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cardiac atrioventricular conduction improved by autologous transplantation of mesenchymal stem cells in canine atrioventricular block models

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Journal of Geriatric Cardiology 2007年第4期4卷 238-243页

作者： Xiaoqing Ren Jielin Pu Shu Zhang Liang Meng Fangzheng Wang cardiac arrhythmia Center Cardiovascular Institute and Fuwai HospitalCAMS and PUMCBeijing 100037China

Objective Atrioventricular block(AVB)is a common and serious *** present,there is no perfect method of treatment for this kind of *** purpose of this study was to regenerate cardiac atrioventricular conduction by autologous transplantation of bone marrow mesenchymal stem cells(MSCs),and explore new methods for therapy of atrioventricular *** Eleven Mongrel canines were randomized to MSCs transplantation(n=6)or control(n=5)*** models of permanent and complete AVB in 11 canines were established by ablating His bundle with radiofrequency *** 4 weeks after AVB,bone marrow was aspirated from the iliac *** were isolated and culture-expanded by means of gradient centrifugal and adherence to growth technique,and differentiated by 5-azacytidine in *** MSCs(1ml,1.5×10^(7)cells)labeled with BrdU were autotransplanted into His bundle area of canines by direct injection in the experimental group,and 1ml DMEM in the control *** 1-12 weeks after operation,the effects of autologous MSCs transplantation on AVB models were evaluated by electrocardiogram,pathologic and immunohistochemical staining *** Compared with the control group,there was a distinct improvement in atrioventricular conduction function in the experimental *** transplanted in His bundle were differentiated into analogous conduction system cells and endothelial cells in vivo,and established gap junction with host *** The committed-induced MSCs transplanted into His bundle area could differentiate into analogous conduction system cells and improve His conduction function in canine AVB models.

关键词： mesenchymal stem cells His bundle cell transplantation differentiation 5-azacytidine

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cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device

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Journal of Geriatric Cardiology 2017年第10期14卷 649-651页

作者： Han JIN Wei HUA Li-Gang DING Jing WANG Hong-Xia NIU Min GU Cong XUE Shu ZHANG The cardiac arrhythmia Center Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

The right ventricular pacing （RVP） is the standard treat- ment for patients with severe bradyarrhythmias; however, it may cause and exacerbate heart failure symptoms in a long run under some circumstances.{1] In fact, significant left ventricular （LV） systolic dysfimction and symptomatic heart failure （HF） is commonly found in patient population with pacemaker implantations.

关键词： cardiac resynchronization therapy Chronic right ventricular pacing Heart failure Upgrade

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Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire

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World Journal of Cardiology 2015年第8期7卷 499-503页

作者： Martina Zucchetti Michela Casella Antonio Dello Russo Gaetano Fassini Corrado Carbucicchio Eleonora Russo Vittoria Marino Valentina Catto Claudio Tondo cardiac arrhythmia research centre Centro Cardiologico Monzino IRCCS 20138 Milan Italy

A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "Safe Sept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "Safe Sept" guidewire, when advanced into the left atrium, becomes atraumatic.

关键词： Trans-septal puncture "Safe Sept" guide-wire Atrial fibrillation Interatrial septum Intracardiac echocardiography

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Will the symbiotic pacemaker, a self-powered cardiac implanted electronic device, be the next evolution in pacemaker technology?

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Science Bulletin 2019年第13期64卷 877-878页

作者： Yiran Hu Wei Hua The cardiac arrhythmia Center State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

The first permanent implanted pacemaker was successfully used in clinical practice in 1958. In the past 60 years, the development of pacemakers has been witnessed in clinical application [1]. Early pacemakers were large and cumbersome, and had a short battery life, providing only a single-chamber asynchronous pacing (VOO) pacing mode. In 1967, on-demand pacemakers with synchronous pacing (WI) mode just came out. The emergence of the first dual chamber pacemaker in 1977 symbolized the entry into the physiologic pacing era. In 1982, pacemakers began to provide rate adaptive functions. In this age of accelerating development in scientific technologies and clinical researches, pacemakers have evolved into implantable cardioverter-defibrillators for the treatment of sudden cardiac death and cardiac resynchronization therapy for chronic heart failure, instead of simply being an electronic device that treats bradycardia by pulsing the heart (Fig. 1)[2,3].

关键词： symbiotic pacemaker self-powered cardiac implanted electronic device

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Does ‘super-responder’ patients to cardiac resynchronization therapy still have indications for neuro-hormonal antagonists? Evidence from long-term follow-up in a single center

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Journal of Geriatric Cardiology 2019年第3期16卷 251-258页

作者： Yi-Ran HU Wei HUA Han JIN Min GU Xiao-Han FAN Hong-Xia NIU Li-gang DING Jing WANG Shu ZHANG cardiac arrhythmia Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains *** We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to ***-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50% in absolute values at 6-month *** CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-hormonal antagonists (NHA)(defined as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term *** A total of 60 patients met criteria for *** of thirteen (7.7%) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3%) in CRT-SRs with NHA (P = 0.526).However,3 of 13 (23.1%) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1%) CRT-SRs with NHA had this endpoint (P = 0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75%,P = 0.014),which was not observed in non-ischemic etiology group (2.6% vs.0,P = 1.000) during long-term *** Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF ***,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.

关键词： cardiac resynchronization therapy Heart failure Super-responder Optimal medical therapy

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Clinical outcome of cardiac resynchronization therapy in dilated-phase hypertrophic cardiomyopathy

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Journal of Geriatric Cardiology 2017年第4期14卷 238-244页

作者： Min GU Han JIN Wei HUA Xiao-Han FAN Hong-Xia NIU Tao TIAN Li-Gang DING Jing WANG Cong XUE Shu ZHANG cardiac arrhythmia Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.

关键词： cardiac resynchronization therapy Dilated-phase hypertrophic cardiomyopathy Idiopathic dilated cardiomyopathy Ischemic cardiomyopathy

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Predictors of super-response to cardiac resynchronization therapy： the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing

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Journal of Geriatric Cardiology 2017年第12期14卷 737-742页

作者： Han JIN Min GU Wei HUA Xiao-Han FAN Hong-Xia NIU Li-Gang DING Jing WANG Cong XUE Shu ZHANG The cardiac arrhythmia Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.

关键词： Biventricular pacing cardiac resynchronization therapy Heart failure Super-responders

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Collateral findings during computed tomography scan for atrial fibrillation ablation:Let's take a look around

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World Journal of Cardiology 2016年第4期8卷 310-316页

作者： Francesco Perna Michela Casella Maria Lucia Narducci Antonio Dello Russo Gianluigi Bencardino Gianluca Pontone Gemma Pelargonio Daniele Andreini Nicola Vitulano Francesca Pizzamiglio Edoardo Conte Filippo Crea Claudio Tondo cardiac arrhythmia Unit Agostino Gemelli University Hospital cardiac arrhythmia research centre Centro Cardiologico MonzinoIRCCS

The growing number of atrial fibrillation catheter ablation procedures warranted the development of advanced cardiac mapping techniques, such as image integration between electroanatomical map and cardiac computed tomography. While scanning the chest before catheter ablation, it is frequent to detect cardiac and extracardiac collateral findings. Most collateral findings are promptly recognized as benign and do not require further attention. However, sometimes clinically relevant collateral findings are detected, which often warrant extra diagnostic examinations or even invasive procedure, and sometimes need to be followed-up over time. Even though reporting and further investigating collateral findings has not shown a clear survival benefit, almost all the working groups providing data on collateral findings reported some collateral findings eventually coming out to be malignancies, sometimes at an early stage. Therefore, there is currently no clear agreement about the right strategy to be followed.

关键词： Collateral findings Incidental findings Incidentalomas cardiac computed tomography Image integration

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Electrical storm: A clinical and electrophysiological overview

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World Journal of Cardiology 2015年第9期7卷 555-561页

作者： Sergio Conti Salvatore Pala Viviana Biagioli Giuseppe Del Giorno Martina Zucchetti Eleonora Russo Vittoria Marino Antonio Dello Russo Michela Casella Francesca Pizzamiglio Valentina Catto Claudio Tondo Corrado Carbucicchio cardiac arrhythmia research centre Centro Cardiologico Monzino IRCCS

Electrical storm(ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverterdefibrillator(ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia(VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.

关键词： Electrical storm Ventricular tachycardia/ fibrilla

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Protective and therapeutic potentials of Dunaliella salina on aging-associated cardiac dysfunction in rats

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Asian Pacific Journal of Tropical Biomedicine 2018年第8期8卷 403-410页

作者： Farouk K.El-Baz Gehad A.Abdel Jaleel Dalia O.Saleh Rehab A.Hussein Plant Biochemistry Department National Research Centre (NRC) Pharmacology Department National Research Centre (NRC) Pharmacognosy Department National Research Centre (NRC)

Objective: To investigate the possible protective and/or therapeutic potentials of Dunaliella salina(D. salina) biomass, its carotenoid and polar fractions on cardiac dysfunction associated with D-galactose(D-GAL) induced aging in rats. Methods: Aging associated cardiac dysfunction was induced in rats by injection of D-GAL(200 mg/kg; i.p) for 8 weeks. D-GAL injected rats were treated with two regimens; protective regimen where D. salina biomass(250 mg/kg), its carotenoid(250 μg/kg) and polar(250 μg/kg) fractions were given orally for two weeks concurrently with D-GAL injection as well as treatment regimen where the three treatments were given orally for 28 consecutive days after D-GAL injection. Results: D-GAL injection for 8 weeks was accompanied with dramatic electrocardiographic changes as well as profound elevation in serum levels of homocysteine, creatinine kinase isoenzyme and lactate dehydrogenase in addition to the reduction of the cardiac content of glucose trasporter 4. D-GAL also induced reduction in cardiac superoxide dismutase activity and elevation of inducible nitric oxide synthetase and interleukin-6. On the other hand, oral administration of D. salina carotenoid fraction as well as the total biomass significantly attenuated the D-GAL-induced disturbances in the above mentioned parameters where the protective regimen appeared more successful in controlling the manifestations of cardiac dysfunction. The histopathological examination further emphasized the promising results. Besides, the HPLC analysis of the carotenoid fraction of D. salina revealed the presence of 2.31%. salina carotenoid fraction as well as the total biomass amelior β-carotene. Conclusions: Date D-GAL-induced aging associated cardiac dysfunction which is attributed to the potent antioxidant activity of β-carotene.

关键词： Aging cardiac dysfunction Dunaliella salina Rats

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