Physiological pacing has undergone three stages: atrioventricular sequential pacing,chronotropic pacing and cardiac resynchronization therapy.How to make pacing therapy more physiological,so as to meet the physiological needs of patients,is the unremitting pursuit of clinicians.With further understanding of cardiac function and the development of pacemaker manufacturing technology,pacing function will become more and more physiological.At the same time,the newer generation of pacemakers will have more sophisticated program control function,higher automation,simulation of the doctor's thinking,and the pacing parameters can be optimized automatically after implantation allowing pacemaker to operate in the most effective and energy-saving state.From cardiac rhythm managers to heart disease managers,their unique efficacy will make physiological pacing function perfect day by day.In this paper,the research progress in this field is analyzed,which aims to provide the basis for pacing mode,pacing site and pacing interval in the future.

Objective To study the clinical characterics of 139 patients with wide QRS complex tachycardia.Methods Retrospective analysis was performed on 139 patients with QRS wave tachycardia treated by radiofrequency ablation at TEDA International Cardiovascular Hospital.The patients were divided into supra-ventricular tachycardia with intra-ventricular aberrany group (group A,n =84) and ventricular tachycardia (group B,n =55).The clinical data,electrocardiogram (ECG) and echocardiographic features between the two groups were compared.Results There was no statistical significance between the two groups in terms of gender,height,weight and ventricular rate (P ＞ 0.05).The difference in the course of disease,blood pressure,age,QRS duration,left ventricular diameter by echocardiography and ejection fraction was statistically significant (P ＜ 0.05).Radiofrequency ablation result showed that 81 (96.4％) cases were successful in group A,and 37 (67.3％) cases were successful in group B.The difference in the success rate was statistically significant (P ＜0.05).After 1 year of follow-up,4 (2.9％) cases in group A were recurred,13 (23.6％) cases in group B were recurred.The difference in the recurrence rate was statistically significant.Conclusion The wide QRS wave tachycardia is often accompanied with left ventricular diameter enlargement and left ventricular ejection fraction reduction,The success rate of radiofrequency ablation is low,and the recurrence rate is high when diagnosis is ventricular tachycardia.

Objective To investigate the diagnosis and prognosis value of plasma microRNA-30d (miR-30d)in acute coronary syndrome(ACS)patients.Methods It retrospectively recruited 170 cases of ACS patients from TEDA International Cardiovascular Hospital between September 2011 to February 2012, including 70 STEMI(male 54,female 16), 52 NSTEMI(male 34,female 18),48 UAP(male 29,female 19).At the same time,41 healthy controls(male 24,female 17)were enrolled into the study.Plasma miR-30d levels were determined by real-time quantitative PCR.In order to evaluate the dynamic change of miR-30d and other cardiac biomarkers,20 plasma samples of AMI patients were collected at 0-3 h,4-6 h,7-9 h, 10-12 h after pectoralgia.ROC curves and Kaplan-Meier survival curve were used to investigate clinical value of miR-30d in ACS.Results At 0-3 h after pectoralgia, miR-30d were significant higher in STEMI 7.208(0.170-11 070.735)and NSTEMI 7.989(0.836-151.391)than the controls 1.561(0.044-17.520)（Z1＝-5.792,Z2 ＝-6.113,P＜0.001）, but there were no statistic differences between UAP 1.073 （0.051-11.095）patients and the controls（Z＝-0.325,P＝0.745）.In 20 AMI patients,miR-30d levels peaked at 4-6 h and then dropped following 7-9 h, both earlier than cTnI, and the variation tendency was positive correlated with cTnI（r＝0.402,P＜0.01）.At 0-3 h after pectoralgia, the AUC, sensitivity and specificity of miR-30d for differentiating AMI and UAP were 0.882（95％ CI:0.830-0.935）,0.795（95％CI:0.711-0.861）and 0.854（95％ CI:0.716-0.935）respectively.When combined miR-30d and cTnI, the diagnostic AUC and specificity were 0.937（95％ CI: 0.902-0.972）and 0.937（95％ CI:0.818-0.984）,both enhanced when compared with miR-30d or cTnI alone.Kaplan-Meier survival curves revealed that there were no significant correlations between the miR-30d levels and MACE in both 30 days and 12 months（χ$lt@span sup=1$gt@2$lt@/span$gt@＝0.506,P＝0.477 and χ$lt@span sup=1$gt@2$lt@/span$gt@＝0.002, P＝0.963 respectively）.Conclusion Plasma miR-30d may be used as a potential biomarker for early diagnosis, but not prognosis in ACS patients.

Objective:To understand the interaction effect of general obesity, central obesity, and dyslipidemia on the risk of hypertension to provide scientific evidence for the early prevention and control of hypertension.Methods:From 2019 to 2023, 10 of the 16 districts in Tianjin were selected as project sites. A community and a natural village were selected as monitoring sites in each project site using a multi-stage cluster random sampling method. A questionnaire, physical, and biochemical examination were conducted on permanent residents aged 35-75 who had lived in the surveillance sites for more than half a year. The chi-square test univariate and multivariate logistic regression were used for statistical analysis. The multiplicative and additive models were used to calculate the interaction between general obesity and dyslipidemia, as well as central obesity and dyslipidemia, respectively.Results:A total of 177 160 subjects were included in the study, with an age of (56.44±8.62) years old. There were 29 535 (16.67%) patients with general obesity, 67 338 (38.01%) patients with central obesity, 64 906 (36.64%) patients with dyslipidemia, and 90 266 (50.95%) patients with hypertension. Multiplication interaction analysis results showed that, after adjusting for gender, age, culture level, marriage status, drinking, smoking, and diabetes, the multiplicative interactions between general obesity and dyslipidemia, and central obesity and dyslipidemia on hypertension were statistically significant (all P<0.001), and the adjusted OR and 95% CI were 2.57 (2.47-2.68) and 2.14 (2.08-2.20), respectively. The results of the additive interaction analysis demonstrated that after adjusting for relevant variables, the relative excess risk of interaction ( RERI), the attributable proportion of interaction ( API), and the synergy index ( SI) of the interaction between generalized obesity and dyslipidemia were 0.48 (95% CI: 0.33-0.63), 0.15 (95% CI: 0.11-0.19), and 1.27 (95% CI: 1.18-1.36), respectively; the RERI, API, and SI of the interaction between central obesity and dyslipidemia were 0.37 (95% CI: 0.28-0.46), 0.13 (95% CI: 0.10-0.16), and 1.25 (95% CI: 1.18-1.32), respectively. Conclusions:There might be multiplicative and additive interactions between general obesity, central obesity, and dyslipidemia on the risk of hypertension. Simultaneous control of BMI, waist circumference, and blood lipid levels may effectively reduce the risk of hypertension.