Hong Jiang

Background: Excessive left stellate ganglion (LSG) activity contributes to ventricular arrhythmias (VAs) after myocardial ischemia reperfusion (I/R). C-C motif chemokine ligand 4 (CCL4) is an inflammatory chemokine involved in neuroimmune signaling. However, whether CCL4 contributes to LSG activation and VAs after myocardial I/R remains unclear. Methods: We enrolled 98 patients with acute myocardial infarction undergoing emergency percutaneous coronary intervention (PCI) and assessed circulating CCL4, norepinephrine (NE), heart rate variability, and 24-h VAs. In beagles, CCL4 or CCL4 plus a neutralizing antibody was locally microinjected into the LSG before myocardial I/R. LSG neural activity and function, myocardial sympathetic and inflammatory indices, ventricular electrophysiology, and VAs were evaluated. C-C chemokine receptor type 5 (CCR5) expression and localization, together with local immune inflammatory changes, were assessed within the LSG. Results: Patients who developed VAs during post-PCI monitoring had higher circulating CCL4 levels both before PCI and at 1 h after PCI reperfusion, and the increase in CCL4 from pre-PCI to 1 h post-PCI was significantly greater. CCL4 at 1 h post-PCI correlated with sympathetic-related indices and 24-h ventricular premature beat burden, and remained independently associated with VAs after multivariable adjustment. In beagles, myocardial I/R increased endogenous CCL4 mRNA expression in the LSG. Local CCL4 administration enhanced LSG neural activity and function, increased myocardial TH-positive area and pro-inflammatory cytokine mRNA expression, shortened effective refractory period and action potential duration at 90% repolarization, and promoted VAs, whereas CCL4 neutralization attenuated these effects. CCR5 partially colocalized with tyrosine hydroxylase-positive sympathetic neurons. CCR5 expression and c-Fos activation were increased after I/R and further enhanced by CCL4. CCL4 also increased the numbers of Iba1-, CD3-, and CD11c-positive cells and inflammatory responses within the LSG. Conclusions: Clinically, circulating CCL4 was associated with VAs after PCI. In the canine I/R model, local CCL4 administration enhanced LSG sympathetic activity and ventricular arrhythmia susceptibility, potentially involving CCR5-related and local inflammatory processes.

Purpose: Pulsed-field ablation (PFA) is a novel ablation modality with promising outcomes for atrial fibrillation therapy. However, PFA might lead to dry cough and diaphragmatic contraction, especially under conscious sedation. We aim to explore a novel approach to reduce dry cough and diaphragmatic contraction during PFA procedures performed under conscious sedation. Methods: A total of 16 patients who underwent PFA pulmonary vein isolation under conscious sedation were divided into the asmeton (with preprocedure asmeton) and control groups. A scoring system was developed to assess dry cough and diaphragmatic contraction. Results: A total of 608 ablations and 893 ablations were performed in the control and asmeton groups, respectively. The dry cough score ( P = 0.045) in all pulmonary veins was significantly reduced by 73.1% in the asmeton group in comparison with the control group. The proportion of medium-to-high dry cough incidences decreased from 12.2 ± 10.4% in the control group to 1.8 ± 3.7% in the asmeton group ( P = 0.027). The diaphragmatic contraction score in the asmeton group was 37.5% lower than that in the control group, and the proportion of severe diaphragmatic contraction incidences was significantly reduced from 2.8 ± 8.4% in the control group to 0.0 ± 0.0% in the asmeton group ( P = 0.006). Conclusion: Asmeton might eliminate moderate-to-severe dry cough and reduce the severity of diaphragmatic contraction during pulmonary vein isolation under conscious sedation ablation.

Background: Transcatheter edge‐to‐edge repair (TEER) improves outcomes in patients with heart failure and moderate‐to‐severe functional mitral regurgitation (FMR) who remain symptomatic despite the use of maximal doses of guideline‐directed medical therapy (GDMT). The SQ‐Kyrin‐M system is a novel TEER device designed for FMR treatment. Aims: This multicenter, prospective, single‐arm study (ClinicalTrials.gov number: NCT05988450) evaluates the safety and efficacy of the SQ‐Kyrin‐M system in severe symptomatic FMR. Methods: A total of 125 eligible patients (mean age 65.5 ± 8.1 years) with heart failure and moderate‐to‐severe or severe FMR who remained symptomatic despite the use of maximal doses of GDMT were involved in the analysis. The primary endpoint was the composite rate of all‐cause mortality and heart failure hospitalization at 1 year post‐intervention. Independent assessments were conducted by an echocardiography core laboratory (ECL) and a clinical events committee (CEC). Results: At 1 year, the primary endpoint rate was 16.0% (20/125), and the composite major adverse event rate was 10.4%. Mitral regurgitation was reduced to ≤ 2+ in 94.2% of patients, with significant left ventricular reverse remodeling (LVEDV reduction: 33.8 ± 55.4 mL, p < 0.001). Patient‐reported outcomes improved significantly, with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores increasing by 15.9 ± 18.8 points ( p < 0.001) and 6‐minute walk distance (6MWD) improving by 46.7 ± 90.7 m ( p < 0.001). The proportion of patients in New York Heart Association (NYHA) class I/II increased from 30.4% to 84.4% ( p < 0.001). Conclusions: The SQ‐Kyrin‐M transcatheter mitral valve repair system bolsters the evidence supporting the safety and efficacy of TEER interventions for FMR patients.

High-performance lead-free K_0.5Na_0.5NbO₃ piezoelectric ceramics present a practical alternative to lead-containing counterparts by effectively reducing potential environmental hazards. This advancement is particularly relevant to the development of ferroelectric heterojunction devices for biomedical applications. Here, we design and fabricate a frequency-adjustable ferroelectric heterojunction based on the developed K_0.5Na_0.5NbO₃ piezoelectric ceramics with a high piezoelectric coefficient (d ₃₃ = 680 pC/N). By leveraging flexible encapsulation, the heterojunction achieves miniaturization (φ = 13.3 mm, h = 2.28 mm) and suitability for implantation. After penetrating the rat skull, the ultrasound generated by the heterojunction at a frequency of 3 MHz reaches a focal depth of about 7.9 mm, a focal width of approximately 480 μm at −6 dB, and millimeter-scale continuous focal tuning (1.5 mm) within a narrow frequency range (2.7–3.3 MHz). Additionally, the implanted heterojunction enables long-term and high-precision transcranial neuromodulation, and consequently yields therapeutic effects in a myocardial infarction animal model. Collectively, this study highlights a viable strategy for developing and applying lead-free ferroelectric heterojunctions, expanding their potential in brain modulation, and providing new insights into clinical treatments of myocardial infarction.