We report a 32-year-old primigravida with no prior symptoms, normal baseline ECG, and no family history of sudden death who developed ventricular fibrillation (VF) shortly after uncomplicated vaginal delivery. She received epidural ropivacaine and sufentanil during labor. Post-resuscitation ECG demonstrated coved ST-segment elevation with T-wave inversion in V1–V2, consistent with spontaneous type 1 Brugada syndrome (BrS) pattern. Echocardiography excluded structural heart disease; coronary CT angiography excluded coronary artery disease. Laboratory investigations revealed borderline hypokalemia (3.5 mmol/L) and mild hypomagnesemia (0.75 mmol/L). Clinical whole-exome sequencing revealed no pathogenic or likely pathogenic variants in established arrhythmia-associated genes. The ECG normalized two days later. An implantable cardioverter-defibrillator was implanted. This case illustrates multifactorial unmasking of latent BrS—involving ropivacaine-mediated sodium channel blockade, postpartum autonomic instability, bradycardia, and electrolyte imbalance in a genotype-negative asymptomatic woman, highlighting the importance of recognizing concealed channelopathies in peripartum cardiac arrest.

Background:Routine health care increasingly requires digital access for appointment scheduling, medication refills, test-result review, clinician messaging, remote monitoring, and telehealth. For older adults with cardiovascular-risk conditions, complete internet disconnection may indicate accumulated geriatric vulnerability and barriers to continuous care. We examined whether complete digital disconnection was associated with mortality or residential-care transition and whether the risk gradient was driven by connectivity rather than telehealth use. Methods:We constructed staggered-entry prospective cohorts using rounds 11-14 of the National Health and Aging Trends Study (2021-2025). Community-dwelling Medicare beneficiaries aged ≥65 years with hypertension, heart disease, or diabetes entered the cohort in round 11, 12, or 13 and were followed through round 14. Digital integration was categorized as telehealth use, connected non-use, or complete disconnection. Outcomes were all-cause mortality and a composite of death or transition to nursing-home or residential care. The primary analysis used survey-weighted discrete-time survival models with entry-cohort fixed effects and participant-level cluster-robust variance estimation. Models were sequentially adjusted for demographic, socioeconomic, health, frailty-related, and geriatric-vulnerability factors. Robustness was assessed using multiple imputation, competing-risks models, E-values, and sensitivity analyses addressing reverse causation. Results:Among 12,139 person-baseline observations from 6,530 adults, the survey-weighted prevalence of complete disconnection was 29.7%. Compared with non-disconnected participants, completely disconnected adults had a higher unadjusted risk of the composite outcome; after adjustment for health and frailty-related factors, the association attenuated but persisted (composite hazard ratio [HR], 1.39; 95% CI, 1.12-1.73; mortality HR, 1.50; 95% CI, 1.16-1.94). The survey-weighted 3-year absolute risk difference was 12.1 percentage points. Telehealth users and connected non-users had similar adjusted risks (composite HR, 0.99; 95% CI, 0.79-1.24). Associations weakened after adjustment for functional status and exclusion of first-interval events. Conclusions:Complete digital disconnection was a reproducible and readily measured prognostic marker of mortality or residential-care transition among older adults with cardiovascular-risk conditions. These findings support a prognostic rather than causal interpretation. Age-friendly digital care should preserve offline-accessible pathways for older adults who remain completely disconnected.

Acute arterial occlusive mesenteric ischemia (AOMI) is a catastrophic vascular emergency associated with exceedingly high mortality rates. The lack of reliable early prognostic tools creates an urgent need for accessible biomarkers to guide management. This study aimed to evaluate mortality outcomes and assess the prognostic utility of baseline serum D-dimer levels in patients with AOMI. We conducted a retrospective cohort study of all AOMI patients admitted to China-Japan Friendship Hospital between January 2010 and August 2024. Patients were stratified by 30-day survival status. The predictive value of serum D-dimer levels, measured within 24 h of diagnosis, for mortality was assessed using multivariate Cox regression analyses. Prognostic performance was evaluated using receiver operating characteristic (ROC) curves and Kaplan-Meier survival analysis. Among the 61 patients included, the all-cause mortality rate was 47.5

目的:探讨环肺静脉隔离（PVI）基础上联合Marshall静脉化学消融治疗持续性心房颤动的安全性、有效性以及远期疗效。方法:回顾性分析2018年12月至2020年12月于中日友好医院心脏科因持续性心房颤动首次行射频消融的120例患者，根据治疗策略分为单纯PVI组（PVI组， n=90），PVI+Marshall静脉化学消融组（Marshall组， n=30）。观察两组的手术时间、X线曝光量及术后6、12个月有无心房颤动/房性心动过速（房速）发作、手术并发症等。 结果:共纳入首次行射频消融的持续性心房颤动患者120例。PVI组年龄（55.4±7.4）岁，其中男72例（80.0%，72/90）；Marshall组年龄（58.4±6.6）岁，其中男23例（76.7%，23/30）。①与PVI组相比，Marshall组二尖瓣峡部持久性损伤的成功率提高，也增加了手术时间[（150.3±30.7） min对（120.3±20.6） min， P<0.001]及X线曝光量[（180.3±45.7） mGy/cm 2对（50.3±25.5） mGy/cm 2， P<0.001]，差异均有统计学意义。②随访结果：Marshall组较PVI组术后未发作心房颤动/房速、维持窦性心律成功率高，差异均具有统计学意义[6个月：80.0%（24/30）对70.0%（63/90）， P=0.013；12个月：76.7%（23/30）对64.4%（58/90）， P=0.012]。③Marshall组与PVI组相比，两组并发症方面差异无统计学意义（ P=0.057）。 结论:PVI联合Marshall静脉化学消融安全、有效，且可增加持续性心房颤动的远期成功率。

We present the case of a 69-year-old man with chronic congestive heart failure and persistent atrial fibrillation with drug-refractory tachycardia. He received atrioventricular node ablation and right ventricular pacing therapy with a baseline heart rate programmed to be 50 beats/min. He experienced acute deterioration of heart failure just 3 h after a procedure with increased brain natriuretic peptide level, reduced left ventricular ejection fraction and diffuse left ventricular wall hypokinesis, and spetal wall no-movement. We programmed the baseline pacing rate to a higher level of 70 beats/min and optimized the therapy for heart failure, and then his symptoms were relieved accompanied by improvement in cardiac function. There may be a relationship between atrioventricular node ablation combined with right ventricular pacing and temporary deterioration of heart failure.

患者男性,78岁,主因"间断呼吸困难1年,加重伴下肢水肿2个月"于2023年3月29日入院.患者1年前出现劳力性呼吸困难,伴胸闷,近2个月症状逐渐加重,出现中度可凹性双下肢水肿,夜间无法平卧入睡.既往高血压病史20余年,口服沙库巴曲缬沙坦(200mg,Qd)控制血压;糖尿病20余年.入院生命体征及心肌标志物结果(见表1),心电图(见图1).超声心动图:左心室射血分数(left ven-tricular ejection fraction,LVEF)27％,左室壁运动普遍减低,左室舒张功能减低,右室壁运动减低(见表1).胸部CT示:间质性肺水肿,左心增大,双侧胸腔积液.冠状动脉造影:左主干未见狭窄,前降支未见狭窄,回旋支近段狭窄25％,右冠近段狭窄25％,TIMI血流均为3级.

患者男性,70岁,因"胸闷、心悸3月,再发1天"入院.图1为入院时心电图,表现为宽QRS波心动过速:心率145次/分,QRS波时限约160ms,aVR导联下降支明显顿挫,根据Verekei四步法诊断流程提示为室性心动过速[1].图1中的星号(*)所示为明显提前出现和变窄的QRS波,井号(#)提示为稍提前和相对变窄的QRS波,进一步提示为室性心动过速伴心室夺获和室性融合波.

1 临床资料 患者男性,90 岁. 因"意识障碍、发热 10h"于 2021 年8 月4 日收入中日友好医院心脏重症监护病房. 患者入院前10h无明显诱因出现昏睡、发热. 既往病史:重度视力障碍、听力障碍多年;高血压病史,间断服用"氨氯地平"及"替米沙坦"(具体剂量不详),日常监测血压;阵发性心房颤动、房颤射频消融术后,日常服用"美托洛尔"治疗(具体剂量不详);抑郁症病史,未接受正规治疗.

血管迷走性晕厥(VVS)是临床上最常见的晕厥类型，其机制涉及多个信号通路，目前尚未完全阐明。VVS的诊断和治疗需要综合考虑患者的发病诱因、临床表现和潜在机制，仍然存在一定困难。本文旨在对VVS的发病机制、诊断和治疗策略作简要综述。

患者男性,28岁,间断胸闷1年,加重6个月,外院门诊行Holter检查:窦性心律,心率增快时Ⅱ、Ⅲ、avF导联ST段上斜型压低.为明确诊断来我院就诊,行平板运动试验(treadmill exercise test,TET),采用 BRUCE 方案.运动试验经过:运动前患者心率76bpm,血压130/80mmHg,心电图示窦性心律,正常范围心电图;运动2分59秒时心率111bpm,V3～6导联ST-T水平型压低(图1,见封3);5分1秒时心率158bpm,心电图示 Ⅰ、Ⅱ、avF导联可见ST段压低0.1～0.2mV,avR导联ST段抬高0.1mV(图2,见封3);5分6秒时心率157bpm,V3～6导联ST段压低0.2～0.6mV,Ⅱ、Ⅲ、avF、V1～3导联T波高尖,avR导联ST段抬高0.3mV;平板运动试验进行到5分6秒(图3,见封3),突发室性心动过速,立即停止试验,让患者在检查床上平躺,在恢复期间突发意识丧失,呼吸心跳骤停,本科室医师立即给予心外按压,随后心电图示室颤(图4,见封3),室性逸搏心律(图5,见封3),紧急转运至急诊抢救室进行除颤,0.5h后恢复颈动脉搏动.考虑患者不除外急性心肌梗死,急诊行冠脉造影检查:冠状动脉左前降支(LAD)中段狭窄25％～50％(图6,见封3),TIMI血流3级,其余血管未见异常.肌酸激酶同工酶4.06ng/ml、肌钙蛋白1.360ng/ml.超声心动:心脏各腔室大小正常,室壁运动正常,射血分数67％,少量心包积液.临床诊断:呼吸心跳骤停、恶性心律失常、心室颤动、持续性室性心动过速、心脏复苏后、高脂血症.

目的 观察高龄(＞80岁)患者起搏器术后急性并发症发生率及危险因素.方法 入选2014年1月至2018年1月共127例植入心脏起搏器的高龄患者,观察60天随访期内急性并发症的发生率,对相关因素进行多因素Logistic回归分析.结果 共127例患者中,随访期间出现并急性发症者21例(16.5％),其中电极脱位1例(0.8％),气胸2例(1.6％),局部血肿9例(71％),术侧神经损伤2例(1.6％),皮下气肿1例(0.8％),静脉血栓1例(0.8％),心包积液1例(0.8％),术后室性心律失常4例(3.1％).多因素Logistic逐步回归分析显示,女性、身体质量指数(BMI)低、合并心房颤动对出现急性并发症具有统计学意义(p＜0.05).结论 高龄患者永久起搏器植入术后发生急性并发症比例为16.5％,相关危险因素为女性、BMI低、心房颤动,需加强此类高龄患者起搏器术后的治疗及监测.

Marshall静脉(vein of marshall,VOM)是左上腔静脉的残存物,因其为部分房性心律失常的触发灶,而成为心房颤动的致病原因之一.同时VOM也是交感神经和副交感神经与左心房组织联系的媒介,促进房颤的持续状态.肺静脉隔离(pulmonary vein isolation,PVI)是目前治疗阵发性房颤最有效的策略[1～4].持续性房颤(persistent atrial fib-rillation,PersAF)由于其发病机制较为复杂,导管消融成功率不高,术后窦律维持比例在50％～70％不等[5,6].文献报道,目前针对PersAF的导管消融策略[1,7,8]为单纯PVI、PVI加线性消融、PVI加碎裂电位消融(CAFEs)等,研究结果证实上述方法未能提高导管消融成功率[9,10].VOM位于心外膜,是参与PersAF维持的重要解剖结构.经心内膜导管消融无法彻底损毁VOM及其附属结构.经导管途径行VOM化学消融是房颤消融领域重大的技术创新,其治疗效果远优于外科途径.该技术有望使PersAF消融成功率在目前基础上再提高15％左右.目前已有少数几家中心开展此项技术[11～14].本文拟综述VOM化学消融持续性房颤方法、电生理特点、致心律失常作用及治疗方法.

Objective To investigate the potential factors influencing myocardial fibrosis (MF) in non-ischemic heart failure(HF) patients with an emphasis on the role of right heart catheter (RHC) parameters. Methods This retrospective research collected clinical data from 33 non-ischemic heart failure patients admitted to China-Japan Friendship Hospital who received endomyocardial biopsy (EMB) and right heart catheter (RHC) examination. All the patients were divided into two groups: mild MF (n=17) and severe MF (n=16), by means of K-means cluster analysis. MF was quantitatively evaluated by Masson staining. Potential factors influencing MF were analyzed. Results Compared with that in mild MF group, patients in severe MF group had aggravated cardiac function (cardiac index, 2.15±0.76 vs. 2.94±1.10,P＜0.05), accompanied by higher systolic right ventricle pressure (RVP), systolic pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP) and total pulmonary resistance (TPR) (P＜0.05). Hypertension and TPR were independently correlated with the degree of MF in multiple linear regression analysis (Adjusted R2=0.454, P＜0.001). Conclusions Hypertension and TPR, reflecting afterload of left and right ventricle, are found to be independently correlated with degree of MF in non-isch- emic heart failure patients. Cardiologists should pay more attention to high-risk patients in order to retard MF progression through timely intervention.

目的:探讨双腔心脏起搏器植入术后患者的心力衰竭发生率及相关危险因素.方法:入选2014年1月～2017年1月共247例植入双腔心脏起搏器的患者,其中215例完成随访,统计随访期间心力衰竭的发生率,对相关因素进行多因素Logistic回归分析.结果:215例患者中随访期间出现心力衰竭者42例,发生率19.5％.多因素Logistic逐步回归分析显示,植入时射血分数低、心室起搏比例高是起搏器术后发生心力衰竭的危险因素(OR=4.89、3.21,均P＜0.05).结论:植入双腔永久起搏器患者术后发生心力衰竭比例为19.5％,危险因素包括植入时射血分数低和心室起搏比例高,需加强此类患者起搏器术后的治疗及监测.

2019年11月27日凌晨,艺人高以翔在录制节目过程中突发晕厥,经近3小时抢救后,仍不幸去世,年仅35岁.医生宣布原因为心源性猝死. 什么是心源性猝死 世界卫生组织(WHO)对猝死的定义是:平素身体健康或貌似健康者,在出乎意料的短时间内(＜6小时),因自然疾病而突然死亡,即为猝死.猝死的原因包括心源性猝死和非心源性猝死.

在心脏介入手术中，包括心房颤动的肺静脉隔离术、经皮二尖瓣球囊扩张术、左心耳封堵术、经皮二尖瓣钳夹术等，房间隔穿刺术的应用越来越广泛，大直径鞘管的使用越来越多，跨房间隔的操作也越来越复杂。房间隔穿刺可能造成一过性或永久性的房间隔缺损。本文对医源性房间隔缺损的发生率、危险因素、血流动力学影响、临床意义以及处理原则等方面的研究进展做一综述。

Objective:To observe the effect of closed-loop stimulation (CLS) on rapid atrial arrhythmia.Methods:From August 2016 to March 2018, 30 patients with CLS dual chamber pacemaker implanted in China-Japan Friendship Hospital were selected in this study. The average age was (64.3±14.7) years, including 18 males. The patients were divided into A group (DDD-CLS mode before DDDR mode, both mode for 3 months) and B group (DDDR mode before DDD-CLS mode, both mode for 3 months) by simple randomization with single blind and crossover design.We observed and compared the percentage of atrial and ventricular pacing rate and the frequency and duration of auto mode switch (AMS) and atrial tachycardia burden percentage of the same patient under DDD-CLS mode and DDDR mode by pacemaker programmer.Results:Comparing to DDDR mode, DDD-CLS mode showed higher atrial pacing rate (66.5%±11.8% vs. 55.8%±14.0%, OR=1.30, 95% CI 1.06-1.73, P=0.007) , lower AMS counts[ (369±409) times vs. (596±761) times, OR=0.62, 95% CI 0.32-0.88, P=0.025]and lower atrial tachycardia burden percentage (17.9%±3.6% vs.29.3%±7.3%, OR=0.61, 95% CI 0.18-0.71, P=0.034) . Conclusion:CLS function may reduce the rapid atrial arrhythmia burden in patients treated with permanent dual chamber pacemaker.

Abstract To investigate factors predicting the onset of major adverse cardiovascular and cerebrovascular events (MACCEs) after primary percutaneous coronary intervention (pPCI) for patients with non-ST-segment elevation infarction (NSTEMI) and single concomitant chronic total occlusion (CTO). Neutrophil gelatinase-associated lipocalin (NGAL) and glycosylated hemoglobin (HbA1c) both play essential role in cardiovascular and cerebrovascular homoeostasis. However, current knowledge of its predictive prognostic value is limited. 422 patients with NSTEMI and CTO (59.7 ± 12.4 years, 74.2% men) who underwent successful pPCI were enrolled and followed for 2 years. Multivariate cox regression analysis and receiver operating characteristic (ROC) curve analysis were performed to determine the factors predicting MACCEs. 140 patients (33.2%) experienced MACCEs in the follow-up period. Multivariate cox regression analysis found when we process the model with NGAL at admission, low left ventricular ejection fraction (LVEF, HR = 0.963, 95% CI 0.940 to 0.987, P = .003) and fasting blood glucose (HR = 1.078, 95% CI 1.002 to 1.159, P = .044), but not NGAL at admission, were independent predictors of 2 years MACCEs. While HbA1C (HR = 1.119, 95% CI 1.014 to 1.234, P = .025), LVEF (HR = 0.963, 95% CI 0.939 to 0.987, P = .003), estimated glomerular filtration rate (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) and NGAL value 7 day (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) showed their predictive value in another model. ROC analysis indicated NGAL 7 day (AUC = 0.680, P = .0054 and AUC = 0.622, P = .0005) and LVEF (AUC = 0.691, P = .0298 and AUC = 0.605, P = .0021) could predict both in-hospital and 2 years MACCEs, while higher NGAL at admission could only predict poorer in-hospital prognosis (AUC = 0.665, P = .0103). Further analysis showed the prognostic value of NGAL was particularly remarkable among those HbA1C<6.5%. Patients with NSTEMI and single concomitant CTO receiving pPCI with higher NGAL on 7 days during hospitalization are more likely to suffer 2 years MACCEs, particularly in those with lower HbA1C.

Most implantable devices rely on a power supply from batteries and require replacement surgeries once the batteries run low. Mini-generators that harvest intracorporeal energy available in the human body are promising replacements of batteries and prolong the lifetime of implantable devices, thus reducing surgery pain, risks, and cost. Although various sources of energy available in the human body are used for electricity generation using piezoelectric and triboelectric materials or intravascular turbines, concerns about material durability or thrombus risks remain, and developing novel strategies to fabricate a mini-generator to harvest the intracorporeal energy is still challenging. Herein, a mini-generator system is designed by exporting the systolic/diastolic blood pressure from the femoral artery of a sheep to trigger the pressure-responsive reciprocating vertical motions of a conductor. By applying a magnetic field, an induced voltage of 0.32 V and a stable output power of 13.86 µW are obtained, which is promising to power a state-of-the-art pacemaker (8-10 µW). The noncontact electricity generation strategy provides a novel avenue to sustainable power supply for implantable devices.

目的 探讨双腔心脏起搏器患者术后发生房性快速型心律失常的相关因素,为合理防治提供依据.方法 回顾性调查我院392例植入双腔心脏起搏器的患者,对217例随访期间合并房性快速型心律失常(观察组)与175例未合并房性快速型心律失常(对照组)进行Logistic回归分析.结果 392例患者中,合并房性快速型心律失常217例,发生率55.4％.单因素及多因素Logistic逐步回归分析显示,合并高血压、植入指征:窦性心动过缓、冠状动脉粥样硬化性心脏病(冠心病)、心功能不全、高龄、心室起搏比例高,对并发房性快速型心律失常的影响差异有统计学意义(p＜0.05).结论 加强起搏器术后患者并发房性快速心律失常的监控.需针对危险因素早期预防和治疗.