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.

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 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 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 compare the effects of pressure bandage with ultrasound-guided compression repair (UGCR) for femoral artery pseudoaneurysms (FAPs) after percutaneous coronary intervention. Methods One hundred and five patients with FAPs were enrolled in the study. Patients were classified into 2 groups (UGCR vs pressure bandage) according to different treatment modalities,and clinical status and therapeutic effects were compared. Results There were no differences between the two groups in gender,age,body mass index,type of intervention,sheath size,anti-platelet agents,low molecular weight heparin,systolic blood pressure and diastolic blood pressure during the procedure. The successful repair rate was higher in the UGCR group than that of the pressure bandage group (85% vs 63%,P =0.03). No complications occurred in both groups. Conclusion UGCR is simple and safe with low cost and complications,which can be used preferably for FAPs repair.

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.