Objective To investigate the efficacy and safety of segmental electrical isolation of pulmonary veins (PVs) during atrial fibrillation (AF) Methods Nine patients were included, of whom 4 had recently persistent AF (3～4 months) and 5 suffored from paroxysmal AF occurred AF frequently We adopted one transseptal procedure Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum RF ablation was applied at the pulmonary vein potential (PVP) breakthrough using thermo control RF catheter during AF Results Twenty nine PVs were targeted for segmental RF ablation and isolated completely PVPs in target PVs were in higher spike and more frequent than left atrial potentials There were no complications associated with the procedure Seven patients were converted to sinus rhythm during the procedure Two patients restored sinus rhythm by cardioversion Conclusion It is suggested that the method of segmental PV isolation during AF is safe and has higher success rate It is not necessary to stop antiarrhymic drugs before RF ablation This study provides a reliable method for segmental electrical isolation of pulmonary veins in patients with persistent AF

Objective To analyze the electrophysiological characteristics of atrioventricular nodal reentrant tachycardia(AVNRT) requiring ablation at the mitral annulus.Methods Ablation was carried out at the mitral annulus by mapping the slow pathway with resetting method in order to acquire the electrophysiological parameters needed for successful ablation of AVNRT.Results Three cases with AVNRT who had prior failed ablation were successfully ablated by targeting the slow pathway located at the mitral annulus.The location of the left-sided slow pathway was selected by a positive resetting response and verified by junctional automaticity elicited by radiofrequency application and elimination of tachycardia.Conclusion AVNRT refractory to ablation of slow pathway at the posteroseptal area may require ablation at the mitral annulus.Resetting response may help to locate the slow pathway along the mitral annulus.

Objective To investigate the efficacy and safety of the segmental electrical isolation of pulmonary veins (PVs) in patients with paroxysmal atrial fibrillation (PAF). Methods Thirty-nine patients (28 males, 11 females) with recurrent documented symptomatic PAF were included. In order to avoid the risk of cardiac tamponand, we adopted one transseptal procedure and obtained unselective angiography of all PVs and left atrial appendage using pigtail catheter. Lasso mapping catheter and ablation catheter were put into target pulmonary vein ostium through the same site of atrial septum. We routinely mapped the right inferior PV lest any pulmonary vein potential (PVP) that triggered PAF should be omitted. RF ablation was applied at the PVP breakthrough and slightly right and left by moving the RF catheter. Results Eighty-five PVs were targeted for segmental RF ablation. Eight-one were isolated completely. Immediate successful rate was 95%. There was not any complication associated with the procedure. Conclusion It is suggested that the method of segmental PV isolation has a higher cure rate and a shorter procedure time compared with other traditional methods. It can minimize the lesion of pulmonary veins and avoid PV stenosis.

Objective To evaluate the clinical value of 12-lead Holter monitoring for coronary heart disease (CHD) patients with inferior myocardial ischemia. Methods Ninety-six patients with CHD had accepted coronary angiography (CAG) and 12-lead Holter examination. Results The sensitivity for detecting inferior myocardial ischemia in 12-lead Holter monitoring was 64.91%, the specificity 53.85%, and the positive detecting value 67.20%. In 12-lead Holter monitoring, inferior myocardial ischemia was recorded in 20% of only RCA lesion group, and in 70.37% of double -vessel lesion group, and in 80% of three-vessel lesion group.Conclusion 12-lead Holter monitoring is of some value to evaluate the inferior myocardial ischemia in CHD patients, but other clinical data should be considered.

Objective To study the incidence and the effect of intracoronary stenting for spontaneous coronary artery dissection (SCAD). Methods Data from coronary angiography performed in 2?216 patients were analyzed to discover SCAD. Intracoronary stents were implanted in the patients with SCAD suited for percutaneous coronary intervention (PCI). Aspirin, clopidogrel, heparin or low molecular weight heparin were used on demand during the operation-around period. Results Twenty-six cases of SCAD [19 males, 7 females, mean age (60.9?11.6) years] were discovered. The incidence was 1.17%. Among the 26 patients, 15 suffered from acute myocardial infarction and 11 unstable angina. SCAD occurred in 28 blood vessels of the 26 cases, of which, 1 was in LM, 9 in LAD, 4 in LCX and 14 in RCA. Twenty-three stents were implanted in 19 coronary arteries of 18 patients (15 stentings after PTCA and 4 direct stentings). After PCI, remaining stenosis of one SCAD lesion was

0 05 There was 1 case of cardiac tamponand and 1 case of 60% stenosis of the left superior PV associated with the procedure Conclusion ERAF after segmental PV isolation is common, occurring in approximately 39% of patients with paroxysmal AF However, approximately 35% of ERAF patients without early repeat ablation have no further AF during long term follow up It is suggested that temporary antiarrhymic drug therapy may be more appropriate than early repeat ablation in patients with ERAF

Objective To investigate the incidence and clinical significance of coronary artery anomalies in adults undergoing coronary angiography. Methods Data of all patients underwent coronary angiography from Jan 2001 to Nov 2003 in our hospital were reviewed retrospectively. Results Among 2?824 adult patients, 61 had coronary artery anomalies of which 84.1% were anomalous origin and distribution. The total detection rate of coronary artery anomalies was 2.1%. Anomalies were found to be happened more in the right coronary artery than in the left coronary artery. Four cases failed to undergo selective right coronary angiography. Conclusion Coronary artery anomalies are not rare in adults. Some types of coronary artery anomalies can induce myocardium ischemia and require intervention. Catheterization diagnosis and therapy of patients with anomalous origin of coronary artery may be difficult2?

Objective The aim of this study was to investigate the mechanisms and the possible treatment of early and frequent recurrence of atrial fibrillation after segmental pulmonary veins isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). Methods and Results Guided by Lasso mapping catheter, segmental pulmonary veins isolation was performed using radiofrequency energy in 54 consecutive patients (mean age 53?15 years) with recurrent documented symptomatic paroxysmal AF. Early recurrence of AF and rapid atrial arrhythmia occurred in 10 out of 54 patients (18.5%) within two weeks after PVI. 4 out of 10 patients (7.4 %) experienced early and frequent recurrence of atrial fibrillation and atrial tachyarrhythmia, which we termed as “atrial arrhythmic storm". The 4 patients were treated with class Ⅰ and Ⅲ antiarrhythmic drugs for 3 months. The “atrial arrhythmic storm" subided apparently and disappeared within two weeks after antiarrhythmic drug therapy. Only 1 patient still suffered from paroxysmal AF after drug control at mean follow-up of 3 months. After repeat ablation, there was no occurrence of AF and atrial arrhythmia in this patient.Conclusion A few paroxysmal atrial fibrillation patients experienced “atrial arrhythmic storm" after segmental pulmonary veins isolation. It is suggested that “atrial arrhythmic storm" after PVI may due to a lot of factors and combined antiarrhythmic drug therapy may be feasible. Early repeat ablation in patients with “atrial arrhythmic storm" may not be necessary.

1.5 mm were included for the analysis. The results were compared with catheter coronary artery angiography. Results In all patients, 16-slice CT were performed without complications. 1?267 segments were considered as stenosis by 16-slice CT. With the results of conventional coronary angiography as the golden standard, the sensitivity of 16-slice CT was 75.43% and its specificity was 95.88%. Its positive predicted value was 74.58% while its negative predicted value was 96.01% and its accuracy was 93.05% for stenosis of greater than 50%. Conclusion 16-slice CT provides a good visualization of the coronary tree in most patients, allowing accurate non-invasive detection of significant coronary stenosis.

Objective To investigate the prognostic implications of the size of left atrium with catheter ablation of atrial fibrillation.Methods Forty-two consecutive patients with symptomatic and drug-refractory paroxysmal or persistent AF admitted from 2005 May to 2006 November were included in the present study.The mean age was 60?12 years and 25 patients(58%)were male.Paroxysmal AF was present in 37 patients(88%)and persistent AF in 5 patients(12%).A 3D electroanatomic map of the LA including the pulmonary vein(PV)ostia was constructed with a nonfluoroscopic navigation system(Carto,Biosense Webster).The left and right PVs were encircled by continuous radiofrequency ablation lines.The left atrial diameter(LAD)was measured by 2D-guided M-mode echocardiography,in terms of anteroposterior diameter,left-right diameter and superior-inferior diameter by ”Simpson” method.Left atrial volume(LAV)was calculated by ”Pumbo” method.Body surface area(BSA)(m2)was used for indexing body size variables.The respective formulae are:left atrial volume index(LAVI)=LAV/BSA(mL/m2);left atrial diameter index(LADI)=LAD/BSA.Results Fifteen patients(34%)suffered from recurrent AF after 3 months of follow up.The LAVI of the recurrent group of patients was(68.19?23.68)mL/m2 compared with that of the non-recurrent group of(52.07?17.34)ml/m2(P=0.019).Logistic regression analysis revealed LAVI was the only independent risk factor of recurrence(OR=1.04,95% CI 0.99-1.09,P=0.04).Age(P=0.806),sex(P=0.338),AF history(P=0.46),hypertension(P=0.963),LAD(P=0.41),LADI(P=0.093),LAV(P=0.471),LVEF(P=0.91)between the 2 groups had no statistic differences.Conclusion Left atrial volume index(LAVI)is a better parameter compared with LAD,LADI and LAV in reflecting the left atrial size.LAVI is an independent predictor of recurrence of AF after catheter ablation.We found that LAVI≥55 mL/m2 was the strongest predictor,independent of age and other clinical parameters.