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.

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.

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.

Objective To introduce a simple and reliable way for atrial septal puncture. Methods Atrial septal puncture had been carried out in 627 patients with various underlying heart diseases, and the patients aged between 4-78 years old. Three protocols for precise location of atrial septal puncture points were recommended, 1) Site of atrial septal puncture point in cranial-caudal direction was determined under posterior-anterior projection, which was confined to the cranial side of the inferior margin of left atrium silhouette at a distance of 1 cone body height along the midline of spine. If the inferior margin of left atrium silhouette was unclear, angiogram of pulmonary artery to display left atrium and placement of coronary sinus electrodes could be done to verify it. 2) Under right anterior oblique 45 degree view, the puncture point was located between one cone body height anterior to posterior margin of left atrium silhouette and the isometric line between the posterior margin of left atrium silhouette and atria-ventricular suculus. 3) The arch feature of puncture needle and distal part of sheath turned into a straight line under 45 degree of right anterior oblique view. Results The success rate of atrial septal puncture was 99.8% (626/627), and that with only one try was 71.93% (451/627), the rate of tamponade was 0.32% (2/627). No death occurred. Conclusion Simple, reliable and safe, atrial septal puncture under 45 degree of right anterior oblique view is an easily-mastered approach.

Objective To evaluate the feasibility of catheter ablation for atrial fibrillation (AF) guided by 3 dimensional (3D) mapping combined with pulmonary vein (PV) circumferential mapping Methods 14 consecutive patients (M/F=10/4, age 52 4?12 8 y o, left atrium diameter 46 7?5 4 mm) with drug refractory paroxysmal ( n =10), permanent ( n =3) and persistent ( n =1) AF were included in this study Left atrial modification guided by 3D mapping system were performed first,and then, all PVs were isolated by circumferential mapping guided segmental ablation The endpoint of ablation included: (1) all left artial ablation lines finished; (2) all PVs were isolated and (3) non inducibility of AF was observed Results (1) Ten (71 4%) patients with paroxysmal AF reached the endpoint of the ablation completely (2) Total procedure and fluoroscopy time periods were 292?49 min and 54?9 min, respectively (3) After a mean follow up of 5 2?5 7(1-23)weeks, 7 (50%) patients with paroxysmal AF were free of AF and 3 (21 4%) patients with paroxysmal AF had significant improvement (4) No complications occurred during the procedure and the follow up period Conclusion Catheter ablation for AF guided by 3D mapping combined with PV circumferential mapping is feasible, safe and effective for patients with paroxysmal AF and left atrial enlargement

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 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 the clinical and electrophysiological characters of atrial fibrillation(AF) originated from superior vena cava(SVC).Methods Patients with SVC-originated AF admitted into our centre during the past 2 years were retrospectively investigated,and their clinical and electrophysiological characters were systematically analyzed.Results The AF in 16 patients(M/F=12/4 cases,mean age of 53.4?10.6 years old,paroxysmal/persistent AF=11/5 cases) were confirmed to be originated from SVC,who contributed to 2.9%(16/545) of total cases underwent AF ablation during the same period.Among the 16 cases,2 patients were diagnosed as SVC-originated AF by surface ECG,and isolation of SVC terminated AF in these 2 patients.In the remaining 14 patients with non-classic surface ECG,AF or organized atrial tachycardia(Ata) still sustained after initial left atrial(LA) ablation.The sustainable AF and Ata were found to be driven by fast activations within SVC,and were terminated by isolation of SVC.The average applications and procedure time for isolating SVC were 6?2 times and 10?3 minutes respectively.The average muscle connections between SVC and LA were 3?1.After a mean period of 6-month-follow-up,only one patient recurred with organized Ata.Except femoral hematoma in one patient,no other complications were found.Conclusion In addition to pulmonary vein and LA,SVC could be the orgin of AF.Therefore,for patient with sustainable AF or organized Ata after initial LA ablation,SVC origin should be put under consideration.

Objective To compare the effects of low-molecular-weight heparin (LMWH,fragmin) and aspirin versus aspirin alone on transient myocardial ischemia and in-hospital prognosis in patients with unstable angina pectoris (UAP).Methods A total of 86 patients with UAP were randomized into a group receiving aspirin (ASP group) a group receiving aspirin plus LMWH (fragmin group) for one week.Results The effective rate was 88.37% in the fragmin group and 67.44% in the aspirin group after one week (P

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.