第一部分:LADA和2型糖尿病患者的胰岛β细胞功能

~~第一部分:LADA和2型糖尿病患者的胰岛β细胞功能@周智广!410011长沙$中南大学湘雅二医院代谢内分泌研究所 @杨琳!410011长沙$中南大学湘雅二医院代谢内分泌研究所~~     

心房颤动经胸直流电转复的疗效观察

~~心房颤动经胸直流电转复的疗效观察@温尚煜!163001黑龙江省$大庆市第一医院心内科 @孙志奇!163001黑龙江省$大庆市第一医院心内科 @王满庆!163001黑龙江省$大庆市第一医院心内科 @王柏影!163001黑龙江省$大庆市第一医院心内科 @唐玉龙!163001黑龙江省$大庆市第一医院心内科 @潘震华!163001黑龙江省$大庆市第一医院心内科 @刘丹!163001黑龙江省$大庆市第一医院心内科 @王丽娜!163001黑龙江省$大庆市第一医院心内科 @王金平!163001黑龙江省$大庆市第一医院心内科 @黎辉!163001黑龙江省$大庆市第一医院…     

小剂量舒降之对老年冠心病患者降脂治疗的临床观察

~~小剂量舒降之对老年冠心病患者降脂治疗的临床观察@谢英!100029$北京安贞医院老年心内科 @田雨贤!100029$北京安贞医院老年心内科 @张妍!100029$北京安贞医院老年心内科 @宋劼!100029$北京安贞医院老年心内科 @田磊!100029$北京安贞医院老年心内科 @程秀琴!100029$北京安贞医院老年心内科 @王龙华!100029$北京安贞医院老年心内科~~     

70岁以上老年人冠状动脉介入治疗分析

~~70岁以上老年人冠状动脉介入治疗分析@万琪琳!475000$开封市河南大学淮河医院心内科 @程冠昌!475000$开封市河南大学淮河医院心内科 @王治中!475000$开封市河南大学淮河医院心内科 @洪岩!475000$开封市河南大学淮河医院心内科 @何瑞利!475000$开封市河南大学淮河医院心内科 @张媛!475000$开封市河南大学淮河医院心内科 @陈颖!475000$开封市河南大学淮河医院心内科 @潘增源!475000$开封市河南大学淮河医院心内科…     

70岁及以上冠心病患者冠状动脉内支架置入术的临床评价

~~70岁及以上冠心病患者冠状动脉内支架置入术的临床评价@沈亚平!310013杭州市$浙江医院心内科 @沈法荣!310013杭州市$浙江医院心内科 @黄抒伟!310013杭州市$浙江医院心内科 @凌锋!310013杭州市$浙江医院心内科 @陈建明!310013杭州市$浙江医院心内科 @孟丽萍!310013杭州市$浙江医院心内科 @金宏义!310013杭州市$浙江医院心内科~~     

Kappa 700系列起搏器的临床应用

~~Kappa 700系列起搏器的临床应用@黄新平!650021昆明$云南省第二人民医院心内科 @张荣华!650021昆明$云南省第二人民医院心内科 @洪云飞!650021昆明$云南省第二人民医院心内科 @李丹若!650021昆明$云南省第二人民医院心内科 @杨骥!650021昆明$云南省第二人民医院心内科 @陈芳!650021昆明$云南省第二人民医院心内科~~     

起搏器心室自动阈值管理功能的特殊心电图表现

~~起搏器心室自动阈值管理功能的特殊心电图表现@陈岗!200080$上海交通大学附属第一人民医院心内科 @孙宝贵!200080$上海交通大学附属第一人民医院心内科 @金炜!200080$上海交通大学附属第一人民医院心内科 @张建军!200080$上海交通大学附属第一人民医院心内科 @汪爱虎!200080$上海交通大学附属第一人民医院心内科 @汪芳!200080$上海交通大学附属第一人民医院心内科     

心包穿刺置管引流术的临床应用体会

~~心包穿刺置管引流术的临床应用体会@刘俊明!830002$新疆乌鲁木齐市兵团医院心内科 @黄文军!830002$新疆乌鲁木齐市兵团医院心内科 @李辉!830002$新疆乌鲁木齐市兵团医院心内科 @谢伟!830002$新疆乌鲁木齐市兵团医院心内科 @高霞!830002$新疆乌鲁木齐市兵团医院心内科 @刘志强!830002$新疆乌鲁木齐市兵团医院心内科     

有自动夺获功能的双腔起搏器的临床观察

~~有自动夺获功能的双腔起搏器的临床观察@张燕!510120$广州中山大学附属第二医院心内科 @王景峰!510120$广州中山大学附属第二医院心内科 @伍卫!510120$广州中山大学附属第二医院心内科 @聂如琼!510120$广州中山大学附属第二医院心内科 @周淑娴!510120$广州中山大学附属第二医院心内科 @孔敏仪!510120$广州中山大学附属第二医院心内科     

阵发性心房颤动射频导管消融进行心房-肺静脉电隔离术的方法学

~~阵发性心房颤动射频导管消融进行心房肺静脉电隔离术的方法学@杨延宗!116001$大连医科大学附属第一医院心内科 @刘少稳!116001$大连医科大学附属第一医院心内科 @高连君!116001$大连医科大学附属第一医院心内科 @林治湖!116001$大连医科大学附属第一医院心内科~~     

Tracking an unusually migrated pacing lead

A rare and fatal complication was encountered during a forensic deliberation. The case focused on a delayed pacing lead migration with multiple organ perforation and a trajectory crossing the right ventricular wall, pericardium, left inferior lung lobe, diaphragm, abdominal cavity to the left retroperitoneum, with the end of the pacing lead stopping close between the left psoas muscle and the left kidney. The above path—identified as the source of fatal bleeding—was found during revision surgery when the lead was removed. The bleeding was made easier by inhibiting platelet function and by a temporary decrease in platelet count as a result of low molecular weight heparin. No symptoms related to the above passage of the lead through the patient´s body were noted.     

"Add-on pacing lead": An effective and safe alternative to lead replacement in ICD pacing failure

Despite recent advances in implantable cardioverter defibrillator (ICD) technology, the long-term reliability of ICD leads remains a significant problem. Lead failures constitute a major risk for patients with an implantable cardioverter defibrillator. There is no clear consensus on treatment strategy of ICD lead failure and decision should be individualized. We report a pacing-dependent elderly male with ICD lead pacing failure secondary to insulation break resulting in recurrent syncope. We emphasize the technique of "Add-on pacing lead implantation" could be an effective and alternative to ICD lead replacement.     

Percutaneous extraction of entrapped infective transvenous pacing lead

A 57-year-old woman had an entrapped infected transvenous pacing lead successfully removed percutaneously with a Dormier basket under fluoroscopy, thus avoiding a major surgical procedure.     

Left heart pacing lead implantation using subxiphoid videopericardioscopy

INTRODUCTION: Recent clinical data support the utility of left heart pacing. The transvenous approach for left heart pacing lead implantation is imperfect. A direct epicardial approach may have advantages, but heretofore its utility has been limited because of the requirement for thoracotomy. We sought to examine the feasibility of a method for epicardial lead implantation that did not require thoracotomy. METHODS AND RESULTS: In five large swine, percutaneous access to the epicardium was achieved with subxiphoid videopericardioscopy, using a device that marries endoscopy with a port through which pacing leads could be introduced. In each animal, standard, active fixation pacing leads were implanted onto the left atrium and ventricle. The atrial lead was implanted at the base of the appendage. The ventricular lead was implanted on the anterior, lateral, and inferior walls. Continuous direct visualization of the epicardium provided guidance for lead localization and fixation, including avoidance of complications such as trauma to epicardial coronary vessels. Capture thresholds were uniformly low. Postmortem examination demonstrated anatomically accurate, uncomplicated lead fixation. CONCLUSION: Using subxiphoid videopericardioscopy, uncomplicated, anatomically accurate left heart epicardial pacing lead implantation can be achieved without thoracotomy.     

新型主动固定起搏导线的临床应用

目的评估植入新型主动固定起搏导线的可用性和安全性。方法选择本中心植入永久性人工心脏起搏器患者101例,分为新型导线组（n=25）和传统导线组（n=76）,新型导线组患者植入Medtronic3830导线3根,5086MRI导线14根（包括心房、心室导线）,Boston Scientific4471导线15根;传统导线组患者植入心室主动固定导线76根,心房被动固定导线58根,测量植入后各相关起搏参数,手术时间,曝光时间及心室导线过三尖瓣的次数,并常规随访。结果两组导线的阈值[（0．62-4-0．14）V、（0．63-4-017）V]、振幅[（1129±4．28）mV、（12．74±6．08）mV]、阻抗[（76768±132．73）Q、（815．14±182．46）Q]、电流[（077±0．19）mA、（0．85±0．33）mA]、斜率（2．46±1．07、2．844-102）差异均无统计学意义（均P〉005）,两组起搏导线损伤电流[（6,83±1157）mV、（6．61±1187）mV]、植入手术时间[（44．204-4．65）min、（43．42±5．55）min]、曝光时间[（3．24±1．04）min、（3．33±1．05）min]、导线过三尖瓣次数（1．36±0．57、1．34±0．63）差异均无统计学意义（均P〉0．05）。三种新型起搏导线植入时均未发生并发症,4471导线出现1例术后完全脱位。1年时随访两组导线的阈值、振幅、阻抗异均无统计学意义（均P〉0．05o结论新型起搏导线均符合起搏器植入要求,未增加手术时间和曝光时间,植入安全。     

Clinical surveillance of a thin bipolar pacing lead

A total number of 415 co-radial, bipolar pacing leads (189 atrial leads; 226 ventricular leads) were implanted in 228 patients between November 1994 and July 1999. Mean pacing thresholds at the implantation were normal at 0.6 V in the atrium and at 0.4 V in the ventricle with a pulse duration of 0.4-0.5 ms. Lead impedance was relatively low (337-447 ohms for atrial leads; 369-459 ohms for ventricular leads) at the implantation and during the follow-up periods. No definite failure in lead materials was observed in either atrial or ventricular leads (mean follow-up of 19.7 and 19.2 months, respectively: up to 52.9 months for both leads). Predicted clinical surveillance up to 10 years calculated statistically showed that the upper 95% confidence limit was a constant of 100%. The lower 95% confidence limits at 5, 7, and 10 years were estimated to be 98.0%, 97.2%, and 96.0%, respectively. From the present study, the ThinLine lead is reliable for both sensing and pacing thresholds, and has excellent predicted lead longevity. Nevertheless, further observation is required regarding cost performance, such as early replacement of the pacemaker generator, because of the lower pacing lead impedance.     

Intrapulmonary artery coiling of a permanent pacing lead

Intrapulmonary artery displacement of a permanent ventricular lead is reported to be a severe form of lead coiling and is attributed to the failure of the fixation procedure. The lead instability indicated a need for surgical correction.     

Tracking the path traversed by temporary pacing lead

Persistent left superior vena cava (PLSVC) results from abnormal development of the sinus venosus in the early stages of fetal life. Though there are numerous reports of successful permanent pacemaker implants in such cases, placement of permanent pacing leads in such cases is technically challenging, often requiring shaping of stylets and considerable lead maneuvering. We describe an interesting case wherein a temporary pacemaker lead after entering the PLSVC followed an unusual fluoroscopic course with demonstrable pacing in right ventricle (RV), right atrium (RA) and the left ventricle (LV). Interventional cardiologists and intensivists performing pacing procedures need to be aware that one may rarely encounter such interesting radiographic and electrocardiographic patterns in these cases with anomalous systemic venous drainage.