Objective: To explore the feasibility and safety of a newly developed simple and rapid axillary vein puncture technique based on the surface landmarks for pacemaker implantation. Methods: From January to November 2018, we enrolled 110 patients who underwent pacemaker implantation in Beijing Anzhen Hospital. Basic clinical characteristics, such as gender, age, major diagnosis, type of pacemaker, and His-purkinje system pacing, were collected. The success rate of this axillary vein puncture technique, complications, and technical parameters of present puncture method were analyzed. Results: There were 58 (52.7%) male patients in this cohort and the average aged was (70.26±10.45) years old. This "blind" axillary vein puncture method was successful in 105 out of 110 patients (95.5%). The relevant puncture-related parameters included: the distance between points "a and b" was (3.89±0.40) cm, the first angle α was (25.84±5.54)° and the second angle β was (66.18±10.26)°. There were no puncture-related complications, such as hematoma, pneumothorax and hemothorax. Conclusion: The new "blind" axillary vein puncture approach is a simple, effective and safe technique for pacemaker implantation, which is easy to learn and practice and suitable for promotion.

Objective To evaluate the long - term clinical effect of percutaneous coronary intervention (PCI) in the treatment of coronary artery bifurcation with simple and complex strategies.Methods The databases of PubMed, Embase, the Cochrane Library and CNKI until July 2017 were retrieved for collecting the randomized controlled trials (RCTs) comparing PCI simple strategy with complex strategy for bifurcation lesions. The Meta-analysis was performed using Stata 12.0 software.Results 4 RCTs with a total of 1455 patients reported clinical outcomes of 5 years follow-up. The result of Meta-analysis showed that there was no significant difference with respect of all cause death (RR=1.50, 95％CI: 0.98～2.29,P=0.065), major adverse cardiac event (RR=0.97, 95％CI:0.62～1.51,P=0.889), cardiac death (RR=1.09, 95％CI: 0.49～2.44,P=0.832), myocardial infarction (RR=1.69, 95％CI: 0.92～3.09,P=0.090), target lesion revascularization (RR=0.92, 95％CI: 0.53～1.61,P=0.774) and stent thrombosis (RR=1.00, 95％CI: 0.47～2.14,P=1.000) between two strategies.Conclusion Complex strategy for treating patients with bifurcation lesions didn't increase adverse events rate in long-term. Complex strategy may be an optimal method for the patients with ACS or truth bifurcation lesions.

目的 比较心脏起搏装置在植入术后不同缝合方式对患者伤口愈合的影响,为不同手术切口缝合提供临床依据.方法 回顾性分析2012年1月到2012年11月接受心脏起搏装置植入患者.以缝合方式不同将患者分为传统组(采用皮下缝合)和改良组(采用皮内缝合).比较两组间手术缝合时间,住院时间,术后感染事件以及瘢痕形成因素.结果 改良组较传统组住院时间短[(3.3±0.7)d vs (7.1±0.9)d,P=0.102].瘢痕形成率低(0.6％ vs 2.7％ P=0.049).感染发生率无差异.结论 改良皮内缝合较传统皮下缝合住院周期减少,医疗成本降低,患者满意度增加.

充血性心力衰竭是心内科治疗学上的难题，是使患者丧失工作能力，具有较高死亡率的严重疾患。充血性心力衰竭的临床症状主要由于左心室扩大，心功能减退，心输量减少造成，相当一部分患者往往合并房室传导或心室内传导延迟，进一步加重心力衰竭。目前主要治疗以药物为主，包括应用强心、利尿、扩血管药物，以减轻心脏的前负荷、后负荷及增加心脏收缩力。虽然应用药物可缓解症状，但仍有相当数量的患者，即便应用最佳的药物治疗，仍不能改变心功能衰竭进行性加重及改善预后。

Objective:To explore the correlation between coronary atherosclerotic plaques and MMP2,MMP9levels by observing the changes of MMP2,MMP9levels in patients with coronary atherosclerotic plaques before and after undergoing atorvastatin therapy.Methods:Totally 72patients admitted to our hospital from May 2012to May 2013were selected and divided into acute coronary syndrome group(ACS group,n=40),stable angina group(SA group,n=32).Serum MMP2and MMP 9levels were determined and compared between the two groups by enzyme association immunity before and after treatment.Results:(1)MMP2and MMP9levels were significantly higher in the ACS group than in the SA group(P0.05).(2)MMP2and MMP9levels were significantly different in both ACS and SA patients before and after undergoing atorvastatin therapy(P0.05).(3)The majority of the coronary plaque of the ACS group was typeⅡwhile in SA group,most of the plaque were typeⅠ and typeⅢ.(4)MMP2 and MMP9levels were significantly higher in typeⅡplaque than those in typeⅠand typeⅢ(P0.05). Conclusion:Levels of MMP2and MMP9are strongly associated with coronary atherosclerotic plaques,and they can be decreased after atuovastatin treatment,thus atuovastatin could be beneficial in maintaining coronary atherosclerotic plaque.

Objective To study the effect of adenosine diphosphate (ADP)-mediated platelet aggre-gation inhibition rate on pocket hematoma in patients after arrhythmia control device placement . Methods Eighty-six patients who underwent arrhythmia control device placement in our hospital from January 2010 to June 2013 after anti-platelet therapy were divided into hematoma group (n=43) and non-hematoma group (n=43) .Risk factors for pocket hematoma during perioperative pe-riod were analyzed .Results The ADP-mediated platelet aggregation inhibition rate was signifi-cantly higher in hematoma group than in non-hematoma group (P<0 .05) .However ,no signifi-cant difference was found in arachidonic acid-mediated platelet aggregation inhibition rate between the two groups (P>0 .05) .Multivariate binary logistic analysis indicated that the ADP-mediated platelet aggregation inhibition rate more than 80% was the risk factor for pocket hematoma(OR=0 .264 ,95% CI:0 .082-0 .850 ,P=0 .026) .Conclusion Elevated ADP-mediated platelet aggrega-tion inhibition rate increases the risk of pocket hematoma in patients after antiarrhythmia control device placement .

Objective To investigate clinical features and ischemic J wave analysis of coronary atherosclerotic heart disease. Methods A retrospective analysis was made of treatment of coronary atherosclerotic heart disease cases admitted to Beijing Anzhen Hospital from January 2011 to December 2013. A total of 236 cases was assigned as the observation group,60 patients with non-coronary atherosclerosis as the control group and 30 healthy subjects as blank group. RDW,hs-CRP,TnI,TNF-α,IL-6,TC,LDL-C,FFA and other differences were compared and ischemic J wave features were analyzed. Results RDW level was significantly different between CHD group and blank group( P 0. 05,female RDW levels are quite different),while it was not significantly different between CHD group and CAD group( P 0. 05). hs-CRP and CHD TnI levels were significantly higher in CHD group than non-coronary heart disease combined control group,with significant difference( P 0. 01). TNF-α in CHD group compared with the control group was significantly different( P 0. 01),IL-6 levels were significantly higher in CHD group than non-coronary heart disease combined control group,with significant difference( P 0. 01); TC and TnI levels were significantly higher in CHD group than non-coronary heart disease combined control group,with significant difference( P 0. 05). The number of CHD patients with ischemic J wave was 193( 81. 78%). The number of heart attack was significantly more in patients with ischemic J wave than those with non-ischemic J wave. When there was acute severe chest pain,obvious J wave appeared before the elevation of ST segment. Conclusion Coronary artery disease is associated with a variety of indicators,and the severity of disease is related to ischemic J wave,which is significant to timely diagnosis and treatment.

Objective To investigate N-tenninal pro brain natriuretic peptide(NT-proBNP) level changes in heart failure patients after interventional therapy and value prediction on cardiac function.Methods A hundred cases of heart failure patients in our hospital from August 2011 to August 2012 treated by percutaneous coronary intervention treatment were chosen as the research object,who were divided into cardiovascular events group and non-cardiovascular event group according to different prognosis.NT-proBNP,C reactive protein(CRP),left ventricular ejection fraction(LVEF),Gensini and Syntax integral calculation were measured in two groups,and Logistic regression analysis was used to analyze the factors influencing BNP level.Results NT-proBNP,CRP,Gensini score and Syntax scores in cardiovascular events group were significantly higher than those in non-cardiovascular event groups(P 0.05).LVEF was significantly lower than that in non-cardiovascular events group(P0.05).Logistic regression analysis showed that CRP,Gensini scores and Syntax scores were correlated with BNP,and LVEF negatively correlated with BNP(P0.05).Conclusion NT-proBNP can reflect the prognosis of patients with heart failure to a certain extent;it can be used as one of the predictors of cardiac function.

Objective To investigate the incidence of pocket hematoma after electrophysiological device (EPD) placements in patients with dual anti-platelet (DAP) and low molecular weight heparin (LMWH) bridging.Methods One hundred and seventy-three patients with dual antiplatelet drug received the pacemaker implantation and enrolled in this prospective observational analysis.Eighty-seven patients received continue DAP therapy,86 patients replaced DAP drugs with enoxaparin bridging.The adenosine phosphate-mediated platelet aggregation and the ratio platelet aggregation induced by the arachidonic acid (AA) were tested before operation.The incidence of pocket hematoma was investigated.Results Incidence of pocket hematoma in continuing DAP group was lower than that of discontinue dual AP therapy with (LMWH) bridging therapy group (3.4％ vs 16.3 ％,x2 =11.73,P =0.003).Patients with LMWH bridging were 5.102 fold more likely to develop pocket hematoma than DAP individuals.A multiple Logistic regression analysis revealed that LMWH was an independent risk factor for the development of pocket hematoma (P =0.025).Conclusion Continuing dual anti-platelet therapy does not increase the risk of pocket hematoma after antiarrhythmic device placement.

Objective To investigate the effect of continuation of warfarin sodium on the incidence of pocket hematoma compared to heparin bridging.Methods We studied 180 consecutive patients taking warfarin long term underwent pacemaker-implanting procedures.Patients were classified into two groups.The first group continued warfarin therapy while maintain a therapeutic INR within a "safe" range (n =90).The second adopted heparin bridging strategy (n =90).Within 2 weeks after pacemaker implanting surgery during hospitalization.Results Twenty-two patients (12.2％) had pocket hematoma.Six patients (6.7％) from continuing warfarin group and 16/90(17.8％) from heparin bridging group (P =0.023).Logistic regression analysis showed that low molecular weight heparin was an independent risk factor for the development of pocket hematoma (RR =2.665,95％ CI:1.073-8.156,P =0.023).Conclusion Continuation of oral anticoagulation therapy with an INR level of 2-3 does not increase the risk of pocket hematoma occurrence,while precaution is still necessary to avoid supra therapeutic warfarin.

心脏性猝死( SCD) 严重威胁心脏病患者的生命,其最常见的直接原因是心室颤动(VF) 和室性心动过速(VT) .植入型心律转复除颤器( ICD) 是预防SCD 的首选治疗方法.现将2009年1例首次植入Medtronic双腔ICD患者资料报道如下.

目的:评价高龄冠心病患者冠状动脉介入治疗的安全性和临床效果。方法:96例高龄冠心病患者,经冠状动脉造影检查冠状动脉狭窄≥75%而行支架植入术,观察生化指标,比较桡动脉、股动脉途径介入治疗的疗效。结果:高龄冠心病患者合并高血压、糖尿病比例分别为76.1%,39.6%。术后B型钠尿肽、花生四烯酸、二磷酸腺苷较术前改善(P<0.05)。冠状动脉造影显示桡动脉、股动脉入径组钙化病变、分叉病变比例分别为51.7%/60.3%,52.6%/52.6%,桡动脉入径组外周血管损伤较股动脉入径组低(6.89%∶23.7%)(P<0.01),手术时间、术后观察时间较股动脉入径组短(P<0.05或<0.01)。结论:高龄患者选择桡动脉介入术可减少局部血管并发症,冠状动脉血运重建术可显著提高老年患者远期生存率和生活质量,近期治疗风险小,病死率低。

AIM: To study the clinical characteristics and pathological changes in coronary artery in patients with recurrent myocardial ischemia after coronary artery bypass grafting(CABG).METHODS: Data were retrospectively reviewed in 247 patients who had recurrent myocardial ischemia after CABG and underwent percutaneous coronary intervention(PCI).Patients were divided into two groups: diabetes mellitus(DM) group and non-DM groups.RESULTS: The ratio of recurrent myocardial ischemia was higher and PBG and HbAl were significantly higher in DM group(P0.05).A significant difference was observed in blood vessel changes and types of PCI stent(P0.05).Long-term ratio of the AMI was higher in DM group(11.9%) compared with that in non-DM group(5.1%)(P0.05) and the revascularization rate was also higher in DM group(22.4%) than the rate(15.3%) in non-DM group(P0.05).CONCLUSION: Recurrent myocardial ischemia after CABG is high in patients with diabetes mellitus along with severe coronary vessel involvement and complications.

Objectives Cardiac function might be altered with the change of different pacing atrioventricular delay(PAVD)in congestive heart failure patients implanted with dual-chamber pacemaker,though little is known if it exerts the same effect in those with normal left ventricle function as well as the potential effect on diastolic function.The aim of this study is to assess both the systolic and diastolic function alteration in different PAVD with echocardiography.Methods Forty complete atrioventicular block patients receiving permanent dual-chamber pacemaker with right ventrieular pacing were assessed by conventional 2D and color-tissue Doppler Imaging echocardiography when programmed to different PAVD.The optimized PAVD was defined as the maximal cardiac output(CO).Results CO Was significantly affected by PAVD and mean optimal PAVD was (155.7±20.4)ms with around 70%optimized at 150 ms and 175 ms.Septal annulus E'and E/E'as well as Tei index were also improved at the optimized PAVD.Conclusion Optimizing PAVD could be in favorable of both systolic and diastolic function,suggesting the individual and long-term follow-up facilitate the maximal benign effect to those with DDD pacemaker.

Objective:To assess electrocardiographic changes in patients with pulmonary embolism and some of them complicated with coronary artery disease.Method:To retrospect the electrocardiography(ECG) changes in 70 patients hospitalized in the department of cardiology from Jan.2003 to July 2005.50 of them were complicated with CAD.All diagnosis in them were confirmed by ventilation-perfusion scanning and coronary angiography.Result:ECG abnormal rate is 70.0%.The rate of P pulmonale,S_ⅠQ_ⅢT_Ⅲ,right bronch block and precardial T wave inversion is 22.9%.Comparing the ECG abnormal rate between PE and PE complicated with CAD patients,there was not statistically significant difference(χ2=2.99 P=0.084).Conclusion:The ECG alone has very limited value in confirming PE diagnosis.

Objective To report the primary experiences on the diagnosis and treatment of 4 patients with short QT syndrome (SQTS). Methods To review the diagnosis and treatment of 4 SQTS patients,and two of them were successfully treated with catheter ablation. Results One patient died suddenly in the hospi-tal. One patient was treated with quinidine. Two patients underwent radiofrequency catheter ablation, and no symptom and ventricular tachyarrhythmia was founded during follow-up of 3 years and 4 months respective-ly. Conclusion In patients with short QT syndrome, the QT intervals varies in wide range. The catheter abla-tion is effective to eliminate ventricular tachyarrhythmia and to prevent sudden death. Catheter ablation probably is one of effective treatment for SQTS patients.

Objective Right ventricle(RV) apical pacing might lead to left ventricle(LV) systolic function depression, the underlined mechanism is thought to be related to the systolic synchrony induced by RV pacing. The aim of this study is to explore the potential effect of systolic synchrony caused by RV pacing on LV function. Methods Sixty-five patients diagnosed as sick sinus syndrome and implanted with dual chamber pacemaker were assessed by conventional and color-tissue Doppler Imaging (TDI) both at the mode of ventricle sensing (Vs) and ventricle pacing (Vp) respectively. LV ejection fraction, LV asynchrony index (Ts-SD), LV outflow tract velocity time integral (LVOT-VTI), Tei Index and mean systolic velocity of the six basal segments (Mean Sm) were analyzed respectively. Patients were also divided into 2 groups according to the Ts-SD after RV pacing. Result During Vp mode, LVEF, LVOT-VTI, mean Sm and Tei index decreased together with increasing Ts-SD. LV systolic parameters decreased more in patients with higher Ts-SD during Vp. Furthermore, the changing of Ts-SD was moderately correlated to the mean Sm reduction. Conclusion LV systolic function is worsened by RV pacing, which is associated with systolic dyssynchrony.

OBJECTIVE:To study the efficacy and safety of the coronary interventional therapy to prevent electrical storm (ES) in patients with coronary artery diseases (CAD) but without myocardial infarction or ischemic cardiomyopathy.METHODS:Coronary angiography and stent implantation were performed in CAD patients with ES as major symptom, according to the standardized methods. Holter Electrocardiography was recorded regularly during follow-up.RESULTS:Six patients, five male and one female, with mean age of 49.5 +/- 9.1 year-old, were hospitalized. In 2 patients with repetitive syncope, multiple episodes of ventricular tachycardia and/or ventricular fibrillation (VF) were documented by Holter recording. One patient developed VF during exercise test. Three patients experienced chest pain and multiple episodes of cardiac arrest. Before procedure, averaged 16.5 +/- 5.3 episodes of syncope or VF were documented in 6 patients. Coronary angiography revealed severe one or multi-vessel diseases. Total 8 stents, including 3 drug-eluting stents, were implanted in 6 patients. Symptom, ST-T changes and ES disappeared after coronary stenting. During 4 month to 6.5 year follow-up (mean 47.7 +/- 30.7 months), ES was not documented, no appropriated shock occurred in patients with implantable defibrillator for 6.5 years.CONCLUSION:In CAD patients without myocardial infarction, coronary stenting can relieve the ischemic substrate of ES, hence prevents sudden death effectively.

OBJECTIVE:To analyze the therapy of hypertensive outpatients among different grade hospitals in Beijing. METHODS:Thirty-nine hospitals including 4 third grade hospitals, 4 second grade hospitals and 31 first grade hospitals in Beijing were selected randomly (by stratified randomization). The grade was accredited according to the hospital accreditation standard issued by Ministry of Health of the People's Republic of China. RESULTS:The average hypertension control rate (< 140/90 mm Hg, 1 mm Hg = 0.133 kPa) in outpatients was 32.3%. The hypertension control rate in the third grade, second grade, first grade hospitals were 37.7%, 36.9%, and 31.2% respectively. There was no difference in the control rate among the three different grade hospitals (P > 0.05). The frequency to use anti-hypertension drugs including long-acting calcium antagonism, ACEI, beta-receptor blocker in the third grade hospitals was significantly higher than those of the first and second grade hospitals. The rate of examination using ultrasonic cardiogram, CT, Holter and ambulatory blood pressure monitoring were significantly higher in the third grade hospitals than that of the first and second grade hospitals. There were significant differences in annual cost of hypertension treatment among three different grade hospitals (P < 0.01), being the highest (1567.5 yuan) in the third grade hospitals, medium (845.4 yuan) in the second grade hospitals, the lowest (651.8 yuan) in the first grade hospitals. CONCLUSIONS:Significant difference in the cost of hypertensive treatment among three different grade hospitals exists in Beijing. However, there was no difference in the control rate among them. The overall hypertension control rate is 32.3%, leaving 67.7% uncontrolled. Efforts to increase the hypertension control rate should be made in all hospitals. How to guide and arrange the hypertension patients to consult a suitable hospital is important for rational and economical use of health cost.

高血压病在全球患病率很高,特别是西方,已占成人人口的1/3[1],我国高血压患病率也在不断上升.1991年高血压患病率调查显示:15岁以上人口高血压标化患病率为11.26%[2].高血压病不仅是心脑血管疾病的重要危险因素,其增加心力衰竭、肾衰竭及左心室肥大的危险,并且造成患者严重的经济负担.在心脑血管疾病死亡中约30%～40%是由于高血压引起.脑卒中每年新发病率按150万人计算需要11.25亿元医疗费用,每年直接与间接经济损失约100亿元.