Objectives:To investigate whether the gender differences exist in distribution of bradyarrhythmia and implantation age among patients with pacemaker.Methods:We retrospectively enrolled consecutive patients for pacemaker implantation from January 2015 to December 2017 in Center of Arrhythmia Fuwai Hospital Ward 1. The clinical data were collected, including age, sex, types, of bradyarrhythmia and complication, etc. The type of bradyarrhythmia and the average of pacemaker implantation in young and middle-aged group (18-59 years old) and the elderly group (≥60 years old) were compared.Results:A total of 1 431 adult patients with pacemaker implantation were finally enrolled with 47.5% (680/1 431) male cases, the age of all patients ranging from 19 to 96 years old with average (68.1±13.1) years old.①The distribution of various bradyarrhythmia was significantly different between male and female patients. In overall patients, the prevalence of sick sinus syndrome in female patients was significantly higher than that in male patients[60.1% (451/751) vs. 41.2% (280/680) , P<0.001], while the prevalence of atrioventricular block[23.3% (175/751) vs. 32.5% (221/680) , P<0.001] and atrial fibrillation with long interval or low heart rate[9.6% (72/751) vs. 14.6% (99/680) , P=0.004] were significantly lower than that in male patients. This gender differences were also found in the young and middle-aged group as well as in the elderly group.②In the young and middle-aged group, the mean age of pacemaker implantation of female patients with sick sinus syndrome was significantly older than that of male patients[ (53.0±7.1) years old vs. (49.7±10.3) years old, P=0.037]. In the elderly group, the age of pacemaker implantation of male patients was older than that of female patients with second-degree atrioventricular block[ (75.9±7.0) years old vs. (72.2±6.4) years old, P=0.012] and atrial fibrillation with long interval or low heart rate[ (74.5±8.4) years older vs. (70.8±6.9) years old, P=0.007]. Conclusion:Gender differences were found in the distribution of various bradyarrhythmia in patients with pacemaker. The age of pacemaker implantation was also different between sex in some type of bradyarrhythmia.

1 临床资料 患者男性,54岁.因"活动后胸闷气短6年"入院.患者6年前出现活动后胸闷、气短,就诊我院行超声心动图检查提示主动脉瓣重度狭窄,行主动脉瓣生物瓣置换术.术后症状缓解,抗凝治疗半年后停药.4年前复查时发现持续性心房颤动、完全性左束支阻滞.4个月前因胸闷、气短加重复查超声心动图提示左心室舒张末期内径(LVEDD) 72 mm, 左心室射血分数(LVEF) 40％,二尖瓣脱垂,二尖瓣中-大量反流,给予卡维地洛、地高辛、托拉塞米、螺内酯、培哚普利等药物抗心力衰竭治疗,1个月余前因症状不能缓解,为行二尖瓣置换术来我院住院.

目的:应用超声心动图评估左束支区域起搏(LBBP)电极位置及安全性.方法:入选2018年10月至2019年5月我院行LBBP患者122例,其中起搏器植入86例(起搏器组),左束支再同步(L-CRT)植入36例(L-CRT组).术前及术后3个月对其临床症状、起搏器程控以及超声心动图指标进行记录和随访.结果:术后3个月超声心动图检查显示,电极无明显移位,无室间隔血肿、室间隔穿孔等并发症.起搏器组和L-CRT组电极旋入深度分别为(10.1±1.4)mm和(9.6±1.7)mm,电极旋入点至三尖瓣隔叶根部距离分别为(20.9±3.8)mm和(24.3±6.2)mm,电极旋入点距主动脉右冠瓣距离分别为(10.3±2.4)mm和(10.5±3.9)mm,差异均无统计学意义(P均>0.05).起搏器组和L-CRT组分别有8例和2例患者三尖瓣反流量较术前增加,但均为少量至少中量.所有患者植入电极均无明显限制三尖瓣活动表现.结论:LBBP短期随访起搏电极位置及安全性良好.

Objective To investigate the thrombolysis and safety of patients with non-valvular atrial fibrillation(NVAF) complicated with left atrial appendage (LAA)thrombosis after treatment with non-vitamin K antagonist oral anticoagulants (NOACs,rivaroxaban and dabigatran) and warfarin.Methods This was a retrospective,observational study.We consecutively enrolled NVAF patients with LAA thrombus detected by transesophageal echocardiogram (TEE)and/or left atrium computed tomography (LACT)from January 2016 to October 2017 in Fuwai Hospital.The patients were divided into 3 groups by the use of different anticoagulants:warfarin group (dose:adjusted with target international normalized ratio range 2.0-3.0),rivaroxaban group (dose:15 mg bid for three weeks then followed by 20 mg qd)and dabigatran group(dose:110 mg bid).All patients underwent TEE or LACT at 1 month,2 months,3 months and 4 months to determine the status of thrombus.Follow-up of bleeding events by telephone.Results A total of 14 cases were enrolled,with four patients receiving warfarin,six patients receiving rivaroxaban,and four patients receiving dabigatran.After 1 month of anticoagulant therapy,thrombolysis of LAA was only observed in one case receiving rivaroxaban,33％ (2/6) and 50％ (3/6) in patients taking rivaroxaban,50％ (2/4) and 75％ (3/4) in dabigatran group,0 (0/4)and 50％ (2/4)in warfarin group at 2-month and 3-month follow-up,respectively.After 4 months' treatment,all 6 patients had LAA thrombolysis with rivaroxaban(100％) treatment compared to 3 patients receiving dabigatran (75％),and 2 patients taking warfarin (50％).During 4 months' follow-up,only mucocutaneous hemorrhage was observed in two cases receiving rivaroxaban or warfarin.Conclusion NOACs could be used safely and effectively compared to warfarin in the treatment of LAA thrombus in NVAF in the real world.

Objective This study aimed to investigate theproportion of magnetic resonance imaging (MRI),the location of examination,clinical characteristics,and factors affecting the completion of MRI in patients with MRI-conditional pacemaker.Methods We retrospectively enrolled consecutive patients who had received MRI-conditional pacemaker implantation from January 2012 to July 2017 in Fuwai Hospital.The baseline clinical data of patients before and after operation were collected,and all patients were prospectively followed up by telephone or clinic visiting.Body region for MRI examination,reasons for unfinished MRI examination,and pacing parameters before and after MRI examination were collected.Results A total of 524 patients with MRI-conditional pacemakers were enrolled in this study.There were 114 (22％) patients who had undergone MRI examination before pacemaker implantation,with head and neck as the most common body region for MRI in 52 (46％) cases.During an average follow-up of (29 ± 9) months,there were 62 patients (12％) had clinical MR1 requirements,and still 50％ (31/62) cases required head and neck MRI examination.The MRI examination was finally performed in only 15 patients (24％).As compared with patients without requiring MRI,patients requiring MRI had a higher prevalence of cerebrospinal disease (5％ vs.2％,P=0.026).No adverse events were found in patients performing MRI,while 27％ (4/15) of them without pacemaker programing before and after MRI examination,and no significant changes in pacing parameters were found in those with pacemaker programing.MRI examination was not finished in 76％ (47/62) of patients.The reasons were potential risk (39％,24/62),choosing alternative examinations (23％,14/62),and rejection by local hospital (14％,9/62).Conclusions Nearly one-third of patients with MRI-conditional pacemaker required MRI examination,and head and neck might be the most common.Patients with requirement of MRI examination had high proportion combined with cerebrospinal disease.Safety concern from both patients and doctors may lead to the abortion of MRI examination in patients with MRI-conditional pacemaker.

Objective This study aimed to investigate the feasibility and safety of active-fixation lead for protective temporary cardiac pacing during permanent pacemaker implantation.Methods We retrospectively enrolled 90 severe complete atrioventricular block patients who needed protective temporary pacing during pacemaker implantation from September 2016 to March 2019 in Fuwai Hospital,and patients were classified into 2 groups by protective temporary cardiac pacing strategies.Patients in group A (n=40)received routine temporary pacing through right femoral venous access,and the temporary pacing lead was removed after permanent pacemaker implantation procedure.Patients in group B (n=50) firstly received temporary cardiac pacing by using an active-fixation lead through venous access (axillary or subclavian vein)during routine procedure of permanent pacemaker implantation.After fixation of ventricular lead for permanent ventricular pacing,the first temporary pacing lead was withdrawn and placed for atrial permanent pacing.The total procedural time,perioperative complications,and X ray exposure were compared between the two groups.Results Patients in two groups had similar baseline clinical characteristics.The frequency of patients needing temporary pacing during procedure was comparable between two groups (83％ vs.84％,P=0.535).The average time of total procedure in group B was significantly shorter than that in group A (69 rmin vs.81 min,P=0.011).The exposure time(3.2 min vs.7.1 min,P=0.000)and the exposure doses of X ray (2.1 mGy vs.3.3 mGy,P=0.029) were significantly reduced in groupB as compared with group A.Two cases had hematomas at puncture site of femoral vein and one case had arteriovenous fistula in group A.No perioperative complications were detected in group B.Temporary pacing lead and delivery sheath used in group A increased additional cost as compared to group B.Conclusion Application of active-fixation lead as temporary pacing lead during permanent pacemaker implantation might be a novel approach with improved cost effectiveness reduced time of procedure,and X-ray exposure instead of routine temporary pacing via femoral venous access.

奎尼丁是一种广谱抗心律失常药.作为IA类抗心律失常药物代表,曾广泛用于房性及室性心律失常的治疗.20世纪90年代CAST研究指出IA类抗心律失常药物增加器质性心脏病患者死亡率,加之药物相关到作用发生率高,奎尼丁逐渐退出临床抗心律失常用药的应用.近年来,研究者发现奎尼丁在遗传性心律失常的治疗中表现出优势,尤其在恶性室性心律失常恶预防方面.现就奎尼丁在遗传性心律失常中的应用进行综述.

Objective To analyze the clinical characteristics of patients with idiopathic right ventricular outflow tract (RVOT) ventricular arrhythmias (VA) and factors related to the immediate success rate of radiofrequency ablation. Methods Patients diagnosed as idiopathic RVOT arrhythmia in Fuwai Hospital from February 2009 to January 2013 were retrospectively screened. Patients with structural heart disease or inherited arrhythmia were excluded. All patients underwent endocardial electrophysiological study and radiofrequency catheter ablation. Baseline clinical and operation records were collected and analyzed. Immediate success rate was defined as no inducible ventricular arrhythmia by isoprinosine and electrophysiological induction at the end of ablation. The origins of idiopathic RVOT were classified as septal, anterior, posterior, free wall site, epicardial and RVOT-aorta root site. Results A total of 468 patients were finally included, and the age was (40.4 ± 13.3) years old and 60.5%(283/468) patients were female. Immediate radiofrequency success rate was 89.3%(418/468). Patients were divided into ablation success group (n=418) and ablation failure group (n=50). Percent of female patients and patients with interventricular septal origin was significantly higher in the ablation success group than in ablation failure group (261(62.4%) vs. 22(44.0%), P=0.01, and 233(55.7%) vs. 18(36.0%), P=0.005), while percent of patients with epicardial origin was significantly lower in the ablation success group than in ablation failure group (17 (4.1%) vs. 11(22.0%), P<0.001). Immediate success rate was the highest for patients with the septal origin and the lowest for patients with epicardial origin (92.8%(233/251) vs. 60.7%(17/28), P<0.05). Multivariate analysis showed that the origin site of VAs was the most important independent factor related to the success rate of ablation. Compared with the septal origin patients, patients with RVOT-aorta root and epicardial origin VAs faced with 1.82-fold and 8.26-fold increased risk of failed ablation, respectively ( OR=2.82, 95% CI 1.05-7.57, and OR=9.26,95% CI 3.60-23.86). Sex category was not the independent risk factor for failed ablation(OR=1.76, 95%CI 0.93-3.33, P=0.08). Conclusions The immediate success rate of radiofrequency catheter ablation for idiopathic RVOT ventricular arrhythmia is relative high, however, immediate success rate of radiofrequency catheter ablation is relatively low for patients with epicardial and RVOT-aorta root origin arrhythmia and VAs origin is an independent risk factor of immediate ablation success rate.

Objective The present study was aimed to explore the effect of radiation dose reduction by using three-dimensional mapping system in radiofrequency catheter ablation of idiopathic right ventricular outflow tract ventricular arrhythmia.Methods From January 2013 to February 2014,we recruited consecutive patients with right ventricular outflow tract ventricular arrhythmias who underwent intra-cardiac electrophysiological study and radiofrequency catheter ablation.Patients were divided into two groups according to two cardiologists who both had more than ten years' experience of radiofrequency catheter ablation.The whole procedure was guided on by X-ray in X-ray group while by three dimensional mapping system plus X-ray in the3D+X-ray group.The cumulative radiation dose (CD),dose area product (DAP) and fluoroscopy time were recorded automatically by a fluoroscopy system,and were compared between two groups.Results A total of 90 patients were enrolled (average age:41.5±14.1 years old) with45patientsin each group.As compared with the X-ray group,3D+ X-ray group had significantly lower average value of CD(6.5±7 mGy vs.63.7±170.5 mGy,P＜0.001),reduced DAP(45.2±45.8μGym2 vs.208.0±249.7μGym2,P＜0.001),decreased X-ray time(6.3±3.9 min vs.19.9±15.7 min,P＜0.001),and shorter total procedure time(41.3±4.1 min vs.50±16.2 min,P＜0.01).No significant difference was observed in the success rate of ablationbetween two groups (91％ vs.89％,P=0.73).Conclusions The application of three-dimensional mapping system plus X-ray guided radiofrequency catheter ablation should be safe,effective,and can significantly reduce the radiation dosein the treatment of idiopathic right ventricular outflow tract ventricular arrhythmia.

Objective To analyze the clinical characteristics of elderly female hypertension patients in Xinyang rural areas of Henan Province,China.Methods The clinical data of 2847 elderly female hypertension patients aged 45-75 years in Xinyang rural areas of Henan Province,China from October 2004 to March 2005 were retrospectively analyzed.The patients were divided into ≥ 60 years old group (n =1166) and 45-59 years old group (n =1681).Their clinical complications,laboratory testing data,blood pressure were compared.Results The baseline SBP was significantly higher while the baseline DBP was significantly lower in ＞60 years old group than in 45-59 years old group (P＜0.01).The incidence of grade 3 hypertension,abdominal obesity,hyperlipidemia,hyperuricemia,coronary artery disease,ischemic stroke,renal dysfunction,postural hypotension was significantly higher in ≥60 years old group than in 45-59 years old group (P＜0.05,P＜0.01).The rate of patients in two groups who did not receive antihypertension therapy was similar (59.3 ％).Multivariate regression analysis showed that postural hypotension was positively associated with coronary heart disease and negatively associated with ischemic stroke in elderly female hypertension patients after adjustment of conventional risk factors (OR=1.632,95％CI:1.200-2.218,P=0.002).Conclusion The risk of postural hypotension is hiher in elderly female hypertension patients than in middle-aged female hypertension patients.Postural hypotension is positively associated with coronary artery disease in elderly females.

To explore the clinical features and common complications of fast resting heart rate (RHR) in hypertensionpatients. Methods: We retrospectively analyzed the entire rest electrocardiogram data of Qingdao study 2000 and Xinyang study2005 in community population elder than 18 years including hypertension patients and non-hypertension subjects. Clinical complications as diabetes, coronary artery disease, hyperlipidemia and stroke, laboratory findings, RHR in ECG, body mass index (BMI), waist to hip ratio and office blood pressure were collected in all participants. Results: A total of 18183 participants were enrolled including 61.6% male, the average age was (45.2±12.7) years including 6763 hypertension patients. Compared with normal BP subjects, hypertension patients had the faster RHR (73.5±11.6) times/min vs (70.6±9.6) times/min, P<0.001 and more hypertension patients combining fast RHR (14.5% vs 6.4%), P<0.001. In hypertension patients, compared with normal RHR patients, fast RHR patients had the elder age (53.9±12.2) years vs (51.8±11.2) years, lower BMI (25.8±3.6) kg/m2 vs (26.4±3.4) kg/m2 and higher ratio of grade 3 hypertension (68.2%vs 59.0%), all P<0.001; higher levels of fasting blood glucose (6.0±2.4) mmol/L vs (5.6±1.5) mmol/L and triglyceride (2.0±1.8) mmol/L vs (1.7±1.3) mmol/L, both P<0.001, higher LDL-C (3.2±0.9) mmol/L vs (3.1±0.8) mmol/L, P=0.001;more patients with diabetes (6.6% vs 3.9%), P=0.007 and stroke (11.1% vs 8.3%), P=0.005. Multivariate regression analysis indicated that with adjusted traditional risk factors, fast RHR was positively related to stroke occurrence in hypertension patients (OR=1.306, 95% CI 1.021-1.671). Conclusion: Fast RHR happened more in hypertension patients than in normal BP subjects; it had the increased risk for stroke occurrence in hypertension patients.

目的：本研究目的是评估射血分数重度减低的非缺血性心肌病患者中，低体重指数是否能预测心脏性猝死风险的风险。

心房颤动是肥厚型心肌病最常见的心律失常,心房颤动的发作增加肥厚型心肌病心力衰竭症状及住院率,影响患者生活质量,增加缺血性卒中及心血管死亡风险.肥厚型心肌病合并心房颤动的抗凝治疗有助于改善预后,但抗凝治疗的启动时机仍有争议.近年来新型口服抗凝药(NOAC)已广泛用于心房颤动的抗凝治疗,但在肥厚型心肌病伴发心房颤动人群中的应用经验不多.