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

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.

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 investigate the safety and efficacy of circumferential pulmonary vein linear ablation guided by 3-D mapping system in patients with atrial fibrillation.Methods From April 2003 to March 2006,410 consecutive patients with atrial fibrillation underwent circumferential pulmonary vein linear ablation guided by 3-D mapping system(CARTO system or EnSite NavX TM system).Success was defined as symptomatic atrial tachyarrhythmia free after 3 months washout period.Results 96%of the 410 patients attained the ablation endpoint.After a mean of (12.4?6.8)months' follow-up,clinical success achieved in 77.3% of the patients with paroxysmal atrial fibrillation and 69.4% of the patients with persistent/permanent atrial fibrillation after first-time ablation procedure.The successs rate of the persistent/permanent atrial fibrillation was significantly lower than that of paroxysmal atrial fibrillation.Forty-one of the 103 patients with recurrent atrial fibrillation underwent ablation again.Thirty-one of the 41 patients(75.6%)were atrial tachyarrhythmia free during the follow-up.Severe complications included 4 cases of pericardial tamponade(0.97%)and 3 cases of stroke(0.73%).Pericardial tamponades were relieved by pericardiocentesis.The patients with stroke recovered well without any lingering effects.There was no death case.Conclusion Circumferential pulmonary vein linear ablation guided by 3-D mapping system is an effective therapy for atrial fibrillation patients with an acceptable safety.

Objective To investigate and compare the short-term and long-term outcomes between percutaneous coronary intervention(PCI) or coronary artery bypass graft(CABG) in coronary heart disease(CHD) patients comorbid with diabetes mellitus.Methods The DESIRE register study(Drug-Cluting Stent Impact on REvascularization) was a single-center retrospective study which enrolled 3763 patients who received revascularization therapy during two distinct pesiod.Our study included 670 CHD patients from the whole DESIRE population who received revascularization during July 2003 to June 2004 and comorbid with diabetes mellitus.According to the revasularizaton strategy,the patients were divided into the PCI group(n=400) and the CABG group(n=270).Adverse cardiac and vascular events were the composite endpoints which included all-cause of death,non-fatal myocardial infarction,non-fatal stroke and revascularization.Results Baseline data had no difference between the two groups.In-hospital adverse cardiac events in the PCI group was fewer than in the CABG group(0.5% vs 4.1%,P=0.001) as shown by a lower mortality in the PCI group compared with the CABG group(0.5% vs 3.3%,P=0.012).Duration of follow-up in the PCI group and the CABG group was 592.6?121.3 days and 581.5?148.3 days respectively.The incidence s of long-term adverse cardiac events had no differnce between the two groups,but an increase trend was observed in the PCI group compared with the CABG group(14.2% vs 9.0%,P=0.056),owing to a higher percentage of revascularization(8.5% vs 2.1%,P=0.001).Two groups had a similar incidence of death,non-fatal myocardial infarction,non-fatal stroke during the follow-up period.Conclusion With the wide-spread of DES application,in-hospital adverse cardiac events in the PCI group was fewer than in the CABG group especially in terms of mortality.Long-term adverse cardiac events had no differnce between two groups,but PCI group had more revascularization.

Objective To observe the long-term safety of revascularization with sirolimus-eluting stent in patients with multivessel coronary disease compared with bare metal stents.The study was a single center retrospective study.Methods Five hundred and sixty two patients with two-or three-vessel disease,or left main coronary artery disease who underwent revascularization were included and divided into two groups:the SES(n=251)and the BMS(n=311)group,according to the type of the stents implanted.The clinical end points were death and myocardial infarction one year later after stents implantation.Results Clinical follow up was accomplished in 92.9% of the patients and the median time of follow-up was 19.4 months.One year after stents implantation,3 patients died of cardiac causes in the SES group and 1 patient died in the BMS group.Myocardial infarction occured in 2 patients in each group.There was no significant difference in cardiac event rate between the 2 groups(2.3% versus 1.1%,P=NS).No significant difference was found in cardiac death and nonfatal myocardial infarction event free survival rates estimated by Kaplan-Meier method between the two groups(97.3% versus 97.2%,P=0.951).Conclusion One-year cardiac mortality and the incidence of myocardial infarction after SES implantation in patients with multivessel disease were similar to those after BMS implantation which may suggest that late stent thrombosis does not increase with SES.

Objective To investigate the feasibility and efficacy of single ablation catheter for complete circumferential pulmonary vein antrum(PVA) isolation.Methods After performing initial circumferential lesions in 55 consecutive patients with paroxysmal atrial fibrillation,residual gaps were mapped and closed using single ablation catheter.Results The PVA isolation rates were 61.8%(34/55) in the right side,27.3%(15/55) in the left side,and 18.2%(10/55) in both sides,respectively.Twenty five gaps along the right PVA lesions and 49 gaps along the left PVA lesions were identified.All of these residual gaps were closed with single catheter approach.Mean procedure time and fluoroscopy time were 154?29(99-204) minutes and 32?7(19-49) minutes,respectively.Duration of radiofrequency energy delivery was 53?10(31-72) minutes.Conclusion Single ablation catheter technique is feasible and effective in localizing the residual gaps for complete isolation of the PVAs for ablation of paroxysmal atrial fibrillation.

Objective To investigate the mechanisms of right atrial tachycardia(AT) occurring after atriotomy of structural heart disease under the guidance of image integration system(CartoMerge system) and explore the efficacy of catheter ablation by using the aboved technique.Methods From January 2005 to December 2006,forty consecutive drug-refractory patients presenting with AT underwent complete electroanatomic mapping of spontaneously occurring and inducible right ATs.The ablation strategy was to avoid visible anatomic anomaly under the guidance of image integration system and to transect the isthmus,usually targeting the narrowest portion of the isthmus.Patients were followed up on an outpatient basis with clinical evaluation and 24-hour Holter recordings being performed at three months,six months,and afterwards on a yearly basis.Results Three main tachycardia mechanisms were identified: single-loop macroreentrant atrial tachycardia(MAT)(n=36),double-loop MAT(n=16),and focal AT(n=4).In most MATs,critical isthmus areas were identified most frequently the cavotricuspid isthmus(CTI)(n=35) and the surgical incision isthmus(n=36).Surgical incision causing obvious morphological anomalies including scar-like anomaly,pouch-like anomaly,and node-like anomaly could be visible by image integration technique in 12 patients,which had the electrophysiological characteristics of a surgical incision(a CDP or scar).A mean number of 19.5?10.1 radiofrequency(RF) applications were delivered to terminate the circuit.During a follow-up of 18?10 months the RF ablation was acutely successful in all patients.Eight patients(20%) had an early recurrence of MAT and needed an additional ablation procedure.Conclusion Image integration system not only allows reconstruction of AT mechanisms,but also represents an advance in the accurate localization and ablation of the arrhythmogenic substrate of postsurgical AT.Three-dimensional MR/CT images of RA can be successfully extracted and registered to anatomically guide catheter ablation in RA.The display of real and detailed anatomic information during the procedure enables tailored RF ablation to individual distorted anatomy related with surgical incision.

By using the OEC 9600 mobile digital imaging system, 14 coronary stents were successfully implanted in all 13 cases of coronary heart disease. After the procedure,immediate satisfactory angiographic results were obtained without residual stenosis, and chest pain was relieved or disappeared in all cases. No major complications occurred except for groin hematoma in one case,these results suggest that intracoro-nary stenting is a safe and effective management for coronary heart disease.

Objective To explore the feasibility and safety of primary coronary stenting in the patients with coronary heart disease Methods From march 1997 to august 1999, 80 cases with 90 of lesions were selected for primary coronary stenting without the predilation procedure Their efficacy and success rate were analysed Results We smoothly pushed 85 stents into the lesion in the 80 patients, the success rate of primary coronary stenting was 94% with shorter duration of the procedure and lower cost In 3 lesions the stent did not cross the lesion and was successfully retrieved in the guiding catheter, in 1 cases the stent was lost in the systemic circulation with no further complications Conclusions Primary coronary stenting without predilation was safe and feasible in selected patients