AIMS:With the rapid growth of cardiac implantable electronic device (CIED) implantations, lead management has become increasingly challenging. Transvenous lead extraction (TLE) is now a primary approach for addressing lead-related complications. However, data on TLE in patients with abandoned leads remain limited. This study evaluates the safety and effectiveness of TLE in patients with abandoned leads. METHODS AND RESULTS:Consecutive patients undergoing TLE between January 2013 and January 2021 were enrolled and stratified into two groups: those with abandoned leads presence (Group 1) and those with active leads only (Group 2). The primary safety endpoint was major complications, and the effectiveness endpoint was clinical success of lead extraction. Among 1109 patients (median age 68 years; 70.7% male), 293 (26.4%) had abandoned leads (Group 1), while 816 (73.6%) did not (Group 2). A total of 2222 leads were extracted. Group 1 exhibited a higher number of leads per patient [2.0 (2.0-3.0) vs. 2.0 (2.0-2.0), P < 0.001], longer dwell time of the oldest lead [120.0 (72.0-174.0) vs. 48.0 (16.0-96.0) months, P < 0.001], a higher prevalence of CIED infection (94.9 vs. 87.4%, P < 0.001) and venous stenosis (51.5 vs. 38.8%, P = 0.001), and a higher proportion of MB scores ≥5 (45.1 vs. 15.0%, P < 0.001) and EROS 3 stratification (23.2 vs. 5.0%, P < 0.001). Clinical success was achieved in 1080 patients (97.4%), with major complications observed in 19 patients (1.7%). No significant differences were found between groups in major complication rates (2.4 vs. 1.5%, P = 0.299) or clinical success rates (96.2 vs. 97.8%, P = 0.154). Group 1 had lower manual traction success rate (8.9 vs. 37.5%, P < 0.001), required more advanced tools or multi-venous approaches (8.5 vs. 3.2%, P < 0.001), and showed higher rate of surgical extraction (3.1 vs. 1.1%, P = 0.030) and emergency thoracotomy (1.4 vs. 0.1%, P = 0.019). The dwell time of the oldest lead and number of leads removed mediated procedural risks. Multivariate analysis identified the dwell time of the oldest lead [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.08-1.21, P < 0.001] and the number of leads removed (OR 2.04, 95% CI 1.29-3.21, P = 0.002) as independent predictors of failure. Similarly, the dwell time of the oldest lead (OR 1.12, 95% CI 1.07-1.18, P < 0.001) and the number of leads removed (OR 1.54, 95% CI 1.04-2.28, P = 0.033) independently predicted complications. CONCLUSION:Transvenous lead extraction in patients with abandoned leads is characterized by clinical feasibility and effectiveness. However, the presence of abandoned leads is associated with increased procedural complexity, necessitating more frequent utilization of advanced extraction tools. The adverse consequences provide a clinical rationale for prophylactic removal of non-functional leads.

Introduction Atrial fibrillation (AF) is the prevalent cardiac arrhythmia and can significantly impair the quality of life (QoL). Although catheter ablation (CA) is an established treatment for AF,post-procedural complications or perceived inadequate control of AF may diminish the QoL for some patients, potentially even to levels lower than pre-procedure. Preliminary findings from our previous pilot trial indicate that acupuncture may positively influence QoL in AF patients post-CA. This study aims to increase the sample size to evaluate the efficacy of acupuncture as an adjunctive treatment to conventional medical therapy in improving QoL of patients with AF after CA.Methods and design This multicentre randomised clinical trial will be conducted in China. A total of 146 eligible patients will be randomly assigned in a 1:1 ratio to either the acupuncture group or the sham acupuncture group. All patients will receive standard postablation care and undergo 18 sessions of acupuncture/sham acupuncture within 12 weeks following CA, followed by a 9-month follow-up period. The primary outcome is the change in the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) summary score from baseline to months 6 after CA. Secondary outcomes include the changes in the AFEQT subscale scores at months 6, the AFEQT summary and subscale score at months 3 and 12, AF burden, AF recurrence, heart rate variability, number of cardioversions, repeat CA procedures, European Heart Rhythm Association score, number of arrhythmia-related hospitalisations, average heart rate, use of Six-Dimensional Health State Short Form to assess health status, costs incurred by disease treatment, Credibility/Expectancy Questionnaire and blinded assessments. Adverse events will also be meticulously recorded throughout the trial.Ethics and dissemination Ethics approval has been granted by the Ethics Committee of Beijing University of Traditional Chinese Medicine (approval no: 2020BZYLL0802) and seven other subcentres. The findings of the study results will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.Trial registration number ChiCTR2100049323.

With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. We report four cases of CIED infections from single-center, who were extracted endocardial leads with intra-op transesophageal echocardiography (TEE) monitoring and guidance. Three of them had fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op transthoracic echocardiogram (TTE), which could avoid intra-op embolism. Application of TEE helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Thus, continuously intra-op TEE should be one of the routine monitoring methods in this high-risk procedure.

目的对同一次直立倾斜试验(Head-up Tilt Test,HUTT)中的合并不同血流动力学反应的复合型反应进行总结分析.方法226例晕厥或头晕或走路不稳患者在安静环境空腹进行HUTT持续监测心电和血压,观察其血压、心率变化及症状.结果226例进行HUTT的患者中血管迷走性反应(Vasovagal Response,VVR)阳性 91 例,体位性心动过速(Postural Tachycardia Syndrome,POTS)30 例,直立性低血压(Orthostatic Hypotension,OH)67 例.POTS 合并 VVR(P-CFR)23 例,OH 合并 VVR(O-CFR)15 例,单纯 VVR(Only-VVR)53例.结论直立倾斜试验存在不同类型血流动力学反应的复合型反应,需要对不同阶段HUTT细致观察.

目的 应用高密度标测导管 HD-Grid(HDG),准确识别肺静脉再连接,降低心房颤动(简称房颤)导管消融后复发率.方法 从 2020 年 1 月至 2021 年 1 月,连续入选 30 例因阵发性房颤行射频消融手术,术后房颤复发患者,分别使用环肺电极和 HDG进行左房电解剖标测,比较两组间识别出肺静脉再连接的差异,并以此指导再次肺静脉隔离,观察远期房颤复发率.结果 30 例患者年龄(68.00±8.25)岁,男 18 例,女 12 例.应用HDG标测,24例发现了 72 处肺静脉再连接,应用环肺电极,仅在 12 例患者中发现了 24 处肺静脉再连接.与环肺电极相比,HDG可以识别出更多的肺静脉再连接位点数[3(2,4)vs 0.8(0.4,1.0),P<0.05].30 例在 HDG指导下再次肺静脉隔离后,在 12 个月随访时间内,5 例再次出现房颤复发,其中能够识别到肺静脉再连接者,仅 1 例出现房颤复发.结论 HDG能帮助识别出更多的肺静脉再连接,以其指导肺静脉隔离,降低房颤复发的概率.

Objective:To analyze and summarize the clinical and imaging features of lead perforation.Methods:The medical records of patients with lead perforation who were discharged from Peking University People′s Hospital from January 1, 2008 to April 1, 2023 were reviewed. The demographic data, medical history, laboratory and imaging examination data, lead related parameters were collected.Results:A total of 106 patients were enrolled, 64.1% (68/106) were female, and the mean age was (67±15) years. Ninety-four (88.5%, 94/106) patients had perforation-related symptoms, and chest pain was the most common (65.1%, 69/106). A total of 106 perforated leads were included, 98 (92.5%, 98/106) were pacing leads, and 8 (7.5%, 8/106) were implantable cardioverter defibrillator (ICD) leads. There were 85 active fixed leads (80.2%, 85/106), and 21 passive fixed electrodes (19.8%, 21/106). Eighty-four (79.2%, 84/106) patients had at least one parameter abnormality. Eighty-six cases (81.1%, 86/106) were diagnosed by imaging examination, and 20 cases (18.9%, 20/106) were diagnosed by symptoms, signs, and lead parameters. In terms of the detection rate of lead perforation, the positive rates of CT (88.2%, 53/60) and X-ray multi-position fluoroscopy (90.3%, 84/93) were statistically higher than that of echocardiography (35.2%, 37/106) and chest X-ray (32.1%, 34/106) ( P < 0.001) . Conclusion:The diagnosis of lead perforation should be combined with imaging examination, symptoms/signs and lead parameters. X-ray multi-position fluoroscopy and chest CT examination have a higher detection rate and can be used as the preferred examination methods.

Serum C-peptide exhibits various biological activities. The relationship between C-peptide and atrial cardiomyopathy remains unknown. We aimed to investigate the association between C-peptide level and atrial cardiomyopathy in nondiabetic adults. Our study enrolled 4578 participants without diagnosed diabetes from the Third National Health and Nutrition Examination Survey (NHANES III). Atrial cardiomyopathy was defined as a deep terminal negative P wave in V1 below − 100 µV (more negative), according to the electrocardiogram. The participants were categorized into low C-peptide (≤ 1.46 nmol/L) and high C-peptide (> 1.46 nmol/L) groups, according to the receiver operating characteristic analysis. Odds ratio (OR) and 95

目的:探讨≥65 岁老年患者经静脉拔除心血管植入型电子器械(CIED)导线的安全性和有效性.方法:回顾性分析 2017 年 1 月至 2022 年 1 月因CIED感染或导线故障而转诊至本院心血管内科行经静脉拔除导线的 753 例患者的数据,并根据年龄将患者分为＜65 岁组和≥65 岁组,比较两组患者的临床特点和拔除结果.结果:753 例患者中,429 例(57.0%)≥65 岁[平均年龄(75.6±6.8)岁,男性 70.6%].＜65 岁组和≥65 岁组拔除导线的成功率(97.8%vs.98.8%)和安全性(未发生并发症比例:94.1%vs.96.2%)均较高且差异均无统计学意义(P均>0.05);两组的主要并发症在≥65 岁组稍低(1.9%vs.4.0%,P=0.08)但差异无统计学意义;心脏压塞在主要并发症中发生率最高,为 66.7%(14/21).结论:≥65 岁老年患者经静脉拔除CIED导线安全有效.

A 59-year-old woman with a history of a pacemaker implanted for III-degree atrioventricular block was admitted due to pocket infection. The atrial and ventricular leads were removed via the right femoral vein using a needle's eye snare. Hypoxemia was observed immediately after the removal of the lead. It was refractory to oxygen therapy. The pulse oxygen saturation (SpO2) showed 89% in the supine position and 77% in the upright position. However, the CTPA and pulmonary perfusion SPECT/CT imaging did not reveal any signs of pulmonary embolism. Pulmonary function tests and chest CT showed normal results. Transthoracic contrast echocardiography revealed a patent foramen ovale (PFO) and a right-to-left intracardiac shunt, no significant tricuspid regurgitation, without any signs of elevated right heart pressure or pulmonary hypertension. Hypoxemia was considered to be associated with the right-to-left shunt through PFO. The condition was relieved by percutaneous closure of the PFO. Refractory hypoxemia resulting from an intracardiac right-to-left shunt following pacemaker lead extraction is a rare but serious complication. Transthoracic contrast echocardiography helps in diagnosis. If the right-to-left intracardiac shunt through PFO persists irreversibly and the associated hypoxemic symptoms are significant, closure of the PFO is necessary. Transesophageal echocardiography also revealed the presence of a left-to-right shunt through PFO during cardiac systole. The closure of the PFO is also necessary to avoid long-term complications, such as chronic pulmonary hypertension and right heart failure.

目的:评价心脏起搏装置感染拔除后未再植入新起搏装置的安全性. 方法:回顾性分析 2014 年 1 月至 2020 年 1 月于北京大学人民医院因起搏器感染行电极拔除术患者共 825 例,根据是否植入新起搏装置分为再植入组(n=640)和未再植入组(n=185).收集患者的临床资料,随访拔除后未再植入新起搏装置的患者,分析其安全性.随访的研究终点是患者死亡以及再次植入新起搏装置. 结果:185 例(22.4%)患者感染装置拔除后未再植入新起搏装置.未再植入组与再植入组的年龄、男性、起搏器植入时间、窦性心动过缓或停搏患者比例差异均无统计学意义(P均＞0.05).与再植入组相比,未再植入组的高度或完全性房室阻滞患者比例较低(45.6%vs.1.1%,P<0.05),而心房颤动伴长R-R间期患者比例较高(18.4%vs.62.3%,P<0.05).未再植入组患者中,单纯囊袋感染155例(83.8%),菌血症20例(10.8%),感染性心内膜炎10例(5.4%).未再植入新起搏装置的最常见原因是患者为非起搏依赖且电极拔除后未见长R-R间期(128 例,69.2%;其中包括 12例已行心房颤动射频导管消融治疗且术后未再出现长R-R间期的患者),其次为自主心率<50 次/min但无心动过缓相关症状(55 例,29.7%),2 例(1.1%)患者伴高度房室阻滞但电极拔除后不愿意再次植入.电极拔除过程中最常用的工具是经股静脉抓捕器(50.3%),其次是锁定钢丝(28.7%).对未再植入组患者中位随访 40.6(12.5,52.8)个月,36 例(19.5%)患者达到研究终点,包括 24 例(12.9%)因症状性心动过缓再次植入起搏装置的患者和 12 例(6.5%)死亡患者,所有死亡患者均无症状性心动过缓,均与慢心率无关. 结论:心脏起搏装置感染拔除后,22.4%的患者不需要再植入新起搏装置,最常见的为心房颤动伴长R-R间期患者,密切随访证实未再植入新起搏装置的患者是安全的.

Transcatheter radiofrequency ablation has been widely introduced for the treatment of tachyarrhythmias. The demand for catheter ablation continues to grow rapidly as the level of recommendation for catheter ablation. Traditional catheter ablation is performed under the guidance of X-rays. X-rays can help display the heart contour and catheter position, but the radiobiological effects caused by ionizing radiation and the occupational injuries worn caused by medical staff wearing heavy protective equipment cannot be ignored. Three-dimensional mapping system and intracardiac echocardiography can provide detailed anatomical and electrical information during cardiac electrophysiological study and ablation procedure, and can also greatly reduce or avoid the use of X-rays. In recent years, fluoroless catheter ablation technique has been well demonstrated for most arrhythmic diseases. Several centers have reported performing procedures in a purposefully designed fluoroless electrophysiology catheterization laboratory (EP Lab) without fixed digital subtraction angiography equipment. In view of the lack of relevant standardized configurations and operating procedures, this expert task force has written this consensus statement in combination with relevant research and experience from China and abroad, with the aim of providing guidance for hospitals (institutions) and physicians intending to build a fluoroless cardiac EP Lab, implement relevant technologies, promote the standardized construction of the fluoroless cardiac EP Lab.

2023年3月31日,"第十届心脏起搏及电极导线管理高峰论坛暨心律植入装置感染及并发症处理研讨会"在北京隆重召开,此次会议由中国医药生物技术协会主办,中国生物医学工程学会心律学分会、中国医药生物技术协会心电学分会、中国心律学分会起搏技术创新工作委员会、北京大学人民医院、《临床心电学杂志》承办,来自国内外心血管相关领域的专家们出席了此次大会,共享学术盛宴.

Objective:To evaluate the safety of leadless pacemaker implantation in super-elderly patients.Methods:Eleven patients with average age of 90 (86, 92) years who underwent leadless pacemaker implantation in the Department of Cardiology, Peking University People′s Hospital from March 2021 to May 2022 were included. The clinical data and implantation information were collected. The complications (cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection, femoral vein hematoma) and death of patients were documented at 24 h, 3 d, and 1, 3, 6 months after pacemaker implantation.Results:There were 9 males and 2 females with the body mass index of 21(19, 23)kg/m 2. The underlying diseases were hypertension, diabetes, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, previous cerebral infarction and moderate to severe tricuspid regurgitation in 9, 9, 9, 6, 4, 4, 4 patients, respectively. The left ventricular ejection fraction was 49% (45%, 52%), the hemoglobin concentration was 118 (114, 122)g/L, 4 patients were taking anticoagulant drugs, and 6 patients were taking antiplatelet drugs. Eight patients were newly implanted with a leadless pacemaker, 2 patients were implanted after removal the old ones, and 1 case was implanted at the same time as removal. The implantation time was 45(40, 47) minutes, the X-ray exposure time was 14 (13, 15) minutes, the release time was 1 (1, 2), the threshold value was 0.50(0.38, 0.75)V/0.24 ms, the impedance was 730 (700, 770) Ω, and the perceived R-wave amplitude 8.2(6.7, 12.8) mV. During the follow-up period of 8 (6, 10) months, no patient had pacemaker dysfunction; and the threshold, R wave sensing, and impedance were stable and maintained within the normal range. No cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection or death occurred perioperatively and during the follow-up period; 1 patient had hematoma after femoral vein puncture, which improved after compression treatment. Conclusion:This single-center and small-sample study shows that leadless pacemaker implantation is safe for super-elderly patients.

目的 评估新型冠状窦造影球囊导管在心脏再同步治疗(CRT)起搏器植入术中应用的有效性和安全性.方法 连续入选2019年1月1日至12月1日于北京大学人民医院心内科就诊的具有CRT起搏器(包括CRT-P和CRT-D)植入指征的患者25例,排除既往植入失败和拒绝签署知情同意书者5例,符合入选标准的20例患者应用新型冠状窦造影球囊导管进行CRT植入,统计这些患者CRT植入时间、左室电极植入时间、冠状窦夹层和心包积液发生率,计算CRT植入成功率.结果 20例患者中,男性12例,平均年龄(62.3±4.5)岁,缺血性心肌病6例,平均纽约心脏病协会(NYHA)心功能分级(2.5±0.8)级,平均左室舒张末期内径(52.6±3.3)mm,平均射血分数38.0％±5.0％,平均左室电极植入时间(12.3±2.4)min,平均手术时间(54.6±6.2)min,CRT总体植入成功率100％.全部患者均无膈肌刺激,均未发生冠状窦夹层,术中无患者发生心脏压塞,术后复查超声心动图均无新发心包积液.结论 新型冠状窦造影球囊导管能够在较短时间内完成CRT左室电极植入,与既往植入方法相比,可减少术中X线曝光时间,降低冠状静脉夹层发生率,提高CRT植入成功率.

AimThe most challenging and time-consuming stage of cardiac resynchronization therapy (CRT) device implantation is coronary sinus (CS) cannulation and left ventricular epicardial electrode implantation. This paper reports the initial clinical experience of CS cannulation and left ventricular lead implantation guided by a novel venogram balloon catheter (Lee’s venogram balloon catheter).Methods and ResultsConsecutive patients eligible for CRT were deemed suitable for this novel venogram balloon catheter. Parameters such as left ventricular lead implantation time, procedure time, and fluoroscopy time were recorded. CS cannulation with LV lead implantation guided by Lee’s venogram balloon catheter was successful in all 5 patients, including 4 challenging cases. The total fluoroscopy and procedural durations were 5.0 ± 3.0 and 57.4 ± 12.5 min, respectively. No adverse catheter-related events occurred during the procedures.ConclusionThis initial study of an innovative venogram balloon catheter demonstrated that it greatly facilitated CS cannulation and successful LV lead placement in all patients undergoing CRT system implantation. This significantly shortened the learning curve and showed a decrease in left ventricular lead implantation time, procedure time, and fluoroscopy time.

Objective:To evaluate the performance of multipoint pacing (MPP) in a large Chinese heart failure(HF) patient cohort and collect the real-world experience and clinical evidence.Methods:A prospective, multi-center, nonrandomized study evaluated patients who received cardiac resynchronization therapy pacemaker(CRT-P) or cardiac resynchronization therapy defibrillator (CRT-D) system with the MPP feature that have been approved in China.Data collected included implant experience, echocardiography parameters, and clinical parameters.Response to cardiac resynchronization therapy (CRT) was defined as an absolute increase of ≥15% in left ventricular end systolic volume (LVESV)at follow-up compared to baseline.Results:Between November 2016 and October 2019, a total of 101 patients were enrolled from 11 hospitals in China.The CRT system was successfully implanted in 99 cases[average age was(61.7±11.3) years; 73 (74%, 73/99) were male] with acute complication rate of 1.0%.The MPP feature was turned on in 81% of cases before discharge and in 76% of cases after 12 month.Among patients who completed 6- and 12-month follow-up visit, the CRT response rates were 67.8% and 73.5%, respectively.During the 12-month follow-up, the left ventricular ejection fraction (LVEF, 43%±13% vs. 27%±9%), 6-min walk test[(541.6±472.4) m vs. (320.4±113.5) m], and Minnesota Living with Heart Failure Score (22.5±23.5 vs. 45.3±23.6) all improved significantly compared to baseline( P<0.05). The all cause mortality rate and all cause hospitalization rate at 12 month were 3.0% and 11.1%, respectively. Conclusion:From a large Chinese HF population receiving MPP CRT, we found that MPP is safe and effective for treating HF with significant improvements in clinical outcome and quality of life over one-year follow-up.

目的:分析我院行心房颤动(房颤)射频消融术的患者中房间隔膨出瘤(ASA)或过度运动(HB)的合并情况及此类患者在三维心腔内超声(ICE)指引下进行无射线房间隔穿刺处理的方法.方法:回顾性分析我院2019年4月至2021年4月期间行房颤射频消融术的患者中ASA或HB的合并情况、形态特点以及此类患者在ICE指引下行无射线房间隔穿刺时吸气法的成功率与合并症发生情况.结果:共203例房颤患者在ICE指引下行房颤射频消融术,发现ASA 12例(5.9％),HB 28例(13.8％),男性多见(合并ASA、HB的患者中男性分别占75.0％、67.9％).合并ASA的患者卵圆窝平均膨出长度为(11.6±1.1)mm,HB患者卵圆窝平均摆动距离为(6.4±1.4)mm.在合并ASA或HB的患者中,在ICE指引下采用吸气法进行房间隔穿刺的成功率为100％,未出现合并症.12例ASA患者中,1例在房间隔穿刺过程中使用X线透视.结论:在行房颤射频消融的患者中,ASA或HB并不少见,此类患者在ICE指引下采用吸气法行无射线房间隔穿刺安全、有效.

起搏诱导性心肌病通常定义为长期右心室起搏出现左室射血分数的下降.然而最近的研究数据表明,仅依据左室射血分数下降来定义起搏诱导性心肌病可能低估了长期右心室起搏有害影响的发生率,当出现起搏诱导性心肌病时,主要的治疗方式为升级成心脏再同步化治疗,而最新的数据表明,传导系统起搏可能在预防和治疗起搏诱导性心肌病方面有一定优势.现就起搏诱导性心肌病的研究进展做一综述.