Objective:To evaluate the association between the duration of atrial fibrillation(AF)or atrial flutter(AFL)and stroke events recorded in cardiovascular implantable electronic devices(CIED)and stroke events as well as the intervention effect of anticoagulant therapy.Methods:The study included 2 342 patients with sinus rhythm who received dual CIED in Department of Cardiology Tianjin Chest Hospital between January 2015 to December 2019.Atrial high-rate episodes(AHRE)(electro-cardiogram documented AF/AFL or intracavitary electrogram confirmed AF/AFL, AHRE>6 min and≥250 beats/min)were recorded.Anticoagulant therapy and stroke events were obtained during follow up period.The effects of the longest AHRE duration and CHA 2DS 2-VASc score on subsequent risk of ischemic stroke were evaluated with time dependent covariate Cox models. Results:Among 2 136 patients[mean age(68.9±9.6)years, 868 male]during mean follow-up of 42 months, the longest single episode of AHRE lasted<1.0 h in 79/2 136 patients(3.7%), 1.0-5.9 h in 93(4.4%), 6.0-23.9 h in 135(6.3%) and ≥24.0 h in 211(9.9%). AHRE duration≥6 h was associated with an increased risk of subsequent stroke(adjusted hazard ratio[ HR]=3.8, P<0.05), and the stroke risk was higher when AHREs were longer than 24 hours( HR=17.3, P<0.01). Anticoagulation therapy was associated with reduced stroke risk in those patient who had anticoagulant indication(male patients with CHA 2DS 2-VASc score≥1 or in female patients with CHA 2DS 2-VASc score≥2). Conclusion:Patients with AF≥6 h had an increased risk of ischemic stroke.Regular anticoagulant therapy could reduce the risk of stroke The use of anticoagulant was reasonable in patients with AF≥6 h.

目的:本研究旨在评价心脏不同起搏部位对心室电及机械同步性的影响.方法:选择2019年1月-2019年10月于天津市胸科医院因房室传导阻滞或心房颤动(房颤)伴缓慢心室率行永久起搏器安置术、左室射血分数(LVEF)＞40％的患者53例.根据心室电极植入位置分为希浦系统起搏24例,其中包括希氏束起搏(HBP)组14例,左束支起搏(LBBP)组10例;右室间隔起搏(RVSP)组15例;深部室间隔起搏(DVSP)组14例.测量术后QRS宽度及左室激动达峰时间(LVAT).术后1年起搏器程控评价心室电极参数并行心脏彩超检查及临床不良事件随访.应用二维斑点追踪技术测量并计算胸骨旁短轴水平左室18节段收缩期径向应变达峰时间平均值(Trs-AVG)、标准差(Trs-SD)及最大差(Trs-Dif),评价左室收缩同步性情况.结果:患者术后QRS时限、LVAT、Trs-AVG、Trs-SD、Trs-Dif相比,HBP与LBBP起搏组无明显差异;DSVP组较希浦系统起搏组上述时限均延长并出现统计学差异.DVSP组较RVSP组患者上述时限均显著缩短,两组术后QRS时限:(120.7±7.4)ms∶(152.1±7.4)ms,LVAT:(80.6±6.6)ms∶(108.1±3.4)ms,Trs-AVG:(366.5±32.3)ms∶(422.3±43.9)ms,Trs-SD:(43.5±8.4)ms∶(67.6±9.7)ms,Trs-Dif:(146.6±35.3)ms∶(257.6±47.2)ms,P＜0.01.起搏术后QRS宽度与Trs-SD强相关(r=0.895).与LBBP、DVSP、RVSP组相比,HBP组导线起搏阈值高(2.4±0.9 V/0.4 ms),R波振幅低(4.6±1.1)mV,P＜0.01.RVSP组患者术后LVEF较其余3组相比略减低(P=0.023),4组患者术后左室舒张末期内径未见统计学差异.结论:希浦系统起搏及DVSP的左室电及机械收缩同步性均优于RVSP.

目的 分析沙库巴曲缬沙坦钠对难治性心力衰竭患者血管内皮功能及心室重塑的影响.方法 采用前瞻性随机试验方法,将2018年4月～2020年4月在天津市第一医院接受治疗的90例难治性心力衰竭患者纳入研究,依据随机数字表法分为对照组和观察组各45例.对照组采用卡托普利联合美托洛尔、螺内酯治疗,观察组采用沙库巴曲缬沙坦钠联合美托洛尔、螺内酯治疗,持续治疗10周.治疗前和治疗10周结束时,观察比较两组血管内皮功能[内皮素-1(ET-1)、降钙素基因相关肽(CGRP)]及心室重塑指标[舒张期末室间隔厚度(IVST)、左室后壁厚度(LVPWT)].结果 治疗10周结束时,两组血浆CGRP水平均高于治疗前,ET-1水平低于治疗前,且观察组血浆CGRP水平高于照组,ET-1水平低于对照组,差异均有统计学意义(P<0.05);治疗10周结束时,两组IVST、LVPWT水平低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05).结论 沙库巴曲缬沙坦钠可改善难治性心力衰竭患者血管内皮功能,抑制心室重塑.

目的 评价导管消融非右房入路二尖瓣置换术后房性心动过速(简称房速)的电解剖基质及射频消融.方法 分析非右房入路二尖瓣置换术后房速消融病例,应用三维电解剖标测心房,结合拖带标测,明确房速机制后进行线性及基质消融.结果 共入选17例患者,其中间隔入路11例,左房入路6例.共诱发25种房速,其中间隔入路组诱发15种房速,大折返机制11例,局灶机制4例.左房入路组诱发10种房速.其中大折返机制6例.局灶机制4例.首次消融手术成功率94.1％(16/17).平均随访(29±12)个月,有3例患者复发.手术成功率82.4％(14/17),2例进行二次消融后成功.结论 非右房入路二尖瓣置换术后房速行导管消融治疗安全、有效.

Objective:To evaluate the relationship between the atrial high rate episodes (AHRE) and atrial fibrillation (AF) or atrial flutter (AFL) in contemporary pacemakers.Methods:The study included 2 109 patients implanted pacemakers which could supply intracavitary electrogram during follow-up period in Tianjin Chest Hospital from January 2015 to December 2020. All AHRE recorded with available electrograms were reviewed to determine whether they represented true AF/AFL. The distribution, different rates and durations of AHRE were analyzed.Results:Of 2 440 AHRE ≥30 s and ≥160 beats/min, 86.5% (2 111/2 440) were true AF/AFL. Other false positives included atrial tachycardia (9.7%, 237/2 440) , noise (2.6%, 64/2 440) , cross sensing (0.9%, 21/2 440) , repetitive non-reentrant ventricular atrial synchrony rhythm (0.2%, 5/2 440) , uncertainty (0.1%, 2/2 440) . By using a cutoff of ≥250 beats/min and > 6 h, the positive predictive value of AHRE was 99.9%.Conclusion:AHRE combined with time and frequency analysis is a reliable tool for the diagnosis of AF/AFL.

目的 评价导管消融心脏外科联合迷宫术后复发房性心动过速(简称房速)的电解剖基质及射频消融.方法 回顾性分析本院2016年1月至2019年1月心脏外科联合迷宫术后复发房速消融病例,所有房速应用三维标测于双房电解剖标测,结合拖带标测,明确房速机制后进行线性及基质消融.结果 共入选27例,诱发出33种心动过速.右房起源房速7例,所有右房起源房速均与切口和/或三尖瓣环大折返相关;左房房速26例,大折返机制15例,微折返机制11例.首次消融手术成功率93.9％(31/33).平均随访(31±18)个月,有5例患者复发.2例进行二次消融,总体手术成功率81.5％(22/27).结论 心脏外科联合迷宫术后房速患者行导管消融治疗安全、有效.

目的 评价阵发性心房颤动(简称房颤)患者采取二代冷冻消融(CB)及射频消融(RF)早期复发的对比及其预测因素.方法 入选拟行阵发性房颤消融术的患者160例.分为CB组和RF组,各组80例.比较两组患者临床资料,分别于术前及术后24 h测定炎症因子和心肌损伤标志物.明确两组术后房颤早期复发的危险因素.结果 两组性别 、年龄 、发病时间及左房内径均无差异.CB组与RF组早期复发率无差异(33.8％vs 32.5％,P>0.05).术前两组炎症因子和心肌损伤标志物无差异.术后CB组心肌损伤标志物肌钙蛋白 、肌酸激酶 、肌酸激酶同工酶及谷草转氨酶的升高明显高于RF组(P<0.05).Logistic多因素回归分析示性别 、左房内径 、术前白介素-6(IL-6)值及术后IL-6值是RF组早期复发的独立危险因素,对于CB组,只有性别是房颤早期复发的独立危险因素(女性患者更高,P<0.05).结论 冷冻消融与射频消融早期复发率无明显差别,并且由于其心肌损伤方式不同,术后预测早期复发因素有所不同.

Objective To evaluate the relationship between inflammation and left appendage thrombus in patients with nonvalvular atrial fibrillation. Methods Six-eight patients who received transesophageal echocardiography were enrolled.Left appendage thrombus was confirmed in 23 patients (thrombus group) and excluded in another 45 patients (nonthrombus group).High-sensitivity C-reactive protein (hs-CRP) was tested in all patients. Results The level of hs-CRP was higher in thrombus group (1.66 mg/L, 0.49-2.60 mg/L) than that in nonthrombus group (0.83 mg/L, 0.47-1.32 mg/L).after adjusting for CHA2 DS2-VASc score, left atrium anteroposterior diameter, type of atrial fibrillation, hs-CRP was independent risk factor for left appendage (OR=1.19, 95％CI 1.02-1.39, P=0.02). Conclusion Inflammation may play a role in the formation of left appendage thrombus in patients with nonvalvular atrial fibrillation.

BACKGROUND: We report the 12-lead ECG morphology of left posterior fascicular ventricular tachycardia (LPF-VT) and the relationship between His-ventricular (HV) interval and site of origin in LPF-VT. METHODS AND RESULTS: We studied 41 patients who underwent successful catheter ablation of LPF-VT with HV interval >0 ms (n=8; proximal-LPF group), HV interval 0 to -15 ms (n=15; middle-LPF group), and HV interval <-15 ms (n=18; distal-LPF group). The earliest mapped presystolic potential (PP)-QRS interval was 34.1 +/- 4.2, 24.5 +/- 3.2, and 19.4 +/- 2.8 ms in proximal-, middle-, and distal-LPF groups. The earliest PP ratio (PP-QRS interval during VT/HV interval during sinus rhythm) was 0.59 +/- 0.05, 0.45 +/- 0.07, and 0.31 +/- 0.05 in the proximal-, middle-, and distal-LPF groups. There were statistically significant differences between the 3 groups in earliest PP ratio, and there was close correlation between the HV interval during LPF-VT and earliest PP ratio. The QRS duration in the proximal-LPF group (114 +/- 6 ms) was significantly narrower compared with the middle-LPF group (128 +/- 5 ms) and distal-LPF group (140 +/- 6 ms). In leads I and V6, the ratio of R/S tended to be greater in the proximal-LPF group compared with the other 2 groups. QRS duration, the ratio of R/S in leads V6, and lead I could predict a proximal or distal origin site of LPF-VT with high sensitivity and specificity. CONCLUSION: The HV interval and 12-lead ECG morphology of LPF-VT may help predict the successful site of origin and prove useful in guiding an effective ablation strategy.

目的 评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)指导的线性消融进行心房基质改良的疗效.方法 分析66例持续性心房颤动(简称房颤)消融病例,所有患者标测碎裂电位,行环肺静脉隔离后根据标测结果设计消融径线.明确消融术中房颤终止比例及随访疗效.结果 所有入选患者CFAEs分布比例从高向低依次为:肺静脉前庭、左房间隔、顶部、前壁等,消融径线主要为顶部线、前壁线、间隔线、峡部线等.入选患者平均消融线(1.9±0.4)根.随访(16.5±3.9)个月,52例(78.8％)患者经过一次消融术未再发心律失常.14例复发,1例为典型心房扑动,10例为阵发性房颤,1例为持续房颤,2例房性心动过速.结论 持续性房颤接受CPVI附加CFAEs标测后线性消融有效、安全.

Background We report the 12-lead ECG morphology of left posterior fascicular ventricular tachycardia (LPF-VT) and the relationship between His-ventricular (HV) interval and site of origin in LPF-VT. Methods and Results We studied 41 patients who underwent successful catheter ablation of LPF-VT with HV interval >0 ms (n=8; proximal-LPF group), HV interval 0 to −15 ms (n=15; middle-LPF group), and HV interval <–15 ms (n=18; distal-LPF group). The earliest mapped presystolic potential (PP)-QRS interval was 34.1±4.2, 24.5±3.2, and 19.4±2.8 ms in proximal-, middle-, and distal-LPF groups. The earliest PP ratio (PP-QRS interval during VT/HV interval during sinus rhythm) was 0.59±0.05, 0.45±0.07, and 0.31±0.05 in the proximal-, middle-, and distal-LPF groups. There were statistically significant differences between the 3 groups in earliest PP ratio, and there was close correlation between the HV interval during LPF-VT and earliest PP ratio. The QRS duration in the proximal-LPF group (114±6 ms) was significantly narrower compared with the middle-LPF group (128±5 ms) and distal-LPF group (140±6 ms). In leads I and V6, the ratio of R/S tended to be greater in the proximal-LPF group compared with the other 2 groups. QRS duration, the ratio of R/S in leads V6, and lead I could predict a proximal or distal origin site of LPF-VT with high sensitivity and specificity. Conclusion The HV interval and 12-lead ECG morphology of LPF-VT may help predict the successful site of origin and prove useful in guiding an effective ablation strategy.

Objective To evaluate the safety of magnetic resonance (MR) conditional pacemaker in patients subjected to 1.5 T magnetic resonance imaging (MRI) scanning.MethodsTwelve patients with MRI conditional pacemaker were advised to undergo MRI scanning between Januarary 2014 and December 2016.MRI scanning (n=10) were performed with MRI conditional pacemaker system (Accent 2124,Estella DR/SR) on head,thoracic spine,and abdomen at 1.5 T.Devices were interrogated pre-and post-MRI,programmed to an asynchronous mode,and reprogrammed to their original settings after MRI.Results There were no overall differences in pre-and post-MRI interrogation of right atrial or ventricular lead sensing,threshold or resistance[the threshold of right atrium in pre-and post-MRI:(0.7±0.2)V vs.(0.7±0.2)V;the threshold of right ventricle in pre-and post-MRI:(0.7±0.2)V vs.(0.7±0.2)V,P>0.05].No adverse events were found such as electrical reset,inappropriate pacing and battery capacity abnormal decrease.No clinically significant changes in function were seen at subsequent follow-up[average(7.4±3.0)months post-MRI].ConclusionsThese results demonstrate the clinical safety of the MR conditional pacemaker in patients subjected to MRI scanning in 1.5 T scanners.

1．1对象回顾性分析我科2005年8月至2012年7月年龄≥80岁256例符合AMI 诊断标准的住院患者，其中男163例，女93例。按其是否发生住院期间死亡分为死亡组52例，男34例，女18例，年龄80～90〔平均（84．6±3．8）〕岁；存活组204例，男128例，女76例，年龄80～86〔平均（83．4±3．2）〕岁。两组年龄及性别无统计差异（ P＞0．05）。 AMI诊断标准：①典型胸痛或其他非典型症状发作≥30 min；②心电图≥2个相邻胸前导联ST段抬高≥0．2 mV、肢体导联≥0．1 mV或新出现的左束支传导阻滞；③肌酸激酶同工酶（ CK－MB）≥正常上限的2倍或肌钙蛋白明显增高。满足上述2个条件即可诊断。

O bjective:To investigate the correlation between CETP TaqIB gene polymorphism and lipid metabolism and coronary heart disease (CHD). Methods:A total of 430 patients in Tianjin Chest Hospital were selected in the analysis. All the enrolled patients were divided into CHD group (n=322) and the control group (n=108). After admission total cholesterol (CHO), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) were tested. PCR-RELP was executed to determine the genotypes of CETP TaqIB. Results: (1) In the CHD group, the CETP TaqIB genotype B1B2,B2B2 levels of HDL-C [(1.29±0.35) mmol/L, (1.16±0.36) mmol/L] were higher than genotype B1B1 level of HDL-C [(1.09±0.22) mmol/L], but no statistically significant difference (P>0.05) was found. The levels of CHO,TG,LDL-C,Apo-A1,Apo-B were statistically significant. No significant difference was found in the level of lipid in the control group genotype. (2) The frequencies of genotype B1B1, B1B2 and B2B2 were 35.1%, 45.0%, 19.9%in CHD group, and 37.0%, 43.5%, 19.5%in the control group. The frequencies of B1, B2 allele were 57.6%, 58.6%in CHD group, and 42.4%, 41.2%in the control group. No statistical significance in genotype and allele frequency was found between CHD group and the control group (P>0.05). Conclusion:CETP TaqIB gene B2 people in Tianjin area is consistent with other parts of the country. The existence of correlation between CETP TaqIB gene polymorphism and coronary heart disease needs further evidence.

Objective To analysis the correlation between coronary atherosclerosis and levels of glycated hemoglobin (HbA1c) and endothelin(ET ) ,furthermore to explore the clinical significance of the two indexes in the department of cardiology .Methods 572 inpatients were divided into four groups according to the blood glucose level and coronary angiography results :negative control group with 40 patients ,simplex DM group with 50 patients ,simplex CHD group with 262 patients ,CHD+DM group with 220 pa-tients .The HbA1c and ET levels in the four groups were monitored ,and the correlations between the two indexes and coronary ath-erosclerosis were analysed by Logistic regression analyses .Results HbA1c level :control group and CHD group < DM group<CHD+DM group .No significant differences were observed between control group and CHD group (P> 0 .05) .ET level :control group < CHD group and DM group < CHD+DM group .No significant differences were observed between CHD group and DM group(P>0 .05) .After adjusted the potential risk factors such as age ,sex ,body mass index ,smoking ,the history of hypertension and blood glucose levels with binomial Logistic regression analysis the content of ET was relevant to the onset of CHD ,however HbA1c not .Conclusion ET has obviously correlation with coronary atherosclerosis ,however the simplex DM may cause false posi-tive interferences .Combined determination of HbA1c and ET is beneficial in the preliminary diagnosis of CHD and DM .