMI patients. The worse heart function is associated with higher rate of IHVF and worse pmgnosis （J Geriatr Cardio12010; 7：21-24）.展开更多
BACKGROUND Pulmonary vein isolation(PVI)alone for persistent atrial fibrillation(PersAF)remains controversial.The characteristics of cryoballoon ablation(CBA)to treat PersAF and the blanking period recurrence are unde...BACKGROUND Pulmonary vein isolation(PVI)alone for persistent atrial fibrillation(PersAF)remains controversial.The characteristics of cryoballoon ablation(CBA)to treat PersAF and the blanking period recurrence are underreported.METHODS This study retrospectively analyzed patients with PersAF undergoing second-generation CBA for de novo PVI.The post-procedural efficacy and survival analysis were compared between patients with different PersAF durations.The multivariate Cox regression analysis was used to detect the risk factors for recurrence.Early and long-term recurrence were analyzed relative to each other.RESULTS A total of 329 patients were enrolled,with a median PersAF duration of 4.0 months(interquartile range:2.0–12.0 months);257 patients(78.1%)were male.Kaplan-Meier analysis of freedom from atrial fibrillation recurrence at 12,24,and 30 months showed 71.0%,58.5%,and 54.9%,respectively.Early PersAF had a relatively favorable survival rate and a narrow P-wave duration of restoring sinus rhythm compared with that of PersAF lasting more than three months(P<0.05).The multivariate Cox regression analysis revealed that PersAF duration and left atrial anteroposterior diameter≥42 mm were the risk factors for atrial fibrillation recurrence after CBA[hazard ratio(HR)=1.89,95%CI:1.01–1.4,P=0.042;HR=3.6,95%CI:2.4–5.4,P<0.001,respectively].The blanking period recurrence predicted the long-term recurrence(P<0.0001).CONCLUSIONS CBA of PersAF had safety and efficacy to reach de novo PVI.The PersAF duration and left atrial size were risk factors for atrial fibrillation recurrence after CBA.Blanking period recurrence was associated with long-term recurrence.展开更多
脉冲电场是一种新型心脏导管消融能量源,其通过高压脉冲电场在细胞膜上穿孔,导致细胞凋亡或坏死。脉冲电场消融(pulsed field ablation,PFA)具有(相对)特异性损伤心肌、迅速制造损伤且不依赖变温制造损伤等优势,已广泛用于心房颤动的导...脉冲电场是一种新型心脏导管消融能量源,其通过高压脉冲电场在细胞膜上穿孔,导致细胞凋亡或坏死。脉冲电场消融(pulsed field ablation,PFA)具有(相对)特异性损伤心肌、迅速制造损伤且不依赖变温制造损伤等优势,已广泛用于心房颤动的导管消融治疗。目前,PFA的前沿研究正在向室性心律失常进军。本文结合近年来的研究结果,对PFA在室性心律失常治疗中的最新进展进行综述。展开更多
文摘Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains uninvestigated.Methods We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to 2017.CRT-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50% in absolute values at 6-month follow-up.All CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-hormonal antagonists (NHA)(defined as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term outcome.Results A total of 60 patients met criteria for super-response.One of thirteen (7.7%) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3%) in CRT-SRs with NHA (P = 0.526).However,3 of 13 (23.1%) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1%) CRT-SRs with NHA had this endpoint (P = 0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75%,P = 0.014),which was not observed in non-ischemic etiology group (2.6% vs.0,P = 1.000) during long-term follow-up.Conclusions Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF hospitalization.However,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.
文摘Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-D).Methods We retrospectively analyzed data from 428 patients who had an ICD/CRT-D equipped with home monitoring.Baseline PR and RR interval data prior to ICD/CRT-D implantation were collected from standard 12-lead electrocardiograph,and the PR/RR was calculated.The primary endpoint was appropriate ICD/CRT-D treatment of ventricular arrhythmias (VAs),and the secondary endpoint was cardiac death.Results During a mean follow-up period of 38.8 ± 10.6 months,197 patients (46%) experienced VAs,and 47 patients (11%) experienced cardiac death.The overall PR interval was 160 ± 40 ms,and the RR interval was 866 ± 124 ms.Based on the receiver operating characteristic curve,a cut-off value of 18.5% for the PR/RR was identified to predict VAs.A PR/RR ≥ 18.5% was associated with an increased risk of VAs [hazard ratio (HR)= 2.243,95% confidence interval (CI)= 1.665–3.022,P < 0.001) and cardiac death (HR = 2.358,95%CI = 1.240–4.483,P = 0.009) in an unadjusted analysis.After adjustment in a multivariate Cox model,the relationship remained significant among PR/RR ≥ 18.5%,VAs (HR = 2.230,95%CI = 1.555–2.825,P < 0.001) and cardiac death (HR = 2.105,95%CI = 1.101–4.025,P = 0.024.Conclusions A PR/RR ≥ 18.5% at baseline can serve as a predictor of future VAs and cardiac death in ICD/CRT-D recipients.
文摘Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation （IHVF）. Methods Data of patients with IHVF in a single center were collected. Clinical characteristics of patients were compared between those survived （n=112） and those died （n=94）, and those with IHVF occurred in inpatient ward and in emergency center. Multiple logistic regression analysis was used to identify factors associated with survival. Results There were 206 events in the analysis. The most common underlying disease was coronary artery disease （CAD）, especially acute myocardial infarction （AMI）. On multiple logistic regression analysis, independent predictors for failure to survive were higher NYHA class （odds ratio 1.7, 95% CI, 1.3-2.2, P〈 0.001）, lower serum potassium concentration （ [K＋] ） （odds ratio, 2.9, 95% CI, 1.9-4.3, P--0.007） and adrenaline usage （odds ratio, 25, 95% CI 11.5-55.1, P〈 0.001）. Emergency group have better NYHA class （P = 0.012）, lower [K-] （P 〈 0.001） than in inpatient ward group. Hypokalemia （serum potassium level 〈4.5 mmol/L） was found in all patients with AMI in emergency group. In AMI sub-group, 56.9% of IHVF events occurred within the first day after AMI, and decreasing within 2 weeks. Patients with fight coronary artery as infarction related artery （IRA） oRen （8/9, 88.9~,5） had bmdycardia （R-R interval 〉 ls） before the occurrence of IHVF, while those with left anterior descending artery as IRA often showed tachycardia （R-R interval 〈 0.6s） （8/12, 66.7%）. Conclusion The most common disease causing IHVF is CAD. Keeping [K＋] above 4.5mmol/1 could prevent on-setting IHVF, especially to AMI patients. The worse heart function is associated with higher rate of IHVF and worse pmgnosis （J Geriatr Cardio12010; 7：21-24）.
基金supported by the National Natural Science Foundation of China(No.81670309).
文摘BACKGROUND Pulmonary vein isolation(PVI)alone for persistent atrial fibrillation(PersAF)remains controversial.The characteristics of cryoballoon ablation(CBA)to treat PersAF and the blanking period recurrence are underreported.METHODS This study retrospectively analyzed patients with PersAF undergoing second-generation CBA for de novo PVI.The post-procedural efficacy and survival analysis were compared between patients with different PersAF durations.The multivariate Cox regression analysis was used to detect the risk factors for recurrence.Early and long-term recurrence were analyzed relative to each other.RESULTS A total of 329 patients were enrolled,with a median PersAF duration of 4.0 months(interquartile range:2.0–12.0 months);257 patients(78.1%)were male.Kaplan-Meier analysis of freedom from atrial fibrillation recurrence at 12,24,and 30 months showed 71.0%,58.5%,and 54.9%,respectively.Early PersAF had a relatively favorable survival rate and a narrow P-wave duration of restoring sinus rhythm compared with that of PersAF lasting more than three months(P<0.05).The multivariate Cox regression analysis revealed that PersAF duration and left atrial anteroposterior diameter≥42 mm were the risk factors for atrial fibrillation recurrence after CBA[hazard ratio(HR)=1.89,95%CI:1.01–1.4,P=0.042;HR=3.6,95%CI:2.4–5.4,P<0.001,respectively].The blanking period recurrence predicted the long-term recurrence(P<0.0001).CONCLUSIONS CBA of PersAF had safety and efficacy to reach de novo PVI.The PersAF duration and left atrial size were risk factors for atrial fibrillation recurrence after CBA.Blanking period recurrence was associated with long-term recurrence.
文摘脉冲电场是一种新型心脏导管消融能量源,其通过高压脉冲电场在细胞膜上穿孔,导致细胞凋亡或坏死。脉冲电场消融(pulsed field ablation,PFA)具有(相对)特异性损伤心肌、迅速制造损伤且不依赖变温制造损伤等优势,已广泛用于心房颤动的导管消融治疗。目前,PFA的前沿研究正在向室性心律失常进军。本文结合近年来的研究结果,对PFA在室性心律失常治疗中的最新进展进行综述。
