Right Coronary Artery Damage during Cavotricuspid Isthmus Ablation

Radiofrequency ablation of the cavotricuspid isthmus is the first‐line treatment for typical atrial flutter. Despite the close proximity of the right coronary artery (RCA) to the cavotricuspid isthmus, only four cases of arterial injury have been reported during radiofrequency ablation, all detected postablation by inferior ST elevation. Here, we report atrioventricular (AV) conduction delay during coronary sinus pacing as a possible early sign of RCA involvement and review the previous literature on RCA damage and variations of AV nodal circulation. (PACE 2010; 33:e110–e113)     

Left Atrial Catheter Ablation Promotes Vasoconstriction of the Right Coronary Artery

Background: Multiple cardiac ganglia are present in the left atrial (LA) region, and marked changes in autonomic nervous activity can occur after left atrial catheter ablation (CA) for atrial fibrillation (AF). Vasospastic angina involving the inferior wall of the left ventricle has been reported as a complication shortly after LACA.
Methods: We studied 20 patients with drug-refractory AF who underwent LACA, performed to encircle the left- and right-sided pulmonary veins, 1 to 2 cm from their ostia under fluoroscopic guidance. Quantitative coronary angiography was performed before and after LACA, and we analyzed the minimal lesion diameter (MLD) of the proximal segment of the coronary arteries, and the basal tone, the baseline percent constriction versus maximal dilation after nitroglycerin administration.
Results: No significant difference was observed in MLD or basal tone of the left coronary arteries after LACA. However, in the right coronary artery (RCA), the basal MLD was smaller (P < 0.01) and the basal tone was greater (P< 0.05) after than before LACA. No correlation was found between the baseline MLD or tone of the RCA and total amount of radiofrequency energy delivered or procedure duration. In 75% of RCA, the baseline MLD was smaller after than before LACA, which was significantly higher (P < 0.01) than observed in the left coronary arteries (38%).
Conclusion: Vasoconstriction was promoted in the RCA shortly after LACA, which may explain the variant angina reported after LACA.     

Endocardial Catheter Ablation for Refractory Ventricular Tachycardia Associated with Coronary Artery Disease

Percutaneous endocardial electrode catheter ablation using stored direct current (DC) electrical energy was performed in five patients with recurrent ventricular tachycardia (VT) refractory to many antiarrhythmic drugs, including amiodarone. All had prior myocardial infarction and poor left ventricular function with ejection fractions ranging from 20% to 40%. Endocardial catheter and pace mappings were used to localize the earliest site of activation during VT. Under general anesthesia, two to six shocks with 200 to 300 joules DC energy per shock were delivered to the localized sites. Immediate complications included ventricular fibrillation in one patient, transient QRS complex widening in two patients, transient complete AV block with persistent first-degree AV block in one patient, and transient asystole in two patients. None had inducible VT immediately following ablation, or 4 to 6 days later; none had evidence of intracardiac clot by two-dimensional (2D) echocardiography on the third to fifth day. Peak creatine kinase ranged from 189 to 1610 IU/L with 9% to 18% MB fraction. During a follow-up of 6 to 30 months, three patients had no recurrence of VT. Two patients had recurrent VT with a slower rate, which was controlled with antiarrhythmic drugs. None had worsening of congestive heart failure. Two patients died of nonarrhythmic causes. We conclude that nonsurgical endocardial ablation of VT with an electrode catheter is effective for the treatment of refractory VT in selected patients with coronary artery disease.     

Clinical Impact of an Open‐Irrigated Radiofrequency Catheter with Direct Force Measurement on Atrial Fibrillation Ablation

Background: Electrode‐tissue contact is crucial for adequate lesion formation in radiofrequency catheter ablation (RFCA). Objective: We assessed the impact of direct catheter force measurement on acute procedural parameters during RFCA of atrial fibrillation (AF). Methods: Fifty consecutive patients (28 male) with paroxysmal AF who underwent their first procedure of circumferential pulmonary vein (PV) isolation (PVI) were assigned to either RFCA using (1) a standard 3.5‐mm open‐irrigated‐tip catheter or (2) a catheter with contact force measurement capabilities. Using the endpoint of PVI with entry and exit block, acute procedural parameters were assessed. Results: Procedural data showed a remarkable decline in ablation time (radiofrequency time needed for PVI) from 50.5 ± 15.9 to 39.0 ± 11.0 minutes (P = 0.007) with a reduction in overall procedure duration from 185 ± 46 to 154 ± 39 minutes (P = 0.022). In parallel, the total energy delivered could be significantly reduced from 70,926 ± 19,470 to 58,511 ± 14,655 Ws (P = 0.019). The number of acute PV reconnections declined from 36% to 12% (P = 0.095). Conclusions: The use of contact force sensing technology is able to significantly reduce ablation and procedure times in PVI. In addition, energy delivery is substantially reduced by avoiding radiofrequency ablation in positions with insufficient surface contact. Procedural efficacy and safety of this new feature have to be evaluated in larger cohorts. (PACE 2012; 35:1312–1318)     

Simultaneous Mapping in the Left Sinus of Valsalva and Coronary Venous System Predicts Successful Catheter Ablation from the Left Sinus of Valsalva

Idiopathic ventricular tachycardia originating from the left epicardium (Epi-VT) can be ablated from the left sinus of Valsalva (LSV) in selected patients. We hypothesized that the analysis of electrograms at the LSV and transitional zone from the great cardiac vein to the anterior interventricular vein (GCV-AIV) could predict the efficacy of radiofrequency catheter ablation (RFCA) from the LSV. Simultaneous mapping in the LSV and coronary venous system was performed in 25 patients (12 VTs and 13 premature ventricular contractions). The earliest ventricular activation (VA) during the arrhythmias was found at the LSV or GCV-AIV in all patients. RF applications from the LSV were successful in 17 patients success group (S-Gr) and failed in 8 failure group (F-Gr). The earliness of the VA recorded in the LSV (VA[LSV]) and in GCV-AIV (VA[GCV-AIV]) was compared between the two groups. (1) The VA[LSV] preceded the QRS onset by 28 ± 11 ms in S-Gr and 14 ± 10 ms in F-Gr (P < 0.01). (2) In S-Gr, the VA[GCV-AIV] was earlier than the VA[LSV] in 5 five patients (35%). However, in F-Gr, the VA[GCV-AIV] was earlier than the VA[LSV] in all patients. (3) In patients in whom the earliest VA was found at the LSV or GCV-AIV, a VA [GCV-AIV] preceding the VA[LSV] by less than 10 ms identified successful RFCA from the LSV with a sensitivity of 88 %, specificity of 100%, and high predictive value. With a detailed analysis of the electrograms recorded from the GCV-AIV and LSV, it was possible to identify the successful catheter ablation of Epi-VT from the LSV.     

Primary Percutaneous Coronary Intervention of Anomalous Origin of Right Coronary Artery Above the Left Sinus of Valsalva in a Case with Acute Myocardial Infarction

Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare. We presented a case with anomalous origin of the RCA above the left sinus of Valsalva with inferior wall myocardial infarction and successful primary percutaneous coronary intervention to this artery which is the first report in the literature.     

老年患者冠状动脉搭桥术后胃肠功能紊乱的辨证施护

1998年9月-2006年12月冠状动脉搭桥手术后出现胃肠功能紊乱的老年患者156例,均表现为腹胀、纳呆、恶心呕吐、便秘等症状,辨证属痰浊闭塞证73例,气滞血淤证37例,阴血虚证16例,阳气虚证30例。各证型患者均给予电针双足三里20min,2次／d;进食淮山芡实瘦肉粥,或炖苹果水1次／d;黑芝麻15g加蜂蜜调服1次／d;按摩腹部大横穴1次／d;睡前予开天门按摩及安寐散（朱砂3～5g）贴涌泉穴30min,1次／晚。在此基础上,分别予以中医辨证施护：痰浊闭塞证者指导饮食以清热化痰为宜,避免进食产气之品,密切观察体温变化,对发热者予对症处理;气滞血淤证者预防情志刺激,指导选择活血化淤之饮食;阴血虚证者头晕时指导卧床休息,心悸气短时予氧气吸入,指导患者养成良好的睡眠习惯,在睡前行开天门按摩或温水浴足,遵医嘱行耳穴埋豆等处理,指导饮食选择补气养阴之品;阳气虚证者注意防寒保暖,饮食以低脂、高热量、补气助阳之品为宜。经护理,改善了腹胀、纳呆、恶心呕吐、便秘等胃肠功能紊乱症状得以改善。     

冠状动脉软斑块与不稳定型心绞痛患者近期预后的临床研究

目的:探讨不稳定型心绞痛(UA)患者多层螺旋CT(MSCT)检查对冠状动脉软斑块发现以及与近期预后的关系。方法:对97例初次诊断为UA者进行MSCT检查,发现斑块64例,分为软斑块组31例和纤维及钙化斑块组33例。两组均行心脏彩色多普勒超声检查评估心脏收缩功能,随访1年,记录主要心脏事件的发生情况。结果:软斑块组平均左心室射血分数(LVEF)为0.41±0.15,纤维及钙化斑块组平均为0.49±0.22,两组比较差异有统计学意义(P<0.05)。随访1年,软斑块组心脏事件发生率为58.06%,纤维及钙化斑块组发生率为30.30%,软斑块组心脏事件发生率明显高于纤维及钙化斑块组,差异亦有统计学意义(P<0.01)。结论:MSCT发现的冠状动脉软斑块与UA患者近期预后相关,心脏收缩功能差者,预后不良。     

糖尿病合并急性冠脉综合征患者血糖水平预测冠脉病变程度及心血管不良事件的价值

目的 探讨糖尿病（DM）合并急性冠脉综合征（ACS）患者血糖水平预测冠脉病变程度及心血管不良事件（MACE）的价值。方法 选取我院2021年9月至2022年9月期间65例糖尿病合并急性冠脉综合征患者,根据冠脉病变支数分为轻度狭窄组23例、中度狭窄组22例、重度狭窄组20例;同时根据是否发生心血管不良事件分为MACE组20例、非MACE组45例,观察比较各组血糖水平、冠脉病变程度Gensini评分,ROC曲线分析血糖水平预测冠脉病变程度及心血管不良事件的价值。结果 重度狭窄组的Gensini评分及糖化血清蛋白(GSP)、胰岛素样生长因子-1（IGF-1）、血清甘油三酯-血糖指数（TG-G）显著高于中度狭窄组及轻度狭窄组（P<0.05）,中度狭窄组的Gensini评分及GSP、IGF-1、TG-G指数显著高于轻度狭窄组（P<0.05）;非MACE组的GSP、IGF-1、TG-G指数均显著低于MACE组（P<0.05）;建立ROC曲线,血清GSP、IGF-1、TG-G指数水平联合诊断DM合并ACS患者发生冠脉重度狭窄的敏感度、特异度、AUC分别为78.0%、86.7%、0.816,联合诊断DM合并ACS患者心血管不良事件的敏感度、特异度、AUC分别为80.0%、75.0%、0.809,均高于单个指标的诊断效能（P<0.05）。结论 DM合并ACS患者的血糖水平对冠脉病变程度及心血管不良事件有一定的预测价值。     

Left Internal Mammary Artery as an Endocrine Organ: Insights Into Graft Biology and Long-term Impact Following Coronary Artery Bypass Grafting

The left internal mammary artery (LIMA) is considered the criterion standard vessel for use in coronary artery bypass grafting. In recent decades, countless studies have documented its superiority over other arterial and venous coronary artery bypass grafting conduits, although the full mechanisms for this superiority remain unknown. A growing body of literature has unveiled the importance of extracellular vesicles known as exosomes in cardiovascular signaling and various pathologic states. In this review, we briefly compare the clinical longevity of the LIMA relative to other conduits, explore the effects of varying grafting techniques on clinical and angiographic outcomes, and provide physiologic insights into graft function on a cellular and molecular level. Finally, we explore exosome signaling as it pertains to atherosclerosis in support of the LIMA as an “endocrine organ.”     

Association of Coronary Artery Calcium and Coronary Heart Disease Events in Young and Elderly Participants in the Multi-Ethnic Study of Atherosclerosis: A Secondary Analysis of a Prospective,Population-Based Cohort

ObjectiveTo evaluate the association of coronary artery calcium (CAC) and coronary heart disease (CHD) events among young and elderly individuals.Participants and MethodsThis is a secondary analysis of data from a prospective, multiethnic, population-based cohort study designed to study subclinical atherosclerosis. A total of 6809 persons 45 through 84 years old without known cardiovascular disease at baseline were enrolled from July 2000 through September 2002. All participants had CAC scoring performed and were followed up for a median of 8.5 years. The main outcome measures studied were CHD events, defined as myocardial infarction, definite angina or probable angina followed by revascularization, resuscitated cardiac arrest, or death attributable to CHD.ResultsComparing individuals with a CAC score of 0 with those with a CAC score greater than 100, there was an increased incidence of CHD events from 1 to 21 per 1000 person-years and 2 to 23 per 1000 person-years in the 45- through 54-year-old and 75- through 84-year-old groups, respectively. Compared with a CAC score of 0, CAC scores of 1 through 100 and greater than 100 impart an increased multivariable-adjusted CHD event risk in the 45- through 54-year-old and 75- through 84-year-old groups (hazard ratio [HR], 2.3; 95% CI, 0.9-5.8; for those 45-54 years old with CAC scores of 1-100; HR, 12.4; 95% CI, 5.1-30.0; for those 45-54 years old with CAC scores >100: HR, 5.4; 95% CI, 1.2-23.8; for those 75-84 years old with CAC scores of 1-100; and HR, 12.1; 95% CI, 2.9-50.2; for those 75-84 years old with CAC scores >100).ConclusionIncreased CAC imparts an increased CHD risk in younger and elderly individuals. CAC is highly predictive of CHD event risk across all age groups, suggesting that once CAC is known chronologic age has less importance. The utility of CAC scoring as a risk-stratification tool extends to both younger and elderly patients.