犬双心室多点组合同步起搏的心肌力学效应研究

目的 :探讨多点组合同步心室起搏对犬心肌收缩 /舒张力学效应和心脏作功的影响。方法 :12只犬 ,随机进行 5种组合模式的双心室同步起搏 ,并以自身窦性心律状态 (SNR )作为对照。记录各起搏状态下 :左室内压上升和下降最大数率 (±dp/dtmax)、左室松弛时间常数 (τ)、左 /右室游离壁室壁肌张力 (L/RV tensileforce ,L/RV TF)、每搏量 (SV )、左室每搏功 (LVSW )和右室每搏功 (RVSW )等心肌收缩 /舒张力学和心脏作功参数。结果 :双室cHisB LVPL起搏和RVA LVPL起搏的心肌收缩力学参数 +dp/dtmax和L/RV TF较右室双点cHisB RVA起搏增加 ,前两组的心肌舒张力学参数 dp/dtmax也较cHisB RVA起搏增加 ,而τ值较后者缩短。双室三点cHisB RVA LVPL起搏和cHisB RVA LVA起搏的上述各参数均优于双室cHisB LVPL起搏和RVA LVPL起搏。而cHisB RVA LVPL起搏的 +dp/dtmax和L/RV TF均较cHisB RVA LVA起搏增加。cHisB RVA LVPL起搏 dp/dtmax较cHisB RVA LVA起搏提高 6.0 % ,τ值缩短 3 .7%。cHisB LVPL起搏和RVA LVPL起搏的SV、LVSW和RVSW等心室作功参数均较cHisB RVA起搏增加 ,而HisB RVA LVPL起搏的上述心脏作功各参数 ,亦分别较cHisB RVA LVA起搏和cHisB LVPL起搏有不同程度的增加。结论 :双室三点cHisB RVA LVPL组合同     

Right ventricular pacing and sensing function in high posterior septal and apical lead placement in cardiac resynchronization therapy

BackgroundThe conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P.MethodsTwo hundred and thirty-five consecutive CRT-P patients were included from 1999-2010. Pacing thresholds at 0.5 ms and 2.5 V, sensing electrograms and lead impedances were measured at implant and repeated 1,3,6,12,18 and 24 months after CRT-P. Electrophysiological measurements of leads located in RV-A and RV-HS were analyzed retrospectively. Bipolar RV leads were used, including high impedance leads, passive fixation and active fixation.ResultsRV pacing leads were implanted in RV-A (n = 79) and RV-HS (n = 156). Average RV pacing thresholds from CRT implant procedure to 24-month follow-up at 0.5 ms were 0.77 ± 0.69 V in RV-A and 0.71 ± 0.35 V in RV-HS (P = 0.31), and at 2.5 V were 0.06 ± 0.08 ms in RV-A and 0.07 ± 0.05 ms in RV-HS (P = 0.12). Average RV electrogram amplitudes from baseline to 24 months after CRT were 15.3 ± 6.9 mV in RV-A and 12.1 ± 6.0 mV in RV-HS (P = 0.55). Average RV impedances during follow-up were 850 ± 286Ω in RV-A and 618 ± 147Ω in RV-HS (P = 0.57). Similar RV lead revisions between RV-A and RV-HS were observed after 2-year follow-up (P = 0.55).ConclusionsThe RV-HS lead position demonstrated stable and acceptable long-term pacing and sensing function, with rates of complications comparable to conventional RV-A lead position in CRT. The RV-HS lead position is feasible in CRT-P.     

Continuation and bifurcation analysis of a periodically forced excitable system

The response of an excitable cell to periodic electrical stimulation is modeled using the FitzHugh-Nagumo (FHN) system submitted to a gaussian-shaped pacing, the width of which is small compared with the action potential duration. The influence of the amplitude and the period of the stimulation is studied using numerical continuation and bifurcation techniques (AUTO97 software). Results are discussed in the light of prior experimental and theoretical findings. In particular, agreement with the documented behavior of periodically stimulated cardiac cells and squid axons is discussed. As previously reported, we find many different "M:N" periodic solutions, period-doubling sequences leading to seemingly chaotic regimes, and bistability phenomena. In addition, the use of continuation techniques has allowed us to track unstable solutions of the system and thus to determine how the different stable rhythms are connected with each other in a bifurcation diagram. Depending on the stimulus amplitude, the aspect of the bifurcation diagram with the stimulus period as main varying parameter can vary from very simple to very complex. In its most developed structure, this bifurcation diagram consists of a main "tree" of period-2(P) branches, where the 1:1, 1:0, 2:2, 2:1,... rhythms are located, and of several closed loops made up of period-{N x 2(P)} branches (N>2), isolated from each other and from the main tree. It is mainly on such loops that N:1 rhythms (N>2) on one hand, and N:N-1 or Wenckebach rhythms (N>2) on the other hand, are located. Stable M:N and M:N-1 rhythms (M>or=N) can be found on the same branch of solutions. They are separated by a region of unstable solutions at small stimulus amplitudes, but this region shrinks gradually as the stimulus amplitude is raised, until it finally disappears. We believe that this property is related to the excitability characteristics of the FHN system. It would be interesting to know if it has any correspondence in the behavior of real excitable cells.     

Biventricular / left ventricular pacing in hypertrophic obstructive cardiomyopathy: an overview

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT), contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD). In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA) and more recently radiofrequency (RF) septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV) pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term) in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling.     

Gastric Pacing for Morbid Obesity: Plasma Levels of Gastrointestinal Peptides and Leptin

Objective: A gastric pacemaker has been developed to treat morbid obesity. Patients experience increased satiety, the ability to reduce food intake, and a resultant weight loss. However, the mechanism behind the changed eating behavior in paced patients is still under investigation. Research Methods and Procedures: This study was performed on 11 morbidly obese patients (mean BMI, 46.0 kg/m²) treated with gastric pacing. The peripheral blood levels of satiety signals of cholecystokinin (CCK), somatostatin, glucagon‐like peptide‐1 (GLP‐1), and leptin were studied 1 month before gastric pacer implantation, 1 month after implantation, and 6 months after activation of electrical stimulation. Blood samples were drawn 12 hours after fasting and in response to a hypocaloric meal (270 kcal). Patients were followed monthly for vital signs and weight level. Results: Gastric pacing resulted in a significant weight loss of a mean of 10.4 kg (4.4 BMI units). No negative side effects or complications were observed during the treatment. After activation of the pacemaker, meal‐related response of CCK and somatostatin and basal levels of GLP‐1 and leptin were significantly reduced (p < 0.05) compared with the tests before gastric pacing. The weight loss correlated significantly with a decrease of leptin levels (R = 0.79, p < 0.01). Discussion: Gastric pacing is a novel and promising therapy for morbid obesity. Activation of the gastric pacer was associated with a decrease in plasma levels of CCK, somatostatin, GLP‐1, and leptin. More studies are necessary to elucidate the correlations between satiety, weight loss, and digestive neuro‐hormone changes.     

经食道心房调搏术及食道心电图在心律失常中的应用

目的:分析经食道心房调搏术(TEAP)及食道内心电图(EECG)在心律失常中的应用价值。方法:选取2018年6月至2019年12月于我院行食道心电图及经食道调搏的患者189例,其中男80例,女109例,年龄11~83岁。结果:54例为房室结折返性心动过速(AVNRT),34例为房室折返性心动过速(AVRT),8例为房性心动过速(AT),4例为心房扑动(AF),6例为心房颤动(Af),5例为室性心过速,78例为室早或其他。共105例心律失常患者拟行食道心房调搏终止心动过速,所有AVNRT和AVRT患者及17例AT患者经食道心房调搏S1S1成功转为窦律,50例AVNRT、32例AVRT、6例AT、3例AF及2例VT患者通过射频消融术成功根治。其中1例11岁AT患者因无法耐受食道调搏,未能转为窦律,患者经静推普罗帕酮后次日转为窦律。共97例患者拟行食道心房调搏诱发,共49例诱发出心动过速,1例左后分支型室速经静滴异丙肾上腺素后诱发心动过速,且仍需静滴异丙肾上腺素后经心房食道调博终止心动过速,后经射频消融术成功根治。结论:TEAP及EECG可用于复杂心律失常的诊断及治疗,是一种相对安全、临床容易掌握的技术,值得推广。     

Transvenous pacing in complex post-operative congenital heart disease guided by angiography: A case report

Transvenous pacing in patients with postoperative complex congenital heart disease (CHD) can be challenging and pose technical challenges to lead placement because of the complex anatomy, distortions produced by the surgical procedures, and the altered relationship of cardiac chambers. We describe the utility of angiography for transvenous dual chamber pacemaker implantation in a post-operative complex congenital heart disease.     

Chronic tachygastrial electrical stimulation reduces food intake in dogs

Objective: Tachygastria is known to be associated with gastric hypomotility. This study investigated the effect of tachygastrial electrical stimulation (TES) on food intake and its effects on gastric motility. Research Methods and Procedures: Five experiments were performed to study the effects of TES on gastric slow waves, gastric tone, accommodation, and antral contractions, gastric emptying, acute food intake, and chronic food intake in dogs. Results: TES at tachygastrial frequencies induced tachygastria and reduced normal slow waves. TES significantly reduced gastric tone or induced gastric distention, impaired gastric accommodation, and inhibited antral contractions. TES significantly delayed gastric emptying. Acute TES reduced food intake but did not induce any noticeable symptoms. Chronic TES resulted in a 20% reduction in food intake, and the effect of TES was found to be related to specific parameters. Discussion: TES at the distal antrum results in a significant reduction in food intake in dogs, and this inhibitory effect is probably attributed to TES‐induced reduction in proximal gastric tone, gastric accommodation, antral contractility, and gastric emptying. These data suggest a therapeutic potential of the specific method of TES for obesity.     

急性下壁心肌梗死急诊PCI术中应用临时起搏器与阿托品的对比研究

目的：探讨临时起搏器与阿托品在急性下壁心肌梗死急诊经皮冠状动脉介入治疗（PCI）中应用的疗效。方法：入选2012 年2 月至2013 年8 月我院收治的发病12 小时内,诊断为急性下壁心肌梗死并接受急诊PCI治疗的患者92 例,依据治疗方法的不同 将病例分为临时起搏组和阿托品组,并对病例进行为期一年的追踪随访,收集患者平均住院天数、平均住院费用、再灌注心律失 常、心肌梗死后心绞痛、心肌梗死后心衰发生率资料。结果：临时起搏组的平均住院天数、平均住院费用、心肌梗死后心绞痛、心肌 梗死后心衰发生率均显著低于阿托品治疗组（P 均<0.05）,阿托品治疗组的再灌注心律失常发生率则明显低于临时起搏组（P<0. 05）。结论：急性下壁心肌梗死急诊PCI中应用临时起搏器,具有治疗成本低,降低心血管事件发生率的优点,而阿托品治疗在改 善再灌注心律失常的疗效上则显著优于临时起搏治疗。