European Society of Hypertension/European Society of Cardiology jointly published new guidelines on diagnosis and treatment of hypertension in 2007.It reflected the the latest developments on comprehensive assessment,treatment modalities and strategies,as well as therapeutic approach for special populations.In addition,the new guidelines updated evaluation.It also stressed the importance of an early,faster and more stringent treatment and aggressive combination therapy.More impartantly,it requested prevention and treatment earlier.It is of great importance for the guidelines to guide the current diagnosis and treatment of hypertension.

Objective To determine the diagnostic and therapeutic approach of cute cardiac perforation and tamponade complicating percutaneous balloon mitral valvuloplasty. Methods and Results Percutaneous balloon mitral valvuloplasty was performed in 772 patients with rheumatic mitral stenosis from May 1992 to Dec. 2001, 9 were diagnosed cardiac perforation, 2 which developed pericardial tamponade which was successfully controlled by contrast and X ray guided pericardiocentesis using a subxiphoid approach. Conclusions Only a minority of cardiac perforation resulted from PBMV developed pericardial tamponade. The latter could be controlled safely and effectively by contrast and X ray guided pericardiocentesis using a subxiphoid approach.The diagnosis of pericardial tamponade during or after PBMV relies on a strong clinical suspicion, and contrast and X ray guided pericardiocentesis should be carried out without echocardiography for patients in unstable state.

Atrial Fibrillation ; complications ; drug therapy ; Coronary Artery Disease ; complications ; drug therapy ; Fibrinolytic Agents ; therapeutic use ; Humans

Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation (AF) related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated (ABL group). In another 61 patients, paroxysmal AF was treated with anti-arrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control (PM group). Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation at the end of follow-up showed that 47 (94%) patients no longer needed a pacemaker (Class III indication) because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs (PM 42.6%, ABL 6.0%, P < 0.001) while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group (82.0%vs. 21.3%in PM group, P < 0.001). The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group (PM group 14.8%, ABL group 2.0%, P=0.020).The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.

Atrial fibrillation (AF) is the most common arrhythmia,but its pathogenesis is still unclear.With the development of sleep medicine,obstructive sleep apnea (OSA) is found to associate with the occurrence of AF and recurrence after catheter ablation.This article reviews the pathophysiology of OSA,and relationship between OSA and the occurrence of AF,and its mechanism.It indicates that clinicians should pay close attention to the existence of OSA during diagnosis and treatment of AF.

Objective To compare the in-hospital and follow-up clinical results of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)in patients with coronary artery disease and diabetes mellitus.Methods The DESIRE(drug-eluting stent impact on revascularization)is a single-center registry comparing coronary revascularization in our institution before and after the introduction of drug-eluting stents.Between July 2001 and June 2002,July 2003 and June 2004,1040 patients were referred for revascularization(PCI or CABG)during hospitalization.Clinical,angiographic,revascularization data clinical condition in hospital and the follow-up results were collected for retrospective analysis.In the present study,patients with diabetes were selected and divided into PCI and CABG groups.The primary endpoint is in-hospital and follow-up major adverse cardiovascular and cerebral events(MACCE).Results Compared with the CABG group,the PCI group had lower in-hospital MACCE rates(P0.05),but the PCI group had higher rates of repeat revascularization than that of the CABG group(P0.05).Conclusion Although PCI has lower in-hospital MACCE rates in diabetic patients,the follow-up MACCE rates of PCI and CABG are comparable,and PCI has even higher rates of repeat revascularization than CABG.With the increasing use of drug eluting stents,PCI might have better performance.

Coronary-artery bypass grafting(CABG)has been a standard treatment for unprotected left main coronary artery disease.Advancement in percutaneous coronary intervention(PCI)makes PCI as effective as CABG in selected patients.In this study,we assess the optimal revascularization strategy for patients with unprotected left main coronary artery disease.

Objective To investigate the underlying mechanism for recurrence of atrial fibrillation (Afib) after trans- catheter ablation and the impact of repeat ablation on Afib. Methods Patients with symptomatic and ECG confirmed recurrent Afib were enrolled in this study. All patients underwent circumferential pulmonary vein linear ablation (CPVA) under the guidance of three dimension mapping system. The end-points of the procedure were electrical isolation of pulmonary vein (PVs)s and completeness of circumferential linear lesion around PVs. A systematic follow-up was conducted to evaluate the rate of atrial tachyarrhythmia free after the second ablation. Results Twenty-three cases (51.1% of the total recurrent cases of the same time) with recurrent Afib included in this study received second ablation. Among them, 13 cases underwent segmental PV ablation and the other 10 cases received CPVA. 56.5% (13/23) of the patients suffered from persistent and chronic Afib. Recovered conduction rate of PV-left atrium (LA) was 92.3% (48/52) in patients who had undergone SPVA during their first ablation and 75.0% (30/40) in patients who had received CPVA previously. Prolonged procedure time, more fluoroscopic exposure and higher radiofrequency needed were observed in patients who had undergone SPVA during their first ablation. 82.6% (19/23) of the patients were free from atrial tachy-arrhythmia during a mean follow-up of 4.2?3.5 (4.0～9.0) months after the second ablation. Conclusion Recovered conduction of PV-LA was the major factor responsible for the recurrence of Afib after the first procedure. CPVA under the guidance of three dimension mapping system may be feasiable for patient with recurrent atrial fibrilation.

Objective To evaluate the outcome of percutaneous intervention for the diseased bypass grafts in patients with previous coronary artery bypass graft surgery (CABG).Methods Sixty-six patients with diseased grafts after CABG underwent percutaneous intervention between July 2003 and July 2004.Angiographic follow up was suggested to all patients and major adverse cardiac events(MACE,including death,acute myocardial infarction and target lesion revascularization)were recorded within 6 months of follow up.Results Sixty-six patients with 74 diseased grafts(83 lesions) underwent percutaneous intervention.The angiographic success rate was 96.97%((64/66)) and the procedural success rate was 95.45%(63/66).No reflow phenomenon occurred in 2 cases,1 case restored TIMI 3 flow after administering verpamil but the other patient failed to restore the blood flow. Distal embolization occurred in 1 case.Abrupt closure in 1 case because of Dtype dissection not treated during the procedure but TIMI 3 flow was obtained after repairment with another stent.No MACE(death,acute myocardial infarction and acute emergency revascularization) occurred during hospitalization and the incidence of MACE was 31.3%(20/64) at 6 months follow up.In-segment restenosis rate was 32.5%(13/40) in 37 patients with angiographic follow-up.Conclusion Percutaneous intervention for diseased bypass grafts is feasible,safe and effective.

Objective To determine the impact of body mass index(BMI)on clinical outcomes in patients underwent coronary revascularization.Methods The DESIRE-plus(Drug-Eluting Stent Impact on Revascularization-plus)was a single-center registry study of coronary revascularization in our institution between 1 July 2004 and 30 September 2005.We analyzed patients with complete data of BMI from the DESIRE-plus trial,grouped by BMI(low BMI group:BMI