Li Shibei

GW24-e1750 The Comparison of Remedy Vascular Injury with Different Embolisation Agents in the Comprehensive Surgical Treatment Shelter

Objectives There is no report about embolic agent used to treat different types of vascular injury in the comprehensive surgical treatment shelter. Methods Producing different types of vascular injury animal models in the comprehensive surgical treatment shelter, using different types of embolic agent such as gelatin sponge, sodium alginate - chitosan microspheres coil, and evaluating time of surgery, results of operations, image clarity and equipment manipulated, exploring the treatment effect. Results 10 successful operation were performed, the success rate of 100%, 0 cases of death. DSA imaging performance and equipment operability, interventional diagnosis and treatment can effectively for performing the operation. Conclusions It was effectiveness for using suitable embolic agent in the treatment of different types of vascular injury in the comprehensive surgical treatment shelter in disaster site or battlefield first-line.

GW24-e1751 The Diagnosis of Vascular Injury by Ultrasonography Combining Angiography in the Comprehensive Surgical Treatment Shelter

Objectives There is no report about diagnosis of vascular injury by ultrasonography combining angiography in the comprehensive surgical treatment shelter recently. Methods Producing different site of vascular injury animal models in the comprehensive surgical treatment shelter, using ultrasonography combining angiography to diagnose the vascular injury 0/10/30 min after model created successfully, recording the character of the imaging and comparing there detection rate. Results 10 vascular injury animal models were created successfully. 2/5/7 hematomas were checked out by ultrasonography, and 10/8/6 bleeding vascular injury were detected by angiography at the 0/10/30 min point. The imaging has different character at the different time point. Conclusions: It was effectiveness for diagnosis of vascular injury by ultrasonography combining angiography in the comprehensive surgical treatment shelter in disaster site or battlefield first-line.

GW24-e1760 Localisation of the origin site of outflow tract ventricular arrhythmias by surface electrocardiogram

Objectives It has been reported that the origin site of idiopathic ventricular arrhythmias from left or right outflow tract (L/RVOT) can be judged from the transition of R/S on precordial lead of surface ECG, but its value still need to be confirmed in more studies. This study reports the relationship between surface ECG and the origin of the premature ventricular contractions (PVCs) or ventricular tachycardia (VT) in a large series. Methods The ECG characteristics in 207 consecutive patients who underwent radio frequency catheter ablation of LVOT or RVOT origin of VT/PVCs were analysised respectively. All the patients had no significant structural heart diseases. Results The number of patients whose transition of R/S on precordial leads was before lead V2, in lead V3 and after lead V4 were 18 (47.6 ± 8.8 years old on the average), 75 (45.5 ± 13.1years), and 114 ((42.25 ± 13.69), respectively. In the 18 cases of R/S wave transition before lead V2, LVOT origin was defined in all the patients, with the specificity of 100% and sensitivity of 72.00%. In the 75 cases of R/S wave transition in lead V3, the lead V2 R/S transition during sinus rhythm was earlier than that during PVCs or VT in 66 patients, and RVOT origin was determined in all of them. In the other 9 patients with lead V3 R/S transition, 7 of them had a LVOT origin with a later R/S transition in lead V2 during sinus rhythm other than during PVCs or VT. Therefore, in patients with lead V3 R/S transition, if lead V2 R/S transition during sinus rhythm was later than that during PVCs or VT, the specificity and the sensitivity of LVOT origin were 97.06% and 100% separately. In the 114 cases of R/S transition after (≤) lead V4, RVOT origin was defined in all the patients, with the specificity of 100% and sensitivity of 62.63%. Conclusions There is a high specificity of identifying the origin of ventricular arrhythmias from LVOT by R/S transition before lead V2, a high specificity and sensitivity of identifying origin from RVOT by R/S transition after lead V4. The specificity and sensitivity are high to define the PVCs or VT origin from LVOT or RVOT by measuring the R/S ratio on lead V2 between sinus rhythm and PVCs.

ASSA13-02-15 Clinical Characteristics of 4 Cases of Polymorphic Ventricular Tachycardia/Ventricular Fibrillation Initiated by Idiopathic Premature Ventricualr Contraction Originating from Right Ventricular Outflow Tract

Background Ventricular fibrillation and/or polymorphic ventricular tachycardia are occasionally initiated by ventricular extrasystoles originating from the right ventricular outflow tract (RVOT) in patients without structural heart disease. Objective The aim of this study was to report clinical characteristics of 4 cases of polymorphic ventricular tachycardia/ventricular fibrillation (PVT/VF) initiated by idiopathic premature ventricualr contraction (PVC) originating from RVOT. Methods Among 76 patients with ventricular tachycadia (VT) arising from RVOT, the clinical characteristics of 4 patients with PVT/VF triggered by PVC originating from RVOT were investigated and compared with the clinical characteristics of the other 72 patients. Results The same PVC morphology was shown in triggering PVCs that initiated PVT/VF and in isolated PVCs. The coupling intervals of the above two kinds of PVCs were markdly different. The coupling intervals of triggering PVCs were shortened in 2 cases and prolonged in the remain 2 cases compared with those of isolated PVCs, and the variation magnitude of the coupling interval in every case was more than 70 ms. The coupling intervals of isolated PVCs were not fixed in 1 case. The number of PVCs per day, the coupling interval of isolated PVC and the baseline QT interval were 15427 ± 1109, 419 ± 22ms and 404 ± 15ms respectively in 72 monomorphic VT patients. The numbers of PVCs per day of 3 of the 4 PVT/VF patients were equivalent to those of 72 VT patients, and the same equivalence was found in the coupling intervals of isolated PVC and the baseline QT intervals of the 4 patients. The cycle lengths of PVT/VF were all less than 280 ms, which was shorter than that of monomorphic VT (324 ± 59ms) obviously. Among 4 patients, episodes of syncope were documented in 2 patients, and the syncope rate of 72 VT patients was 4.1%. Activating mapping and pacing mapping confirmed that the PVCs of all these 4 patients originated from septal of RVOT, and PVCs were successfully eliminated by radiofrequency catheter ablation. Conclusions PVCs that triggered PVT/VF and originated from tract RVOT had the characteristics of unstable coupling intervals and short circle lenth of PVT/VF. Radiofrequency catheter ablation was effective as a treatment option for these patients.

ASSA13-02-22 Application of a Novel Pacing Guide Wire in Cardiac Resynchronization Therapy

Background The implantation of left ventricular (LV) lead was the most complicated process in the cardiac resynchronization therapy (CRT), the aim of this study was to investigate the availability of a novel Visionwire guide wire in the implantation ofLVlead in CRT. Methods Five heart failure patients selected for CRT were involved in the study. The pacing threshold, R-wave sensing, phrenic nerve stimulation at local coronary sinus (CS) branch were measured by the Visionwire guide wire and LV lead separately. Results The pacing parameters were analysed through the Visionwire guide wire and LV lead separately at the 16 CS branches in 5 patients. There was no significant difference between the pacing parameters measured by the two methods. Significant correlation was found betweenLVpacing threshold assessed by the Visionwire guide wire andLVlead (r = 0.90, P < 0.01). Correlation for R wave sensing was also significant (r = 0.67, P < 0.01). The pacing sites accompanied with phrenic nerve stimulation while pacing at 10 V/0.42 ms were similar by the two methods. Visionwire guide wire could be used for local potential electrical mapping. The procedure time for pacing test in a single coronary sinus branch by Visionwire guide wire was much less than that by LV lead (12.4 ± 7.5min vs 18.3 ± 12.2min, P < 0.01). Conclusions Visionwire guide wire facilitated transvenousLVlead implantation by prediction of pacing parameter and locate the target CS branch quickly. The electrophysiological mapping function of Visionwire guide wire as a unipolar lead might have further potential usefulness.

ASSA13-02-2 Inducibility of Atrial Arrhythmia After Circumferential Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: Clinical Predictor and Outcome During Follow-Up

Background Inducibility of atrial arrhythmia after circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (AF) were analysed to assess whether inducibility of atrial arrhythmia could be used as a clinical predictor of AF recurrence and whether non-inducibility of AF was a clinically useful end point. Methods Forty one consecutive patients with symptomatic paroxysmal AF underwent CPVI guided by 3D mapping system and single Lasso technique. After achievement of CPVI, the induction of atrial arrhythmia (AA) was performed. AA was induced by rapid atrial pacing within the proximal coronary sinus and right atrium. AA was considered inducible only if its duration was more than 30 seconds. Symptoms, Surface ECG, and 24h Holter recording were followed up after the procedure. Results Sustained atrial arrhythmias were induced after CPVI in 16 of 41 patients (39.0%). Thirteen of the 35 patients (37.1%) had inducible AA after the initial procedure and 3 of the 6 patients (50%) after the second procedure, and there was no difference between the two groups (P > 0.05). There were no differences in the baseline data between the two groups (P > 0.05). During an average 6 months of follow-up, 7 of the 16 patients (43.8%) in the AF inducible group had AF recurrence, and 8 of the 25 patients (32.0%) in the AF non-inducible group had AF recurrence (P > 0.05). After the second procedure, 1 of the 3 patients in the AF inducible group had AF recurrence, and no patient of the 3 patients in the AF non-inducible group had AF recurrence (P > 0.05). Four of the 9 patients (44.4%) whose inducible AA lasted between 1 min and 5 min had AF recurrence; 1 of the 3 patients (33.3%) whose AA duration more than 5 min and less than 10 min had AF recurrence; 2 of the 4 patients (50%) whose AA duration more than 10 min had AF recurrence. The recurrences among the above groups showed no significant difference (P > 0.05). The sensitivity, specificity, positive, and negative predictive values of the AF induction test to predict the 6-month ablation outcome were 41.7%, 65.2%, 27.2% and 68.2%, respectively. Conclusions Inducibility of atrial arrhythmia could not predict the clinical efficacy of CPVI in patients with paroxysmal AF, and non-inducibility could not be qualified as a reliable procedural endpoint.

ASSA13-02-8 Safety, Efficacy and Learning Curve of Catheter Ablation of Paroxysmal Atrial Fibrillation Using Circumferential Pulmonary Vein Isolation Technique in the Single Centre and in a Single Operator

Background CARTO anatomical mapping system and circumferential pulmonary vein isolation (CPVI) technique has been used to cure paroxysmal atrial fibrillation (PAF) in most hospitals in China, and have achieved a high success rate. But whether the successful rate, the recurrence rate and the safety are related to learning cure is still unclear. Methods From December 2004 to December 2010, 258 consecutive patients who underwent CPVI for PAF in our hospital were collected. The patients were divided into three groups with equal patient numbers according to the time sequences. Group I consisted of the first 86 cases, Group II consisted of the second 86 patients, and Group III consisted of the last 86 cases. Age, gender, course of disease, echocardiography, other atrial arrhythmias, basic diseases were analysed statistically. The operation X-ray exposure time, recent recurrence, late recurrence and re-ablation procedures were also analysed. In addition, the learning curve of CPVI for PAF and its relationship with peri-operative period complications, and the risk factors to predict the recurrence of atrial arrhythmias were analysed, too. Results There were no significant differences in patients’ age, gender, basic diseases and LAD among three groups. The rates of early recurrence in Group I, Group II and Group III were 38/86 (44.2%), 26/86 (30.2%) and 21/86 (24.4%) respectively (P < 0.05). The successful rates at 1 year were 44.2%, 51.2%, 64.0% respectively (P < 0.05) in three groups. The incidence of general complications was 12.8% in Group I, 4.7% in Group II, and 2.3% in group III. There were statistically significant differences between the total complication rates among the three groups. In many variables, left atrium dimension (LAD) enlargement and early recurrence were the risk factors of recurrent AF (P < 0.01 and P < 0.05, respectively). Conclusion For an experienced operator, CPVI has a higher success rate, a lower recurrence and a lower complication rate for radiofrequency catheter ablation of PAF. However, for a beginning operator, the success rate was relatively lower, both the recurrence and the complication rate were higher, and the X-ray exposure time was longer. The strengthened training of CPVI technique for PAF may be very important for the new operator to increase the success and to avoid or decrease the incidence of complications.

ASSA13-02-25 CARTO Three-Dimensional Mapping System Guided Catheter Ablation of Macro-Reentrant Atrial Tachycardia Following Cardiac Surgery in Patients with Structural Heart Disease

Background Because radiofrequency catheter ablation of macro-reentrant atrial tachycardia (AT) following cardiac surgery of structural heart disease had a low successful rate and a high recurrence, we aimed to explore a successful method to solve this problem. Objective This study was to investigate the electrophysiological mechanisms and radiofrequency catheter ablation of macro-reentrant atrial tachycardia (AT) following cardiac surgery of structural heart disease, and to test the success rate by using CARTO electroanatomic mapping. Methods A total of 20 patients (16 men, aged 35 ± 13.5 years) in ShenyangNorthernHospitalwere studied. After determining the mechanism of macro-reentrant AT, the electroanatomic structures of the right or/and left atria during AT were constructed by using CARTO electroanatomic mapping system. To combine the results of entrainment mapping, the possible reentrant circuits of AT were analysed and the ablation lines were defined. The saline irrigated radiofrequency ablation catheter was used for ablation in all the 20 patients. Results In the 20 patients, 16 patients had 1 form of AT and 4 patients had 2 forms. Twenty-four forms were all macro-reentrant AT confirmed by CARTO system electroanatomic mapping and entrainment. Among the 24 forms of AT, 18 forms were typical atrial flutter of the right atrium, 5 forms were incisional reentrant AT of the right atrium, and 1 form was macro-reentrant AT around the mitral annulus. Eighteen of the 20 patients had a successful ablation, including 17 of 18 forms of typical atrial flutter of the right atrium and 4 of 5 forms of incisional reentrant AT of the right atrium. During the follow-up of 12 months on the average, 17 patients with a successful ablation had no recurrence, and only 1 patient recurred as atrial fibrillation. Conclusions CARTO three-dimensional mapping system guided catheter ablation of macro-reentrant atrial tachycardia following cardiac surgery in patients with structural heart disease had a high success rate and a low recurrence rate.

ASSA13-02-7 Effect of Radiofrequency Catheter Ablation of Left Bundle Potential on Cardiac Electrical and Mechanical Functions in Canines

Background Animal model of left bundle branch block (LBBB) is very important for basic study about cardiac resynchronization therapy (CRT). But the preparation of LBBB model was difficult. Objective This study was to explore the effect of radiofrequency catheter ablation of left bundle potential (LBP) on cardiac conduction and mechanical function in canines and evaluate the preparation method of LBBB model by RF catheter ablation. Methods LBP was mapped and ablated by radiofrequency catheter in the left ventricular endocardium in 10 canines. The influence of LBP ablation on cardiac conduction and whether canine LBBB model was successfully created or not were observed. To assess the systolic and diastolic function of left ventricle, echocardiography was performed before and after LBBB model was successfully created. Results After LBP ablation, LBBB was successfully created in 8 (80%) canines. Atrial and ventricular amplitude ratio (A/V) was less than 1:10 at successful ablation site and the interval of LBP to local ventricular potential (LBP-V) was 17.1 ± 3.2 msec, range from 12 to 22 msec. The QRS duration increased from 52.8 ± 4.8ms to 100.5 ± 11.1ms (P < 0.001) after LBBB created in these 8 canines, but there were no significant changes in PR intervals, AH and HV intervals after LBP ablation. In the remain 2 canines, a similar LBP potential was identified with LBP-V 30 and 32 msec, but complete AV block was produced during or after RF energy application. In 8 LBBB canines, echocardiography showed that systolic and diastolic functions were all decreased, includingleft ventricular ejection fraction and aortic blood flow velocity time integral reducing (P < 0.05), E/A lowering to < 1, E wave deceleration time and isovolumetric relaxation time prolonging (P < 0.05). Significant prolongation of septal-to-posterior wall motion delay and the increased difference of pre-ejection time (P < 0.001) implied intraventricular and interventricular desynchronization after LBBB. Conclusions Radiofrequency catheter ablation of LBP can made a high success rate of LBBB model in canine, but the risk of complete AV block exists. Immediately after isolated LBBB model was created, intraventricular and interventricular desynchronization and left ventricular electrical activation delay occurred, which resulted in decreased cardiac systolic and diastolic functions.

ASSA13-02-1 The Feasibility and Curative Effect of Cardiac Resynchronization Therapy by Targeted Left Ventricular Lead Placement to the Latest Ventricular Electrical Activating Site Mapped in the Coronary Sinus Branches

Background A nonoptimal left ventricular (LV) pacing lead position may be a potential cause for nonresponse to cardiac resynchronization therapy (CRT). Objective The aim of the current study was to investigate the feasibility and curative effect of CRT by targeted LV lead placement to the latest ventricular electrical activating site mapped in the coronary sinus (CS) branches. Methods Ten patients with moderate to severe congestive heart failure, depressed left ventricular ejection fraction (LVEF) in the CS branchs, and the latest ventricular electrical activating site was considered as the target site for LV lead placement. The feasibility and curative effect of this kind of CRT were observed. The clinical variables assessed in this study included QRS duration, NYHA class, 6-min walk test and echocardiography index. Results Seven patients were diagnosed as dilated cardiomyopathy and 3 patients as ischemic cardiomyopathy. Electrophysiological mapping were performed in 28 CS branches which were considered as a possible site for LV lead placement and LV lead was successfully placed at the latest LV electrical activating site in all 10 patients. There were 116 ± 28ms activating time delay at the latest LV electrical activiating site than the QRS onset of ECG. QRS complex were significantly narrowed immediately after CRT than before CRT (121 ± 17ms vs 153 ± 30ms, P(8/9, 89%) and 3 patients as super responders (3/9, 33%), the other 1 ischemic cardiomyopathy patient who died of acute myocardial infarction 2 months after CRT procedure was classified as non-responder to CRT (1/9, 11%). The following clinical variables 3 months after CRT procedure were markedly improved than variables before CRT in these 8 responders (all PNYHA class was improved (1.6 ± 0.5 vs 3.3 ± 0.5) and the 6-min walk test was increased (405 ± 92m vs 307 ± 82m). Echocardiography demonstrated LVEF was improved (0.42 ± 0.06 vs 0.30 ± 0.04), left ventricular end-systolic volume (LVESV) was reduced (121 ± 38ml vs 153 ± 44ml) and mitral regurgitation velocity (MRV) was decreased (3.9 ± 1.2m/s vs 4.5 ± 1.5m/s). Conclusions Targeted left ventricular lead placement to the latest venticular electrical activating site guided by electrophysiological mapping in the CS branches was feasible. This CRT method was effective for improving heart founction of heart failure patients during short-term follow-up.