Efficacy of Antitachycardia Pacing in Patients Presenting with Cardiac Arrest

The efficacy of antitachycardia pacing (ATP) incorporated into implantable cardioverter defibrillators (ICDs) was assessed in 29 consecutive survivors of cardiac arrest, not attributable to acute myocardial infarction, ischemia, or drug and electrolyte effects. The cohort included 25 men and 4 women with a mean age of 65 years and a mean left ventricular ejection fraction of 29%. Seventeen patients had coronary artery disease, 11 had nonischemic dilated cardiomyopathy, and 1 had long QT syndrome. Programmed stimulation yielded monomorphic ventricular tachycardia (VT) in 17 patients, polymorphic VT in 6, and no inducible VT in 6. During a mean follow-up of 22 months, a total of 91 episodes of monomorphic VT occurred, 73 of which were successfully pace terminated (83%). Monomorphic VT amenable to pace termination recurred only in the group that had this arrhythmia inducible. The recurrent arrhythmias in the 12 patients having either no inducible VT or polymorphic VT were all rapid VTs, having a cycle length < 220 ms; and therefore, not amenable to pace termination. These results suggest that ATP incorporated into ICDs is useful in survivors of cardiac arrest and may significantly reduce the number of shocks that these patients would otherwise receive. Programmed stimulation may also help to define those patients who would receive the maximum benefit from ATP.     

仿生嗅觉与味觉传感技术及其应用的研究进展

动物的化学感受系统具有惊人的能力,能够在极低的浓度下识别数千种分子结构各异的化学物质,其灵敏性、选择性和响应速度都远高于当前的人工识别系统.近年来,研究者致力于利用完善的天然分子识别机制,开发出一种与传统嗅觉/味觉传感器相比更具仿生意义的新型化学探测系统,即仿生嗅觉/味觉传感器.仿生嗅觉/味觉传感器通常将动物嗅觉味觉的受体、细胞和组织作为敏感材料,然后使用多种人工检测方法,如光学、电化学和声波检测器件等,实现对化学物质的检测和识别.文中概述了动物嗅觉/味觉感受系统对化学物质的信息处理机制,并结合本实验室的工作,综述了目前仿生嗅觉/味觉传感器的常用技术及其未来发展趋势,并展望了其在医疗、工业和军事等领域的应用前景.     

Comparison of Simultaneous Versus Sequential Defibrillation Pulsing Techniques Using a Nonthoracotomy System

The defibrillation threshold (DFT) using simultaneous (SIML) versus sequential (SEQ) pathways for shock delivery was compared in 16 patients with an implanted cardioverter defibrillator. All patients had three-lead nonthoracotomy systems (NTL) using a left chest subcutaneous patch, a right ventricular endocardial lead, and a lead in the coronary sinus (n = 5) or superior vena cava (n = 11). The DFT were determined 2–44 days (17 ± 17 days) after implantation. The DFT was defined as the lowest energy shock that resulted in successful defibrillation. The first pathway tested was SIML in 12 and SEQ in 4 patients with output beginning at or above the intraoperative DFT, routinely 18 J. The second pathway was tested beginning 2–4 J above the DFT of the first tested pathway. All shocks were delivered in 2–4 J decrement or increment steps. The SEQ pathway shocks resulted in a significantly lower DFT than SIML pathway shocks (14 ± 6 vs 18 ± 6 J; I < 0.01). There was no difference in the time delay after ventricular fibrillation initiation before shock delivery for the successful defibrillation between SIML versus SEQ pathways (7 ± 2 secs for both pathways). In 7 of 16 patients, defibrillation using SEQ pathway resulted in a > 5 J lowering of DFT, while only one patient had > 5 J lowering of DFT using SIML shocks (P <0.05). These results have important implications for selecting the optimal pathway for implantable cardioverter defibrillator therapy with a multilead NTL system.     

Radiofrequency Ablation of Left-Sided Accessory Atrioventricular Pathways in Patients with Unusual Coronary Sinus

Four patients with left-sided accessory pathways (APs)and unusual coronary sinus (CS)received radiofrequency ablation. Unusual CS included occlusion of CS (patient 1), acute anguJation of proximal CS (patients 2 and 3), and narrowing of CS orifice and proximal segment (patient 4). CS catheterization and AP mapping along the CS could not be performed in the four patients. Radiofrequency ablation by left ventricular retrograde technique for the manifest left posteroseptal AP (patient 1), concealed left posterior AP (patient 2), and transseptai left atrial technique for the manifest left posteroseptal AP (patient 3)and manifest left posterior AP (patient 4)were performed successfully without CS catheter guidance. This study suggests that radiofrequency ablation of left-sided AP with unusual CS is feasible by some special techniques.