冠状窦呈偏心性激动的不典型房室结折返性心动过速的电生理特征及导管消融

目的 总结冠状窦（coronary sinus, CS）呈偏心性激动的不典型房室结折返性心动过速（atrioventricular nodal reentry tachycardia, AVNRT）的电生理特点、鉴别诊断及消融方法。方法 回顾性收集2014年1月至2018年12月在复旦大学附属中山医院心内科进行射频消融治疗的524例AVNRT患者的临床资料。其中,CS呈偏心性激动的不典型AVNRT患者共16例,男性6例、女性10例,平均年龄（56.6±11.4）岁。分析16例不典型AVNRT患者的体表心电图和腔内心电图特点、诱发方式、鉴别诊断及射频消融策略。结果 16例CS呈偏心性激动的AVNRT患者的心电图均表现为RP间期>PR间期,P波在Ⅱ、Ⅲ、aVF导联中倒置;发作时12例患者房室传导比例为1∶1,4例患者为2∶1或3∶1;13例患者可以轻易通过心室拖带的方式进行鉴别,2例患者需要多次拖带才能成功,1例患者多次拖带下心房-心室（atrioventricular,VA）仍然分离;14例患者在右心房后间隔靠近三尖瓣环处成功消融,3例患者在CS内成功消融。结论 CS呈偏心性激动的...     

心房颤动射频消融术后心包积液的处理及危险因素分析

目的 探讨心房颤动(房颤)患者导管射频消融术后发生心包积液的处理并分析其相关危险因素.方法 156例房颤患者[男108例,女48例,阵发性房颤114例,平均年龄(57.6±11.3)岁]在三维标测系统及环状标测电极导管指导下行射频消融治疗[包括环肺静脉电隔离、线性消融及(或)碎裂电位消融],记录消融过程、部位、时间等因素,对术后证实出现心包积液的患者根据不同情况(心脏压塞或单纯心包积液)进行不同处理,并门诊随访心脏超声等.对可能影响术后出现单纯心包积液的因素进行分析.结果 所有156例患者均完成肺静脉电隔离,共有16例(10.3%)出现心包积液,其中1例(0.6%)术后即刻出现心脏压塞,予心包穿刺后开胸探查抢救好转,随访18个月无特殊;另15例(9.6%)术后出现少量心包积液但无心脏压塞表现(单纯心包积液组),经保守治疗后好转,其中6例患者的心包积液在术后3个月消失,而另外9例则在术后6个月消失.单因素分析发现,单纯心包积液组与无心包积液组在性别组成(P<0.01)、有无行冠状静脉窦消融(P=0.026)、有无行碎裂电位消融(P=0.037)、有无行上腔静脉消融(P=0.041)等方面差异有统计学意义.Logistic多因素回归分析发现,女性[B=3.594,exp(b)=36.4,95%CI:4.2-312.1,P=0.001]、行冠状静脉窦消融[B=2.419,exp(b)=11.2,95%CI:1.0～124.6,P=0.049]是术后出现单纯心包积液的独立危险因素.结论 房颤射频消融术后心包积液的发生率较高,但绝大部分并不出现心脏压塞,可经保守治疗得到改善,而不需要进一步有创治疗.女性及行冠状静脉窦消融是术后出现单纯心包积液的独立危险因素,房颤射频消融时应谨慎对待该部位的消融,以减少术后心包积液的发生.     

房室结多径路的射频消融治疗

阵发性心动过速是临床上最常见的心律失常之一，其机制主要以房室结折返(AVNRT)或房室折返性(AVRT)等较常见，其它类型较少见。其中AVNRT由多径路同时存在国内文献报道极少。我们在临床心脏电生理检查和射频消融术(RFCA)中发现62例，现报告如下。     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

NT-proBNP对急性心肌梗死患者新发房颤的预测价值研究

目的探讨N末端B型脑利钠肽前体(NT-proBNP)对急性心肌梗死患者新发房颤的预测价值。方法从2008年1月至2010年12月收住我院心脏监护室的患者中入选急性心肌梗死(AMI)患者293例,按照患者住院期间是否出现房颤(AF)分为房颤组(n=43)和非房颤组(n=250)。比较两组间差异,分析血浆NT-proBNP水平对新发房颤的预测价值。结果 (1)AMI患者住院期间出现新发房颤的比例为14.7%;(2)房颤组患者NT-proBNP水平明显高于非房颤患者,且平均年龄较大,左心室射血分数、血红蛋白含量和肾小球滤过率(eGFR)均低于非房颤组;(3)多因素Logistic回归分析显示NT-proBNP可独立预测急性心肌梗死患者新发房颤(OR4.918,95%CI1.662-14.549,P=0.004)。结论血浆NT-proBNP水平可独立预测急性心肌梗死患者新发房颤的发生,可用于患者危险分层及指导早期预防治疗。     

图像融合技术在心房颤动射频导管消融中的应用

目前心房颤动射频导管消融(下称消融)的主要方法是以肺静脉的电隔离为终点的环肺静脉线性消融,在此基础上根据病情决定是否增加其他部位的消融[1].     

急诊PTCA时再灌注预适应预防再灌注心律失常的临床研究

随着ＰＴＣＡ技术的发展 ,急诊心肌梗死病人行ＰＴＣＡ术提供及时再灌注对减少心肌损伤与坏死提供了宝贵时间 ,但术中再灌注心律失常发生率较溶栓治疗再通时高。再灌注预适应可以明显减轻心肌再灌注损伤 ,保护心功能[1] ,对再灌注心律失常的预防作用及异搏定预处理的抗心律失常作用未见报道 ,本文就 110例急诊ＰＴＣＡ时进行预适应再灌注的结果分析。1　资料与方法1 1　资料　 1997～ 1999年急诊ＰＴＣＡ 110例 ,发病时间 3～ 10ｈ。仪器 :Ｂｏｓｔｏｎ公司产 2 0～ 3 5ｍｍ球囊 ,体表十二导同步心电图 ,ＨＰ心电监护除频仪 ,西门子公司产…     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

西拉普利和依那普利治疗原发性高血压的临床对照研究

目的　探讨西拉普利治疗高血压的临床疗效和安全性。方法　采用随机对照的方法治疗 115例高血压患者。结果　服药 8周后西拉普利组总有效率 89.8% ,收缩压和舒张压分别由治疗前 15 3± 15mmHg ,10 4± 9mmHg降至治疗后 131± 11mmHg ,91± 8mmHg ;依那普利组总有效率为 91.1% ,收缩压和舒张压分别由治疗前 15 5± 12mmHg ,10 2± 10mmHg降至治疗后 139± 14mmHg ,90± 9mmHg ,二组比较无统计学意义。西拉普利治疗后使收缩和舒张负荷均有下降 ,与用药前有显著的差别 ;无严重的不良反应。结论　一平苏是一种安全和有效的治疗轻中度原发性高血压的药物。     

镁盐治疗急诊PTCA再灌注心律失常临床观察

目的 :急性心肌梗死 (AMI)患者行急诊 PTCA前 ,利用静脉滴注硫酸镁的方法以探讨镁盐对再灌注心律失常的作用。方法 :1997年至 2 0 0 0年 4月急诊 PTCA113例 ,AMI发病时间 1～ 10小时 ,在行急诊 PTCA前随机分为镁盐组和对照组 ,镁盐组从入院即刻静脉滴注 2 5 %硫酸镁 ,至冠脉开通时输入镁量约为 10 .99mmol,连续作心电监护 ,观察记录冠脉开通 1小时内再灌注心律失常 (阵发室速、室颤 )的发生。结果 :两组阵发室速发生率为 35 .7%和 86 % (P<0 .0 1) ,室颤为 5 .3%和 19.3% (P<0 .0 1)。结论 :AMI早期快速静脉滴注镁盐对减低急诊 PTCA再灌注心律失常有显著作用