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

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 (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 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.

Objective To evaluate the prevalence and the predictors of clopidogrel therapy after DES implantation,and to determine the impact of discontinuation of clopidogrel therapy on the occurrence of late stent thrombosis(ST)and very late stent thrombosis.Methods Between July 2003 and June 2005,2 930 consecutive patients treated with PCI and DES implantation in Anzhen hospital were involved in the study,and among them,13 patients died within 3 dys after PCI.A total of 2 704 patients out of the 2 917 patients were followed up successfully for at least 2 years,or mortality.All of the clinical,angiographic and intervention treatment character were recorded.ST was adjudicated by the definition of ARC Dublin.Patients were grouped by the duration of clopidogrel therapy to 4 groups(group 1,12 months).The duration of clopidogrel therapy and the predictors of the premature discontinuation of clopidogrel were evaluated,and the rate of late ST(1 month to 12 months)and very late ST(after 12 months)in the 4 groups were analysised.Results There were 82(3.0%)patients in group 1,333(12.3%)patients in group 2,1 590(58.8%)patients in group 3,and 699(25.9%)patients in group 4.In contrast with group 4,the mean level of total cholesterol were higher,mean LVEF value were lower,more patients were diabetes,less patients were STEMI,and the mean number of DES implantation was less in group 1-3.In group 1 and group 2,most of the discontinuation of clopidogrel therapy(95.1%,85.9% respectively)were directed by patients themselves;and in group 3,71.1% of the patients discortinued clopidogrel therapy on the doctor's order.There was no significant differences among the 3 groups on discontinuation of clopidogrel for bleeding or other operations.By Cox regression,diabetes(OR=1.542,95% CI=1.184-2.008,P=0.001)and number and DES implantation(OR=0.790,95% CI=0.709-0.880,P

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