1. Background: This case is reported for its novelty in demonstrating a direct link between exaggerated vagal tone and life-threatening coronary artery spasm (CAS), leading to syncope and cardiac arrest. While vasovagal syncope is common, its manifestation as severe CAS causing ST-elevation and high-grade atrioventricular block is rare. Furthermore, this case highlights the critical role of a comprehensive diagnostic approach beyond standard coronary intervention and the successful therapeutic use of Cardioneuroablation(CNA) to prevent recurrent events, offering a potential new strategy for managing similar refractory cases. 2. Case presentation: A 53-year-old male with a significant smoking history presented with a 6-month history of recurrent, episodic substernal burning pain, triggered by heat and at night, often followed by syncope with prodromal symptoms. Initial coronary angiography revealed significant multi-vessel disease, for which he underwent percutaneous coronary intervention (PCI) with stent and drug-coated balloon（DCB） implantation. However, his symptoms persisted. He subsequently suffered a syncope event in hospital, during which ECG showed inferior ST-segment elevation and third-degree atrioventricular block. Emergency angiography revealed diffuse coronary narrowing that resolved with intracoronary nitroglycerin, confirming a diagnosis of coronary artery spasm. Medical therapy with Diltiazem and Nicorandil was initiated. A head-up tilt test was positive (mixed type), reproducing his symptoms and confirming vasovagal syncope(VVS). The final diagnosis was vagally-induced coronary artery spasm. Given the refractory nature of his condition, he underwent successful CNA. At 3-month follow-up, the patient remained free of chest pain and syncope. Then, the patient discontinued the use of Diltiazem and Nicorandil, and the 6-month follow-up remained satisfactory. 3. Conclusions: For patients with recurrent chest pain and syncope, secondary to severe CAS induced by vagal excitation, CNA may represent a effective therapeutic intervention to prevent recurrent syncope and cardiac arrest, suggesting a new method in managing such complex cases.

In this study, we evaluated the potential use of atropine in reducing reperfusion vagal reflex-related events during emergency percutaneous coronary intervention (PCI) for acute inferior ST-elevation myocardial infarction (STEMI). Retrospectively, we included 142 patients with inferior wall STEMI, who were treated between October 2015 and October 2020, in this study. The patients were divided into an experimental group (n = 70) and a control group (n = 72) depending on whether they received prophylactic intracoronary atropine. The experimental group was then subdivided into a low-dose group (0.5 – 1 mg atropine, n = 40) and a high-dose group (2 mg atropine, n = 30). We compared the incidence of reperfusion vagal reflex-related events and the application of temporary pacemakers between these groups. The results showed that the incidence of bradycardia (24.3% vs. 45.8%, P = 0.007), hypotension (18.6% vs. 40.3%, P = 0.005), ventricular tachycardia (4.3% vs. 19.4%, P = 0.005), and ventricular fibrillation (8.6% vs. 20.8%, P = 0.040) as well as the application of temporary pacemakers (14.3% vs. 29.2%, P = 0.032) were all much lower (all P < 0.05) in the experimental group than in the control group. In addition, the incidence of bradycardia (10% vs. 35%, P = 0.016), hypotension (6.7% vs. 27.5%, P = 0.027), ventricular tachycardia (6.7% vs. 25%, P = 0.044), and ventricular fibrillation (0 vs. 15%, P = 0.034) as well as the application of temporary pacemakers (3.3% vs. 22.5%, P = 0.036) were all much lower (all P < 0.05) in the high-dose group than the low-dose group. Our findings demonstrate that atropine pretreatment could prevent reperfusion vagal reflex-related events and reduce the application of temporary pacemakers during emergency PCI for acute inferior STEMI. These effects can be significantly enhanced by high-dose (2 mg) atropine pretreatment.

Catheter ablation of ganglionated plexi (GPs) performed as cardioneuroablation in the left atrium (LA) has been reported previously as a treatment for vasovagal syncope (VVS). However, the efficacy and safety of catheter ablation in the treatment of VVS remains unclear. The objective of this study is to explore the efficacy and safety of catheter ablation in the treatment of VVS and to compare the different ganglion-mapping methods for prognostic effects. A total of 108 patients with refractory VVS who underwent catheter ablation were retrospectively enrolled. Patients preferred to use high-frequency stimulation (HFS) (n = 66), and anatomic landmark (n = 42) targeting is used when HFS failed to induce a positive reaction. The efficacy of the treatment is evaluated by comparing the location and probability of the intraoperative vagal reflex, the remission rate of postoperative syncope symptoms, and the rate of negative head-up tilt (HUT) results. Adverse events are analyzed, and safety is evaluated. After follow-up for 8 (5, 15) months, both HFS mapping and anatomical ablation can effectively improve the syncope symptoms in VVS patients, and 83.7% of patients no longer experienced syncope (<0.001). Both approaches to catheter ablation in the treatment of VVS effectively inhibit the recurrence of VVS; they are safe and effective. Therefore, catheter ablation can be used as a treatment option for patients with symptomatic VVS.

Background: The head-up tilt test (HUTT) is a useful diagnostic tool in patients with suspected vasovagal syncope (VVS).Objectives: We aimed to investigate the direct drug-potentiated HUTT in patients with recurrent syncope or precursor syncope and to assess the diagnostic value of the direct drug-potentiated HUTT.Methods: The medical history and direct drug-potentiated HUTT records of patients who complained of syncope or precursor syncope and who visited The Xianyang Central Hospital from January 2016 to December 2020 were retrospectively reviewed.Results: A total of 4,873 patients (age = 43.8 ± 17.6 years; male = 2,064 [42.4%]) were enrolled in our study. Overall, 2,343 (48.1%) showed positive responses as follows: 1,260 (25.9%) with the mixed type, 34 (0.7%) with the cardioinhibitory type, 580 (11.9%) with the vasodepressor type, 179 (3.7%) with postural tachycardia syndrome (POTS), and 290 (6.0%) with orthostatic hypotension (OH). The study showed that prior to syncope or near-syncope symptoms, patients first presented an increase in heart rate (HR), followed by decreases in blood pressure (BP) and HR successively. Among the patients in the syncope group, the sensitivity of the HUTT was 65.9%, which was significantly higher than a sensitivity of 44.8% for patients in the non-syncope group (P < 0.01). The sensitivity of the HUTT was higher for females than males in both the syncope group (52.6% in males and 77.9% in females, P < 0.01) and the non-syncope group (36.5% in males and 50.6% in females, P < 0.01). Within the four age groups (<20, 21–40, 41–60, and >60 years old), the sensitivities were 74.7%, 67.7%, 45.6%, and 31.2%, respectively. And all gender, age and symptom (whether suffered from a syncope or not) significantly affected the positive responses of HUTT. There were two adverse events and no deaths during the HUTT in this study.Conclusion: The direct drug-potentiated HUTT is a safe and highly sensitive tool with which to diagnose VVS. Patients with precursor syncope symptoms without syncope should undergo a HUTT, especially young females presenting with weakness and sweating, which can decrease the probability of a misdiagnosis or a missed diagnosis.

目的 探讨直立倾斜试验(HUTT)在心脏神经官能症患者中鉴别血管迷走性晕厥(VVS)的应用价值,为临床应用提供指导.方法 回顾性分析2019年1月至12月于咸阳市中心医院行直立倾斜试验的1184例心脏神经官能症的患者资料,观察受试者直立倾斜试验阳性结果情况,分析不同性别、年龄组间结果的差异.结果 受试者中直立倾斜试验阳性583例,阳性率49.2％;其中混和型VVS 424例(72.7％),心脏抑制性VVS 8例(1.4％),血管抑制型VVS 151例(26.0％);不同性别患者间阳性率差异有统计学意义(P<0.05),不同性别阳性类型差异亦有统计学意义(P<0.05).将阳性组以65岁为界,按年龄分为两个亚组,小于65岁者阳性率高于65岁及以上者(P<0.05).结论 直立倾斜试验在心脏神经官能症患者中鉴别血管迷走性晕厥具有较好的临床价值,年轻女性患者阳性率显著增高.

Objective Pulmonary vein stenosis (PVS) is a serious complication in patients with atrial fibrillation (AF) receiving radiofrequency catheter ablation (RFCA). We therefore examined these patients’ clinical characteristics in relation to PVS occurrence. Method We retrospectively analyzed the clinical symptoms, diagnostic procedures, and treatment strategies in patients with AF who developed PVS after RFCA. Results Among 205 patients with AF who underwent RFCA, five (2.44%) developed PVS (all men; age 44–64 years; AF history 12–60 months; 2 paroxysmal AF, 3 persistent AF). One patient underwent two RFCA sessions and the others received one. The time to PVS diagnosed by pulmonary vein computed tomography angiography (CTA) was 3 to 21 months. PVS symptoms included dyspnea and hemoptysis. Nine pulmonary veins developed PVS. Single mild PVS occurred in two asymptomatic patients and multiple PVS or single severe PVS in three symptomatic patients who underwent pulmonary vein angiography and stent placement. Symptoms in the three patients significantly improved after stent implantation; however, stent restenosis occurred 1 year later in one case. Conclusion PVS is a rare complication of RFCA for AF that can be diagnosed by CTA. Pulmonary vein stent implantation can remarkably improve the symptoms, but stent restenosis may occur.

Objective :To comparison of the two treatment of pulmonary throm- boembolism among the vas-cular intervention therapy and non intervention .Analysis the therapeutic effect of two different methods .To explore the best treatment for severe acute pulmonary thromboembolism . Methods :From 66 patients with pulmonary thromboembolism were divided into the Vascular intervention therapy group and the non intervention group .The in-tervention group(n= 30)underwent inferior vena cava filter placement ,pulmonary artery angiography plus transcath-eter thrombus fragmentation and thrombolytic therapy .The non intervention group (n = 36) were for thrombolysis treatment through the right elbow vein .Two groups had same anticoagulation sequential treatmen of heparin and warfarin .Retrospective comparative variety of clinical symptoms ,vital signs ,oxygen and improve index ,laboratory examination ,follow-up treatment outcome in 6 months .The non intervention group has been more simple in opera-tion ,and even shorter in the time of clinical remission significantly .Results :There was no statistically significant difference between the intervention group and the non-intervention group (P> 0 .05) ,and the deterioration rate and complications were not statistically significant (P > 0 .05) .The non-intervention group was improved with ease of operation ,and the clinical relief time was shortened (P< 0 .05) .Conclusion :Early diagnosis and early treatment is the key to determine prognosis .It is extra important that patients with circulatory failure be treated with interven -tional therapy .Fatal pulmonary thromboembolism with severe hemodynamics may be the first choice for treatment . The clinical effect of thrombolysis treatment through the right elbow vein is highly safety and prominent .For severe hemodynamic fatal pulmonary ,thromboembolism through the right elbow vein can be used as the preferred solution in the first place .It is so safe ,effective and avoiding invasive operation that should be recommend as the preferred . Strengthen the anticoagulation of sequential treatment can obviously reduce the mortality of patients with pulmonary thromboembolism ,improve the prognosis .

目的：观察足量阿托品预处理在急性下壁心梗急诊 PCI 术中预防再灌注、抑制迷走反射的效果。方法：将急性下壁心肌梗死急诊 PCI 术中造影证实右冠急性闭塞的患者分为两组，阿托品预处理组（治疗组）46例和对照组60例。治疗组在导丝通过后给予阿托品2mg 静脉推注（0．03mg／kg），观察两组患者出现再灌注反应的阳性率（心动过缓、低血压、阿斯综合征、呕吐、室速室颤）以及病死率，评估阿托品预处理对提高急诊右冠 PCI 手术安全性的作用。结果：治疗组再灌注反应阳性率为2％，对照组再灌注反应阳性率为73％，两组间差异有统计学意义（P＜0．05）。结论：足量阿托品充分阻滞乙酰胆碱，抑制急性右冠血栓性闭塞急诊 PCI 术中低血压、心动过缓等再灌注反应，抑制迷走神经节丛缺血再灌注后乙酰胆碱量子式释放，显著提高急性下壁心肌梗死急诊 PCI术的安全性。

Objective to compare the effectiveness and safety in treating atrial fibrillation between cryoballoon ablation and radiofrequency ablation. Methods A total of 40 atrial fibrillation patients with unsuccessful or poor medicine curative effect were selected in the Central Hospital of Xianyang from December 2013 to May 2015,and they were divided into CBA group and RFCA group according to random number table,each of 20 cases. Patients of CBA group were treated by cryoballoon ablation,while patients of RFCA group were treated by radiofrequency ablation. Pulmonary vein isolation rate, duration of operation and ablation,the lowest freezing temperature of left superior pulmonary vein,right superior pulmonary vein, left inferior phrenic vein,right inferior phrenic vein and left inferior pulmonary vein,incidence of postoperative complications and disease progression - free survival rate were compared between the two groups. Results No statistically significant differences of pulmonary vein isolation rate of left superior pulmonary vein,right superior pulmonary vein,left inferior phrenic vein,right inferior phrenic vein or left inferior pulmonary vein was found between the two groups( P > 0. 05);duration of operation and ablation of left superior pulmonary vein,left inferior phrenic vein and left inferior pulmonary vein,duration of ablation of right superior pulmonary vein of CBA group were statistically significantly shorter than those of RFCA group,the lowest freezing temperature of left superior pulmonary vein,right superior pulmonary vein,left inferior phrenic vein and right inferior&nbsp;phrenic vein of CBA group was statistically significantly lower than that of RFCA group,respectively( P > 0. 05 );no statistically significant differences of duration of operation of right superior pulmonary vein,duration of operation or ablation of right inferior phrenic vein,the lowest freezing temperature of left inferior pulmonary vein was found between the two groups(P >0. 05). the incidence of postoperative complications of CBA group was 5& ,that of RFCA group was 15& ,the difference was not statistically significantly different(P > 0. 05). till the end of follow - up,the disease progression - free survival rate of CBA group was 70. 0& ,that of RFCA was 30. 0& ,the Kaplan - Meier curve for disease progression - free survival rate between the two group was statistically significantly different( log - rank χ2 = 5. 214,P = 0. 020). Conclusion Cryoballoon ablation has similar pulmonary vein isolation effect with radiofrequency ablation in treating atrial fibrillation,but cryoballoon ablation can significantly shorten the duration of operation and ablation,improve the prognosis without increasing the risk of postoperative complications,has better long - term curative effect and relatively high safety.

Objective:To explore the influence of different blood glucose level at hospitalization on no-reflow and prognosis in patients with acute myocardial infarction (AMI),but without diabetes after emergency percutaneous coronary intervention (PCI).Methods:A total of 678 non-diabetic AMI patients undergoing PCI were selected.Ac-cording to blood glucose level at hospitalization,patients were divided into normal group (n=312),blood glucose level higher group (higher group ,n=201)and blood glucose level extremely high group (extremely high group,n=165).Clinical characteristics,no-reflow after PCI and incidence of cardiovascular events within 30d after PCI were compared among three groups.Results:Compared with normal group and higher group,there were significant rise in age,percentages of >1 location of myocardial infarction and Killip's ≥ class II,white blood cell count instant af-ter hospitalization,peak value of creatine kinase (CK)and CK-isoenzyme (CK-MB)in extremely high group,P <0.01 all;Compared with normal group,the age,peak value of CK and CK-MB significantly rose in higher group (P<0.01 all).Along with blood glucose rose,incidence rate of no-reflow significantly increased (17.0% vs.38.8%vs.49.7%),left ventricular ejection fraction (LVEF)on 30d after PCI gradually reduced [(68.6± 5.7)% vs. (62.2±6.4)% vs.(55.6±6.9)%]in above-mentioned 3 groups in turn,there was significant difference between any two groups,P <0.05 or <0.01.Conclusion:Stress hyperglycemia possesses great influence on no-reflow and prognosis in non-diabetic AMI patients after PCI.

Objective To evaluate the efficacy and safety of intravascular interventional treatment accompanied by catheter directed percutaneous thrombosis therapy on pulmonary embolism.Methods Ninety-six patients diagnosed with acute pulmonary embolism confirmed by pulmonary artery CTPA angiography were divided into study group (n =47)and control group (n =49)based on the willingness of patients.There were no contraindications of thrombolysis and anticoagulation treatments for all patients.The patients in study group were applied with percutaneous catheter thrombolysis,balloon dilation and aspiration of thrombus to gain forward blood recanalization of segmental pulmonary artery embolized,followed by treatment of sufficient anticoagulation after operation.The patients in control group were treated for thrombolysis by urokinase application for two hours with anticoagulant therapy after thrombolysis.The changes of clinical symptoms,signs,complications and arterial partial pressure of oxygen as well as pulmonary arterial recanalization in two groups were observed.Results The trunk pulmonary arteries of the patients in study group were opened up instantly after operation and the blood oxygen saturation reached 100% for 46 patients and 93% for 1 patient separately at 24 hours after operation,symptoms such as chest tightness and shortness of breath in study group were also significantly relieved.While for 49 patients in control group,the blood oxygen saturation reached 100% for 26 patients,higher than 90% for 19 patients,and less than 90% for 4 patients individually at 24 hours after treatment, symptoms such as chest tightness and shortness of breath in 40 patients of control group were significantly relieved. After one week of anticoagulant therapy,the pulmonary artery thrombus in study group generally disappeared in 42 cases and apparently disappeared 6 cases.The disappearance of pulmonary artery thrombus was basically for 24 cases and apparently for 6 cases in control group.No death case was observed in study group but 1 patient in control group died of respiratory failure.Conclusion Interventional treatment for pulmonary embolism of large area was effective due to its usefulness in timely opening up the embolized pulmonary artery,recovery of blood dynamics,improvement of hypoxemia and alleviation of clinical uncomfortableness as well as better prognosis.

目的:探讨主动脉覆膜支架治疗B型主动脉夹层的有效性和安全性。方法:收治Stanford B型主动脉夹层患者共18例行覆膜支架治疗,观察术中、术后及出院后1年内并发症情况,分析其临床特点、疗效及随访结果。结果:手术成功率100%,手术时间1～4 h,平均2.3 h,术中平均失血80 ml;2例患者植入了2枚覆膜支架,其余16例各植入1枚。15例患者术后住院期间出现发热,白细胞数增高,对症治疗后症状消失。术后平均住院时间12 d,1例术后3 d死亡。结论:覆膜支架治Stanford B型主动脉夹层具有创伤小、严重并发症少、住院时间较短的优势。

目的:探讨倾斜试验在血管迷走性晕厥中的诊断价值。方法:对53例疑诊血管迷走性晕厥的患者进行倾斜试验,并与健康受试者12例作对照观察。结果:健康对照组12例均为阴性,病例组53例中23例阳性,阳性率为43%。其中基础试验阳性率占阳性病例的13%,药物倾斜试验阳性率占阳性病例的87%。结论:倾斜试验是诊断血管迷走性晕厥的一种较为安全、有效的诊断方法。