特发性室性心动过速射频导管消融标测方法探讨

目的探讨特发性室性心动过速（IVT）的标测方法.方法对52例行射频消融的IVT患者进行标测.39例源于右心室的IVT采用消融导管右心室起搏标测法,以起搏时与室性心动过速（室速）发作时的12导联心电图QRS波形态与振幅完全相同的起搏部位为消融靶点.12例起源于左心室的IVT以发作时消融电极导管在左心室内标测到较体表心电图QRS波提前≥20 ms的最早高频低振幅电位为消融靶点（激动顺序标测法）,1例左心室室速采用起搏标测法.结果左心室IVT消融成功率100%（13/13）,右心室IVT消融成功率94.87%（37/39）.结论起源于左心室的IVT宜采用激动顺序标测法,起源于右心室的IVT宜采用起搏标测法.     

特发性室性心动过速持续发作下的急诊射频消融及远期随访

目的进一步评价特发性室性心动过速(IVT)持续发作下急诊射频消融(ERFCA)的可行性及其远期疗效。方法26例IVT患者(男16例,女10例,年龄48.6±10.2岁)均在持续发作下完成血管穿刺、置入导管、电生理检查及射频消融,并采取门诊或电话定期随访的形式,跟踪5年以上,进一步明确IVT行ERFCA的远期疗效及影响预后的因素。结果26例中有2例IVT复发,经再次射频消融成功,1例左后间隔IVT在ERFCA中并发Ⅲ度房室传导阻滞(AVB),同期置入VVI永久起搏器,随访期间起搏、感知功能良好,室性心动过速亦未复发。均无迟发性AVB或其它并发症发生。结论IVT持续发作下,行ERFCA治疗安全可行,且远期效果良好。     

特发性室性心动过速12例的电磁解剖标测系统标测和消融

目的评价电磁解剖标测系统(Carto)标测和指导射频消融在治疗特发性室性心动过速的临床应用价值。方法入选12例特发性室性心动过速患者,年龄(33±12)岁。心动过速周期(370±95)ms。室性心动过速持续发作时,7FNavi-Star在相关心室标测,实时重建心腔三维电解剖图,右心室室性心动过速在右心室流出道详细标测,根据激动图上最红色区域为较早激动部位,结合大头导管记录心室波最早、且起搏时体表12导联图形与心动过速一致处,作为消融靶点。左心室室性心动过速在间隔部细标,标识较体表QRS波及His束电位提前的P电位处,作为靶点。温控60℃放电消融。以基础态及静脉滴注异丙肾上腺素反复电生理检查.不可诱发室性心动过速作为成功消融终点。结果12例均成功消融,其中右心室室性心动过速7例,均位于右心室流出道前中间隔部,左心室室性心动过速5例,起源于左心室后中间隔4例、中下间隔近心尖部1例。1例左心室室性心动过速于心动过速在左心室后中间隔处标测时,室性心动过速终止,后标志此处作为靶点,放电消融成功。手术时间为(102±25)分钟,曝光时间为(11±7)分钟。随访6～18个月,无复发病例。结论Carto系统通过磁场标测定位,结合心内电图重建室性心动过速时心室电激动图,可有效快速寻找最早激动点或P电位处作为消融靶点,进行电解剖标测,并可在标测导管机械损伤终止室性心动过速处标志,结合起搏标测,作消融参考点指导消融,治疗特发性室性心动过速安全有效。     

儿童左心室特发性室性心动过速临床特点及射频消融治疗

目的:观察儿童左心室特发性室性心动过速(idiopathic left ventricular tachycardia ILVT)的临床特征和射频导管消融(radiofrequency catheter ablation RFCA)治疗的效果。方法:56例ILVT患儿行心内电生理检查和RFCA治疗,左心室特发性VT(ILVT)起自间隔部者以最早的P电位处为靶点,左心室流出道VT(LOT)和左前间隔来源的IVT,均以起搏与VT发作时12导联心电图QRS波,形态完全相同处或最早心室激动处为靶点。消融终点为程序刺激或静点异丙肾上腺素室速不被诱发。结果:RF-CA治疗ILVT的成功率为98.2%,复发率为5.5%。IVT起源部位分别位于左心室后间隔部47例,左前间隔3例,左心室流出道6例。结论:ILVT的RFCA成功率高,并发症少。     

特发性室性心动过速的导管射频消融治疗

目的评价特发性室性心动过速(IVT)的导管射频消融(RFCA)治疗效果。方法20例IVT患者,男11例,女9例,年龄30.4±12.419～40岁。病史1～8年。心动过速频率146～240bpm。所有病例无器质性心脏病的证据。术前停用抗心律失常药物至少5个半衰期。常规心内电生理检查,采用起搏标测与激动标测相结合的方法进行标测,并行靶点消融。结果20例病人中,右室IVT9例,其中右室流出道VT8例,成功7例;希氏束下方VT1例,消融成功;左室IVT11例,其中间隔部VT10例,成功9例,左室游离壁VT1例,成功1例,总成功率90%(18/20)。18例术中成功诱发出VT,2例左室IVT患者术中未诱发出VT,采用起搏标测,记录到与自发VT心电图12导联完全一致的起搏心电图,消融3个月后,1例复发。结论RFCA治疗IVT疗效肯定,成功率高,复发率低。左室IVT应以激动标测为主,记录到最提前的浦肯野电位(PP)或异常电位(AP)提示为成功的靶点,且术中能否诱发出VT是手术成功的关键。右室IVT应以起搏标测为主。     

射频消融治疗特发性室性心动过速103例

总结不同起源部位特发性室性心动过速(IVT)经导管射频消融(RFCA)治疗的成功经验。103例IVT行RFCA治疗,左室特发性VT(ILVT)起自间隔部者以最早的P电位处为靶点,右室特发性VT(IRVT)和其他部位的IVT均以起搏与VT发作时12导联心电图QRS波形态完全相同处或最早心室激动处为靶点。结果:RFCA治疗IVT的成功率为96.12%,ILVT为92.9%,IRVT为98.4%,复发率为2.9%。IVT起源部位分别位于左室后间隔部32例,左室游离壁1例,左室流出道9例,右室流出道60例、流入道1例。结论:IVTRFCA的关键是消融靶点的标测和确定,可根据VT发作时的心电图表现估计其起源位置。IVT的RFCA成功率高。     

特发性室性心动过速射频消融治疗的方法学研究

目的总结不同起源部位特发性室性心动过速(idiopathic ventricular tacycardia,IVT)经导管射频消融(radiofrequency catheter ablation,RFCA)治疗的方法与结果,并对其方法学进行研究.方法85例IVT行RFCA治疗,ILVT中起自间隔部者以最早的P电位处为靶点,其他部位的IVT均以起搏与VT时12导联心电图QRS波形态完全相同处或最早心室激动处为靶点.结果RFCA治疗IVT的成功率为96.5%,ILVT为95.6%,IRVT为97.5%,复发率为3.6%.结论IVT射频消融治疗的关键是消融靶点的标测和确定.IVT发作时体表心电图表现具有特异性,可根据心电图表现确定其起源位置.投照体位的合理应用可以提高标测、消融的成功率.IVT的RFCA是一种成功率较高的根治性治疗法,但仍然有些因素影响其成功率.     

经导管射频消融治疗特发性室性心动过速120例总结

目的 总结不同起源部位特发性室性心动过速(IVT)的经导管射频消融(RFCA)抬疗的方法与结果。方法 对120例IVT进行了RFCA抬疗，男性87例、女性33例，年龄36±19(8～66)岁。左室FVT(ILVT)中起自间隔面者以最早的P电位处为消融靶点，其它部位的IVT均以起搏与心动过速时12导联QRS形态完垒相同处或最早心室激动处为靶点。结果RFCA抬疗IVT的总成功率92．5％(111／120)，ILVT为94．6％(70／74)、右室IVT(IRVT)为89．1%(41／46)，复发率为5．4％(6／111)，永久性三度房室阻滞1例，发生于ILVT消融时(1．3％)。ILVT分别起自间隔面(65例)、左前游离壁基底部(5例)和流出道(4例)。IRVT分别起自流出道(39例)、流入道(4例)、前壁(2例)及心尖部(1例)。左室间隔面ILVT有效靶点处P电位较QRS提前33．4±11．8(18～60)ms，其它部位49例ILVT及IRVT中的病例全部表现为有效靶点处起搏时与心动过速时12导联ORS波形态完全相同(41例，83．7％)或局部心室激动最为提前(8例，13．3％)。对4例未诱发的IVT尝试消融经随访证实均无效。结论不同起源的IVT采用RFCA治疗均具有较高的成功率和较低的并发症。起自左室间隔面的ILVT应以最早P电位处为靶点；其它部位IVT应采用起搏标测，也可采用激动顺序标测。电生理检查未诱发的IVT不宜尝试RFCA。     

窦性心律下射频导管消融起源于希浦系统特发性室性心动过速的临床观察

随着射频导管消融 (RFCA)治疗快速心律失常的广泛应用 ,其治疗特发性室性心动过速 (IVT)的技术日臻成熟〔1〕。对于起源于希浦系统的IVT ,常规的方法是在心动过速下消融最提前P电位而获得成功。我们在实际工作中对一部分患者采用了术前确定最佳诱发条件 ,以心动过速下最早P电位靶点 ,然后终止心动过速 ,在窦性心律下消融 ,取得良好效果 ,现将结果报告如下。1　对象与方法起源于希浦系统IVT患者共 2 3例 ,男 1 3例 ,女1 0例 ,年龄 1 9～ 61 ( 35± 1 2 )岁 ,其中 3例并发高血压 ,术前心脏彩色多普勒示心脏结构正常 ,心电图均呈右束支传…     

左心室起搏下标测并消融左侧隐匿性旁路一例

本文报道１例左侧隐匿性旁路患者,右心室起搏的冲动只经房室结逆传。为此,在消融电极导管的第３、４极起搏左心室的同时,采用消融电极导管的１、２极标测靶点,并消融成功。现报道如下：１　　临床资料　　　　患者男性,５４岁。因反复阵发性室上性心动过速而于２００１年３月５日入院行射频导管消融术。局部麻醉下经静脉放置冠状静脉窦、高位右心房、希氏束、右心室电极。室上速发作时冠状静脉窦远端Ａ波明显提前,诊断为左侧游离壁隐匿性旁路参与逆传的房室折返性心动过速。用不同频率行右心室起搏,均为希氏束处Ａ波领先,提示冲动不…     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.