Objective To study the feasibility and safety of coronary sinus (CS) ventricular pacing comparing with traditional right ventricular (RV) pacing in ordinary pacing treatment.Methods Sixty-one patients with an indication of pacemaker implantation were randomized into traditional RV pacing group and CS ventricular pacing group.The success rate,complications,preoperative and postoperative QRS wave duration and pacemaker parameters were compared between the two groups.Results (1) The instant success rate in traditional RV pacing and the CS pacing groups were 100％ and 68.97％ (P＜0.01);the surgical success rate was significantly higher by using left ventricular electrode than the ventricle tined electrode in CS pacing group (85.71％ and 25％,P＜0.05).There was no significant difference in the incidence of complications between the two groups (P＞0.05);(2) The increase of QRS complex width at postoperative 1 month in CS pacing group is significantly less than the RV pacing group (P＜0.05);(3) Although the pacing threshold and electrode impedance during operation,postoperative 1 month and 3 months in CS pacing group were higher than RV pacing group (P＜0.05),the CS pacing was effective.Conclusion The CS ventricular pacing is as safe and effective as traditional RV pacing,and is more consistent with physiological ventricular activation sequence.Using left ventricular electrode can significantly improve the success rate of CS ventricular pacing.

[Abstract ] Objective Cardiac shock wave therapy (CSWT) can promote arteriogenesis in ischemic myocardia , but the mo-lecular mechanism remains unclear .The study aimed to explore the effect of CSWT on arteriogenesis in human cardiac microvascular endothelial cells ( HCMEC ) and the role of focal adhesion kinase (FAK) and Calcium-activated potassium channels (KCa) in the sig-nal conduction pathway of CSWT arteriogenesis . Methods HC-MEC cells cultured in vitro were randomly divided into control group , CSWT group , CSWT +T ( FAK inhibitor PF-573228 ) group and CSWT+F( SCa inhibitor iberiotoxin ) group.Each group received one CSWT(0.09 mJ/mm2, 200Times) 48 h after added stimulant.24 hours'conventional culture later , tests were made on the levels of endothelial nitric oxide synthase ( eNOS ) and vascular endothelial growth factor ( VEGF) mRNA as well as the changes of related protein expression . Results ①QPCR test showed that eNOS , VEGF mRNA expressions increased in CSWT group compared with control group (4.61 ±0.19 vs 3.99 ±0.17, P<0.05), while compared with CSWT group, eNOS, VEGF mRNA expressions in CSWT +T group were decreased (0.62 ±0.10 vs 0.40 ±0.02, P<0.05), eNOS, VEGF mRNA expressions in CSWT +F group were also decreased (0.53 ±0.02 vs 0.64 ±0.02, P<0.05), all the differ-ences were of statistical significance .②Western blot showed that eNOS , VEGF protein expressions increased in CSWT group compared with control group(0.63 ±0.02 vs 0.43 ±0.02, P<0.05), while compared with CSWT group , eNOS, VEGF protein expressions in CSWT+T group were decreased (0.36 ±0.01 vs 0.29 ±0.02, P<0.05), eNOS, VEGF protein expressions in CSWT +F group were also decreased (0.37 ±0.02 vs 0.30 ±0.02, P<0.05), all the differences were of statistical significance . Conclusion CSWT can improve eNOS , VEGF mRNA and protein expressions in HCMEC cells and FAK and KCa may participate in the signal conduction pathway of CSWT arteriogenesis .

Atrial fibrillation(AF)is one of the most common arrhythmias in clinical practice,with a high rate of death and disability.In recent years,with the help of catheter ablation and other techniques,some patients can maintain sinus rhythm,achieving the goal of eradicating AF.However,the recurrence rate of atrial arrhythmias after the first radiofrequency ablation is still around 20%to 30%at present,and the efficacy of radiofrequency ablation for AF has not yet reached the expected level.Exploring the risk factors for recurrence after ablation,inter-vening and continuously and improving the catheter ablation procedure are extremely important for reducing the risk of recurrence.This article reviews the latest research progress on the recurrence of atrial arrhythmias after catheter ablation for AF.

Atrial fibrillation(AF)is a type of supraventricular arrhythmia characterized by uncoordinated atrial activation,ineffective atrial contraction.It has a high incidence rate and is often complicated by stroke,heart failure,and myocardial disease induced by tachycardia,causing a significant burden on patients and their families.Comprehensive management of AF is crucial for effectively reducing mortality,disability,and improving prognosis.However,traditional electrocardiogram(ECG)monitoring often misses asymptomatic and paroxysmal AF at a higher possibility.In recent years,a new device for monitoring AF,insertable cardiac monitor(ICM),has emerged to overcome the limitations of traditional arrhythmia monitoring,for it provides real-time ECG monitoring and alerts for users.ICMs have been widely used in multiple medical senarios,primarily for patients with unexplained syn-cope,and recently they are adopted to monitor AF However,its role in AF monitoring has not received significant attention in clinical practice.Based on relevant literature,this article reviews the application effect of ICM in moni-toring AF and the latest research progress in the field and evaluates its advantages and disadvantages to provide some references for AF management.

Objective To study the injury factors, pathogenic process and clinical features of delay two-phase multiple organ dysfunction syndrome (MODS) in severe burned patients and to replicate a standardized animal model that would accurately imitate the clinical features of MODS.Methods Forty-five human patients with burn size larger than 30% total body surface area (TBSA) were analyzed. All of them underwent severe burn shock in early stage and sepsis in late stage. Thirty-two goats were randomly divided into three groups: 1) hemorrhagic shock (group H, n=6); 2) endotoxemia (group E, n=6); and 3) hemorrhagic shock plus endotoxemia (group M, n=20). Hemorrhagic shock was produced according to the method of Wigger (6.7 kPa for an hour, 1 kPa=7.5 mmHg). Endotoxin (E. coli O111 B4) was given via the portal vein 24 hours after the resuscitation of hemorrhagic shock, in a dose of 30 ng/kg/min for 5 consecutive days. During the observation period of 10 days, all animals were hemodynamically monitored, given standard metabolic support and due cardiac and pulmonary support according to human intensive care.Results All the patients showed burn shock at 1-3 days and hyperdynamic circulation, hypermetabolism and systemic inflammatory responses over two weeks post-injury. Thirteen cases were found to develop MODS according to the prevailing diagnostic criteria, and 10 of them died with a mortality of 77%. Eighteen animals died in group M with a mortality of 90%, 12 of the 18 developed MODS, with overall incidence of 60%. Most animals in group M showed changes similar to that observed in human cases. The experimentation proved that in the pathogenic process of MODS, there was a two-hit phenomenon in the dvelopment of the syndrome. To prevent the development of MODS, it therefore was imperative to blunt the first hit or the second hit, so that an excessive inflammatory response was alleviated. This postulation has been verified in the treatment of extensive burns. Two patients with burn extent reaching 100% TBSA survived with only mild acute respiratory distress syndrome (ARDS) and renal dysfunction after comprehensive treatment of burn shock, including adequate fluid resuscitation, drugs to remove oxygen free radicals, rapid restoration of pHi, and early extensive excision of burn eschars.Conclusion Both in human patients or animal experimentation, the typical delay two-phase MODS is shown to be produced by two successive insults in the forms of hypovolemic shock and sepsis. This postulation is helpful in formulating the prevention and treatment modality of MODS.