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 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 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

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 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 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