本文主要从射血分数以及病因的角度介绍心肌收缩力调节器（CCM）的最佳适应证人群选择。作为一项新近出现的器械治疗方法，CCM的最佳适应证人群仍需进一步的筛选，也需要新的临床研究拓宽CCM的适应证人群。

To investigate the electrocardiographic effects of left bundle branch pacing (LBBP) in symptomatic bradycardia patients with intrinsic complete right bundle branch block (RBBB).

All of the patients with symptomatic bradycardia and intrinsic complete RBBB were consecutively enrolled from January 2019 to December 2021, attempting to do LBBP in the Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University. In the standard 12-lead electro cardiogram, QRS morphology in lead V₁, QRS duration, delayed right ventricular activation time (dRVAT), left ventricular activation time (LVAT) and inter-ventricular conduction delay (IVD) were documented and compared between before and after LBBP respectively.

A total of 53 patients were included, (72.15±9.39)years old, and 34 of them were male. Forty-six of them underwent LBBP successfully. The QRS morphology was primarily rsR' pattern (83%) before LBBP, whereas the QRS morphology of LBBP was mainly Qr pattern (29/46,63%). When compared to pre-procedure, LBBP significantly reduced the QRS duration [(149.09±12.81) ms vs. (112.46±9.64) ms, P<0.001], fully corrected the QRS duration in 76.08%,(35/463) of cases, partially corrected in 21.73%(10/46), and uncorrected in 2.17%(1/46), and improved IVD [(58.28±12.54) ms vs. (34.34±8.87) ms, P<0.001], but increased LVAT [(42.46±6.95) ms vs. (66.53±10.83) ms, P<0.001]. There was no significant difference in dRVAT [(100.47±12.40) ms vs. (100.86±10.57) ms, P=0.955].

LBBP can reduce the QRS duration of intrinsic complete RBBB, improve the interventricular electrical synchronization, and present a Qr-dominated pattern in lead V₁.

To compare the incidence and characteristics of atrial fibrillation (AF) ablation-related asymptomatic cerebral emboli(ACE) between high-resolution diffusion-weighted imaging(hDWI) and conventional DWI(cDWI).

Thirty eight consecutive AF patients in Jiangsu Province Hospital from November 2018 to December 2018, and 18 consecutive AF patients in Shanghai East Hospital from January 2019 to February 2019 who underwent ablation were recruited. All the patients received hDWI, in order to exclude recent events of cerebral embolism. High-resolution DWI and conventional DWI were performed after ablation within 48 h, and the incidence, number, size, and location of ACE in the same patient were compared.

High-resolution DWI showed a higher incidence of acute ACE (70% vs. 42%, P<0.001), a significantly higher number of ACE lesions (102 vs. 42, P<0.001), and a larger ACE size (5.42 mm vs. 4.21 mm, P<0.001) compared to cDWI. Multivariate regression analysis revealed that impaired left ventricular ejection fraction (P=0.012) and low intraoperative active clotting time (P=0.009) were associated with the incidence of ACE.

High-resolution DWI showed higher incidence and greater features of ACE after AF ablation, and MRI settings should be considered in studies evaluating ACE.

心血管植入型电子器械（CIED）是治疗严重心律失常及部分心力衰竭的有效方法，由于疾病本身的严重性和侵入性的治疗方式，造成部分患者的各种心理问题或心理疾病。本文将介绍和探讨CIED手术伴心理疾病的现状、识别及治疗。

心房颤动患者常合并急性冠脉综合征或需要行经皮冠状动脉介入。这类患者需同时口服双联抗血小板药和抗凝药进行三联抗栓，出血风险显著增加。近年发表多项随机对照研究证实了直接口服抗凝药联合P2Y₁₂受体抑制剂的双联抗栓治疗的安全性和疗效，并获得指南和专家共识的广泛认可，推荐基于患者的血栓栓塞风险、出血风险制订个体化的抗栓降阶方案，尽早停用阿司匹林，转为双联抗栓治疗。但三联抗栓降阶为双联抗栓的时间节点尚存争议。新发表的AUGUSTUS研究和MASTER DAPT研究的事后分析共同提示：30 d以后三联抗栓无明显疗效获益，且增加出血风险。最新研究为三联抗栓获益的最长30 d时限提供了有力证据。

冠心病是我国心血管疾病死亡的首位原因，而抑郁是冠心病预后不良、再发急性心血管事件及死亡率增加的重要危险因素。在临床实践中，一线心血管医生对冠心病合并抑郁认知不足，导致患者未接受合理的评估和治疗，严重影响其长期预后。所以对这类患者如何做到早期识别、正确评估和正规治疗已成为临床心血管医生亟待解决的重要问题。

To evaluate the condition of acute coronary syndrome (ACS) patients comorbid with depression in China and the effect of depression on their cardiovascular prognosis.

From April 2017 to April 2019, patients were consecutively enrolled who received percutaneous coronary intervention (PCI) for ACS in Department of Cardiology of the First Affiliated Hospital of Xi'an Jiaotong University. Major adverse cardiovascular events (MACE), as well as patient health questionnaire (PHQ) self-rating scales were evaluated at each visit. Different trajectories of time-varying PHQ scores and their relationship with MACE were identified. Cox proportional hazards regression models were used to evaluate the hazard ratio (HR) for MACE. Population attributable fractions (PAF) of depression at different time were analyzed to evaluate their contributions to MACE. Finally, time-dependent covariate analyses of repeated measurements of depression were conducted in time-dependent cox models and joint models to estimate the HR of the depression for MACE.

A total of 910 patients with ACS and accepted follow-ups were recruited, including 210 females, aged 60 (53, 66) years, and the proportion of patients with depression was 26.4%(240/910). We found that baseline depression was the independent risk factor for MACE (HR=2.42, 95%CI 1.8-3.26, P<0.001). The PAF of depression at last visit was higher (30.16%) than the PAF of baseline depression (18.75%). Repeated measurements of depression were the independent risk factors of MACE (HR=4.01, 95%CI 2.97-5.41, P<0.001).

Depression is common in ACS patients. Both baseline depression and repeated measurements of depression could increase the risk of MACE. More attention and regular screen need to be paid to these patients.

To investigate the feasibility and safety of percutaneous coronary intervention (PCI) under the monitoring of floating catheterisaion via the median cubital vein in patients with complex and high-risk coronary artery disease and with indications for interventional therapy (CHIP).

This is a single center, retrospective, observational study. CHIP received PCI from January 2020 to June 2022 were selected from the Department of Cardiology of the Second Hospital of Tianjin Medical University. The patients under the monitoring of floating catheter via the median cubital vein were the observation group, and the non-users at the same time were the control group. The parameters of age, sex, complication, blood lipid and so on were documented. The incidence of major adverse cardiovascular events (MACE) during hospitalization were compared in the two groups. Preoperative, intraoperative and postoperative relevant pressure monitoring such as pulmonary capillary wedge pressure(PCWP), pulmonary artery pressure(PAP), right atrial pressure(RAP), right ventricular pressure(RVP) were compared in the observation group.

A total of 98 patients were enrolled, aged (67.16 ± 11.56) years, including 35 women. There were 49 in the observation group and 49 in the control group. There was no significant difference in age, sex, complications and blood lipid between the two groups. Compared with the control group, the observation group had a lower incidence of MACE during hospitalization after surgery[16.33% (8/49) vs. 4.08% (2/49), P=0.045]. Compared with pre PCI, PCWP [(22.58±7.78) mmHg vs. (18.25±6.93) mmHg, P=0.000], PAP [(31.03±9.68) mmHg vs. (25.92±8.63) mmHg, P=0.000], RAP [(14.26±5.80) mmHg vs. (12.06±5.65) mmHg, P=0.002] and RVP [(23.69±8.81) mmHg vs. (21.43±7.75) mmHg, P=0.021] decreased in the observation group after PCI.

Routine monitoring of floating catheterisation in CHIP-PCI can accurately determine right heart pressure, guide treatment, and reduce the incidence of perioperative MACE with good clinical utility.

To explore the effect of different methods of the great saphenous vein harvesting on the outcome of coronary artery bypass grafting (CABG).

This study was a retrospective cohort study. The clinical data of patients who underwent CABG in the Cardiovascular Surgery Department of Heart Center of Fuwai Central China Cardiovascular Hospital from March 2019 to April 2020 were collected retrospectively, such as age, gender, complications, etc. The patients were divided into two groups according to the way of obtaining the great saphenous vein: endoscopic group (obtaining the great saphenous vein through endoscope) and conventional group (traditional open access to the great saphenous vein). The operation time, number of CABG intraoperative flow of great saphenous vein graft, pulsatility index (PI), postoperative renal function impairment, postoperative hospital stay, postoperative stay in intensive care unit (ICU), lower extremity incision complications and graft patency rate, recurrent angina, myocardial infarction with follow-up time of [12-18] months were compared between the two groups.

A total of 132 cases were collected with age (63.64±6.78) years old, 94 males (71.21%, 94/132) , including 58 in endoscopic group and 74 in conventional group. There was no significant difference between the two groups in gender, age, complications and other baseline data(P>0.05).There was no significant difference in terms of operation time [(355.50±75.92) min vs. (346.55±68.74) min, P=0.480], number of coronary artery bypass grafts [2.00(2.00,2.00) vs. 2.00(2.00,2.25), P=0.677], intraoperative flow of great saphenous vein graft [79.00(52.50,115.50) ml vs. 69.50(46.75,100.50) ml, P=0.196], pulsatility index (PI) of saphenous vein graft [1.55(1.38,2.20) vs. 1.60 (1.30,1.90), P=0.910], rate of renal function impairment (37.93% vs. 24.32%, P=0.091), postoperative hospital stay [10.00(8.00,15.25) d vs. 11.00(9.00,14.25) d, P=0.512] and postoperative stay in ICU[66.13(44.17,98.21) h vs. 66.38(43.81,95.46) h, P=0.757], between the two groups. There was no statistically significant difference with respect to the patency rate of graft (87.7% vs. 87.9% P=0.938), incidence of recurrent angina (10.34% vs. 10.81%, P=0.931), and myocardial infarction (10.34% vs. 6.76% P=0.534) in either group, no cases of death, percutaneous coronary intervention (PCI) or secondary CABG with follow-up time of [12-18] months. Lower extremity incision complications were lower in the endoscopic group than that in the conventional group [5.17%(12/74) vs. 16.22%(3/58)] with the difference statistically significant (P=0.047).

There was no difference in the effect of the mode of saphenous vein harvesting on the outcome of CABG, but endoscopic techniques can reduce the complication rate of lower extremity incisions.

本文通过回顾冠状动脉闭塞高风险主动脉瓣重度狭窄经导管主动脉瓣植入术患者的治疗经过，总结了行经导管主动脉瓣植入术后冠状动脉闭塞风险评估及处理方式。

To investigate the influence of personality traits on quality of life (QOL) in patients with atrial fibrillation (AF).

This was a cross-sectional study. Newly diagnosed AF patients in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Xi 'an Jiaotong University from October 2020 to March 2022 were selected, and sex, age, alcohol history and so on were documented. Atrial Fibrillation Effect on Quality of Life (AFEQT) was used to assess their QOL. Subjects were divided into high quality of life group (AFEQT≥80) and low quality of life group (AFEQT<80) according to AFEQT overall score. The Eysenck personality Questionnaire (EPQ) test was used to evaluate the patients' personality traits, the risk factors affecting the QOL of AF patients were analyzed by Logistic regression, and the predictive values of scores on different EPQ subscales [internal and external extroversion (E), psychoticism (P) and neuroticism (N) scales] were evaluated by Receiver Operating Characteristic (ROC) curves.

A total of 124 AF patients were included, including 62 males aged (67.48±11.59) years. There were 27 cases in the high quality of life group and 97 cases in the low quality of life group. There was no significant difference in demographic factors between the two groups. Multivariate Logistic regression showed that alcoholism (OR=1.328, 95%CI 1.016-1.877, P=0.033) and personality traits (P=0.016) were independent risk factors for QOL in AF patients. The independent E, P or N scales had limited effect on the prediction of subjects' QOL (P>0.05). The combination of E and N scales significantly improved the ability to predict the QOL (AUC=0.751, P=0.001).

Personality traits have an important impact on the QOL for AF patients. Early evaluation of personality traits is beneficial to improve the QOL for AF patients.

To explore the correlation between left atrial function and the left atrial low-voltage zones (LVZs) in patients with nonvalvular atrial fibrillation and stroke.

Patients with atrial fibrillation and stroke who admitted to the department of cardiology, The First Affiliated Hospital with Nanjing Medical University were enrolled from April 1st to September 30th, 2022. A pre-procedural echocardiography was performed to assess the left atrial function, such as the max of left atrial volume (LAVmax), the minimum of left atrial volume (LAVmin), the index of left atrial volume (LAVI), and detailed voltage mapping by an electro-anatomical mapping system was applied to evaluate the LA LVZs. Patients were divided into two groups according to the presence of the LVZs: LVZs group (LVZs ratio>5%) and no LVZs group (LVZs ratio≤5%). The correlation between the LVZs and left atrial function was then analyzed.

There were 26 patients enrolled totally, aged (60.77±10.31) years, 8 female (30.77%,8/26), 7 in LVZs group, 19 in no LVZs group. Compared to no LVZs group, the patients in LVZs group presented more women [71.4% (5/7) vs. 15.8% (3/19), P =0.014) and higher CHA₂DS₂-VASc scores (6 vs. 3, P =0.039). Echocardiography showed larger LAV max [(118.43±37.67) ml vs. (88.11±30.00) ml, P =0.043)], larger LAV min [(97.00±37.59) ml vs. [(54.89±29.42) ml, P =0.006], higher LAVI (65 vs. 44, P=0.004), lower LAEF (18.93%±8.30% vs. 40.39%±15.66%, P=0.002) and worse Reservoir function [21.98(12.22, 37.04)% vs. 64.52(38.57, 111.43)%, P=0.002]. Multivariable logistic regression analyses revealed female (OR=54.814, 95%CI 1.104-2721.590, P=0.044), lower LAEF(OR=0.822, 95%CI 0.696-0.970, P=0.020) to be independent predictors of the presence of LVZs.

Echocardiography-based assessment of left atrial function can predict the level of the left atrial LVZs in patients with atrial fibrillation and stroke, thereby guiding subsequent ablation strategies.

To investigate the effect of creatinine clearance (CrCl) on the prognosis of Chinese emergency department (ED) non-valvular atrial fibrillation (AF) patients.

This study prospectively enrolled patients with AF who presented to the ED of 20 hospitals in China from November 2008 to October 2011, and were followed up for 1 year. According to the level of CrCl, the patients were divided into 4 groups: CrCl≥80 ml/min, 50 ml/min≤CrCl<80 ml/min, 30 ml/min≤CrCl<50 ml/min and CrCl<30 ml/min. The primary clinical endpoints were all-cause death, cardiovascular death, thromboembolism, and major bleeding. Univariate and multivariate Cox regression models were used to analyze the effects of different CrCl groups on the above events.

In this study, 863 patients with non-valvular AF were selected as the research subjects. The average age of the patients was (69.4±13.8) years, 57.6% (495/863) were female, and the mean baseline CrCl was (52.9±24.5) ml/min. During 1-year follow-up, 126 (14.6%) patients died.The difference of the all-cause death among the four groups was significant (3.2% vs.6.5% vs.16.2% vs.40.2%, P<0.001). Cardiovascular death and thromboembolic rates also increased with decreasing CrCl levels. In multivariate Cox analysis, all-cause death (HR=5.567; 95%CI 1.618-19.876, P=0.007) and cardiovascular death (HR=11.939; 95%CI 1.439-99.031, P=0.022) risk was highest in CrCl<30 ml/min category, compared with the group CrCl≥80 ml/min. However, for the risk of thromboembolism and major bleeding, after multivariate adjustment, no significant difference was found between the different CrCl groups.

Among Chinese ED non-valvular AF patients, all-cause mortality increased with a decrease in CrCl. CrCl<30 ml/min was an independent risk factor for all-cause mortality and cardiovascular mortality.

心房颤动（AF）是临床上最常见的心律失常，高龄是AF发生的重要危险因素。端粒是染色体末端TTAGGG重复序列串联而成的特殊核蛋白结构，端粒长度随细胞分裂不断缩短。外周血白细胞端粒长度（LTL）充分反映了其他细胞的端粒长度，可作为生物衰老的标志。近年来越来越多的证据表明LTL缩短与AF发生风险有关，本文就LTL在AF发生及进展中的作用作一综述。

本文从冠状动脉微血管功能障碍、心外膜痉挛和神经调节改变等角度阐述了除阻塞性动脉粥样硬化外，可能导致慢性心肌缺血的机制，强调从单一的慢性冠状动脉“疾病”转移到更广泛和更包容的“慢性心肌缺血综合征”的概念。同时对慢性心肌缺血综合征的概念、机制、诊断、治疗和预后进行深入地分析和探讨，希望能对未来心肌缺血治疗临床实践模式的转变有促进作用。

To investigate the impact of atrial fibrillation better care (ABC) pathway on the prognosis of Chinese emergency patients with atrial fibrillation (AF).

This study included patients with AF who presented to the emergency department of 20 hospitals in China from November 2008 to October 2011, and every patient had a 12-months follow-up. Patients were divided into 2 groups according to whether they followed the ABC pathway: ABC adherent and Non-ABC adherent. The primary clinical outcome measure was all-cause death, and the secondary clinical outcome measure was cardiovascular death, stroke, and major bleeding. Univariate and multivariable Cox regression models were used to analyze the effects of the ABC adherence on the clinical outcomes.

A total of 2 015 patients with AF were included in this study.The average age was (68.5±13.3) years, 1 104 (54.8%) were female, and the patients in the ABC/Non-ABC adherent were 126 (6.3%,126/2 015) and 1 889 (93.7%,1 889/2 015), respectively. During the 12-month follow-up, all-cause death and cardiovascular death occurred in 4 (3.2%, 4/126) patients and 1 (0.8%,1/126) in the ABC adherent group, and 275 (14.6%, 275/1 889) and 163 (8.6%, 163/1 889) in the Non-ABC adherent group. Multivariable Cox model analysis showed that the risk of all-cause mortality (HR 0.211, 95% CI 0.078~0.572, P=0.002) and cardiovascular mortality (HR 0.085, 95% CI 0.012~0.612, P=0.014) were significantly decreased in the ABC adherent group compared with the Non-ABC adherent group. The incidence of stroke and major bleeding was not statistically different between the two groups.

In a contemporary cohort of Chinese emergency patients with AF, comprehensive clinical management with the ABC pathway was associated with a significant decrease in the risk of all-cause death and cardiovascular death, and integrated management using the ABC pathway could improve the prognosis of patients with AF.

To retrospectively summarize the complications associated with cardiac resynchronization therapy (CRT) in a single center in order to provide relevant experience for the clinical management of CRT patients.

This study is a retrospective study. Patients with heart failure who underwent CRT implantation in the Department of Cardiovascular Medicine, The First Affiliated Hospital of Xinjiang Medical University from June 2009 to June 2021 were included. The patients were divided into cardiac resynchronization therapy defibrillator (CRT-D) and cardiac resynchronization therapy pacemaker (CRT-P) according to the type of implanted device. In the CRT-P group, the failure of left ventricular lead implantation, diaphragm muscle stimulation, coronary venous system injury and other related complications were analyzed, and the reasons for the complications were recorded.

A total of 469 patients were enrolled, including 359 males (359/469, 76.55%), age (62.31±11.69) years, preoperative mean left ventricular ejection fraction was 34.76%±7.96%, preoperative mean QRS duration was (161.82±30.57) ms. The success rate of left ventricular lead implantation was 95.1% (446/499), intraoperative diaphragm stimulation in 2 cases (0.43%); acute left heart failure in 3 cases (6.40%); coronary vein dissection in 15 cases (3.19%). Hematoma occurred in 4 cases (0.85%), and lead dislocation in 10 cases (2.13%), including acute dislocation in 2 cases (20%), subacute dislocation in 4 cases (40%), and delayed dislocation in 4 cases (40%).

The risk of complications related to CRT is high, and at the same time, we should be alert and rule out the possibility of related postoperative complications.

心力衰竭是各种心脏疾病的终末表现，心力衰竭患者合并室性心律失常是临床上一种常见现象，室性心律失常是心力衰竭患者心脏性猝死的主要原因。通过研究心力衰竭患者室性心律失常发生机制和猝死风险，对患者进行危险分层并实施安全有效的干预措施，对于降低心力衰竭患者的死亡率及改善预后有重要临床意义。

糖尿病和心力衰竭作为全球疾病负担，与之相关的治疗研究进展一直备受关注。恩格列净是钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）中的一种，不仅作为新型降糖药物近年来广受欢迎，且目前已有相关研究表明其对心力衰竭也同样有获益，是目前被证明可降低心血管死亡发生风险的SGLT-2i。恩格列净的有效性及安全性在得到证实的同时，其治疗心力衰竭的机制也成为如今的研究热点。