CARTO指导下射频消融低位环右心房逆钟向折返不典型心房扑动

目的 分析逆钟向低位环折返不典型心房扑动的特点，评价CARTO标测系统对其鉴别诊断的意义。方法 一57岁男性患者，因长期反复的心房扑动进行心脏电生理检查和导管射频消融治疗。常规放置右心房内导管、希氏束导管、冠状窦导管和标测消融导管。在心动过速中进行激动标测、电-解剖标测及三尖瓣环至峡部的连续性线性消融。以宽分离的双电位为射频消融的终点。结果 体表心电图和心内激动顺序提示为典型心房扑动。多部位拖带标测发现右心房侧壁远离折返环，低位右心房后壁在折返环上，峡部隐匿性拖带。进一步CARTO标测提示折返环沿下腔静脉逆钟向折返(尾头方向观)。进行峡部至三尖瓣环的连续性线性消融终止心动过速，并出现宽分离的双电位。随访6个月，未服用任何抗心律失常药物，无心房扑动复发。结论 逆钟向低位环折返不典型心房扑动可与典型心房扑动共用三尖瓣环与下腔静脉间的峡部作为缓慢传导区。峡部消融可以终止并消除心动过速。传统的标测方法容易漏诊，CARTO标测系统对折返环部位的判定有帮助。     

Ebstein畸形合并预激综合征的射频消融治疗

目的探讨对Ebstein畸形合并预激综合征采用射频消融治疗的临床效果。方法我院2009年1月至2019年11月收治Ebstein畸形患者101例,将其中9例合并预激综合征并进行了射频消融治疗的患者作为Ebstein组,另外选择同期行射频消融的25例心脏结构正常的B型预激综合征患者作为对照组。比较2组患者的手术时间、消融时间、放电次数、放电功率及临床疗效。结果Ebstein组9例患者的10条旁路被成功消融,其中有3例患者选用Swartz鞘辅助使消融电极贴靠稳定而完成手术;对照组25例患者均顺利完成消融,效果满意。Ebstein组患者手术时间、消融时间、放电次数和放电功率均大于对照组,差异有统计学意义(P<0.05)。Ebstein组患者平均随访(64.44±34.85)个月,对照组患者平均随访(53.12±13.83)个月,2组均无手术并发症发生,均无复发病例。结论与心脏结构正常的预激综合征患者相比,Ebstein畸形合并预激综合征患者行射频消融治疗可取得同样的临床效果,但手术时间、消融时间、放电次数和放电功率会增加。     

肝癌的射频消融治疗进展

目的：探讨射频消融在肝癌治疗中的治疗进展。方法：查阅相关中外文献,对射频消融治疗肝癌的效果进行综述。结果：射频消融治疗肝癌疗效确切、微创小,发展迅速。射频消融联合其他治疗进一步扩大了治疗范围,提高了治疗效果。结论：射频消融是治疗手术不能切除的肝癌的理想方法。     

X线图像引导射频消融系统的研制

目的研制一种用于快速治疗心律失常的X线图像引导射频消融系统。方法通过X射线图像来引导消融导管,确定导管顶端的电极位置,在病灶处放出交电流,实现病灶的消融。并结合了多道电生理记录的功能,在进行消融手术的同时,可以观察和监控病人的电生理状况,保障病人的手术安全。结果一例隐性左侧旁道患者通过系统治疗,经过图像引导的消融后,A波与V波分开,获得了心脏消融的成功。结论通过X线图像的引导并结合多到电生理记录系统的射频消融系统,能有效快速的治疗简单的快速心律失常。     

射频消融治疗阵发性室上性心动过速35例分析

目的 总结射频消融（RFCA）治疗阵发性室上性心动过速（PSVT）35例的经验。方法 左房室旁路消融二尖瓣室侧，右侧房室旁路消融三尖瓣房侧；房室结双径路通过下位法能量递增消融法改良房室结。结果 19例房室折返型心动过速，左侧旁道13条，右侧旁道6条，16例房室结折返型心动过速（AVNRT）首次消融均成功。术后1周1例AVNRT复发，再次消融成功。1～20个月随访无复发及严重并发症。结论 RFCA治疗PSVT安全、有效。     

高频电刺激指导肾动脉射频消融的实验研究

目的:用电刺激的方法指导肾脏去神经术(renal denervation,RDN)中射频消融靶点的选择,同时比较电刺激与射频消融时血压变化的异同。方法:成年健康昆明犬6只,行肾动脉造影排除肾动脉畸形后,每侧肾动脉从远段开始,由远及近选择数个位点进行电刺激并消融。连续记录术中血压的变化,术后通过软件分析血压的变化情况。采用常规HE和Masson染色观察肾动脉壁结构及其周围组织;采用酪氨酸羟化酶(tyrosine hydroxylase,TH)免疫组化染色观察消融后肾动脉去神经效果。结果:本实验中刺激/消融位点共计50个,其中对电刺激有反应的位点占34%,无反应位点占66%。对有反应位点进行120 s电刺激时,其收缩压按每20 s分段与基线血压相比分别变化(0.34±3.38)、(0.41±3.04)、(10.47±5.73)、(13.27±3.63)、(10.17±1.87)和(0.78±1.87)mm Hg;将120 s连续消融时的收缩压数据同样按每20 s与基线血压相比,变化分别为(0.88±3.44)、(-1.64±3.47)、(13.17±3.12)、(12.82±3.21)、(9.50±2.68)和(-6.09±2.21)mm Hg。无反应位点进行电刺激和射频消融时均无明显血压升高。组织病理学检查显示,有反应位点肾动脉神经面积为(0.51±0.28)mm~2,无反应位点处为(0.09±0.06)mm~2,差异有统计学显著性(P0.01);免疫组化染色表明消融部位神经TH的表达显著低于未消融部位(P0.01)。结论:高频电刺激可以标测肾交感神经,且电刺激指导下的射频消融能对肾动脉交感神经造成有效损伤。     

心律失常的消融治疗方法及其进展

消融是一种非手术治疗心律失常的方法，经导管的消融方法免除了治疗某些心律失常疾病长期对手术的依赖。本文首先阐明了消融方法病理解剖基础，并从能量守恒的观点对消融过程中的热传输和能量转换进行了分析，然后，详细介绍了最新的几种消融方法即射频消融，微波消融，最后，展望了消融在临床应用和研究上的发展趋势。     

射频消融治疗房颤的热损伤有限元分析

目的:本文探讨分析了心肌组织加热温度随时间、电压变化,温度横向、纵向变化,以及热损伤区域随电压不同而变化的情况。方法:利用射频消融治疗房颤手术过程中电热场耦合效应形成的温升变化及消融区域的物理模型仿真得到结果。结果:仿真结果表明使用射频电流进行迅速加热可以使能量集中在目标治疗区域内,11s左右达到预先设定的治疗要求。并对实际应用时可能出现的情况进行了探讨。结论:仿真结果表明该仪器符合临床要求。     

多极射频消融系统的研究

多极射频消融作为一种有效的抗癌手段，因其适应症广，疗效好，安全方便而成为目前较具前景的肿瘤治疗方法，本文介绍了一种基于射频原位灭活技术的智能化多极射频肿瘤治疗系统的研制。     

导管射频消融治疗特发性室性心动过速

目的探讨标测特发性室性心动过速(IVT)有效靶点的方法及对射频消融成功的影响。方法8例IVT的病人,其中右室流出道特发室速(RVOT)5例,左室特发室速(ILVT)3例,先采用激动标测,然后采用起搏标测,标测到靶点后行射频消融。结果8例室速病人均一次消融成功,无复发。结论不论RVOT或ILVT,激动标测 起搏标测具有很高的准确性。     

植入式心电记录器在心房颤动射频消融术后随访中的应用

目的探讨植入式心电记录器（ILR）在观察心房颤动射频消融术后疗效中的价值。方法收集2010年10月至2012年8月心房颤动射频消融术后复发患者7例,其中男性2例,女性5例;年龄23～67岁,平均年龄51岁。经常规检查未能明确复发原因,根据病情分别选择植入Medtronic公司RevealRDX9528型、Reveal XTTM9529型ILR监测复发时的心电事件,以帮助确诊。结果 7例植入ILR的患者平均随访（12.7±5.1）个月。随访期内7例患者共记录心电图191段,其中患者手动触发记录49段,ILR自动触发记录142段,64段心电图为心律失常事件。根据症状-心律相关性,监测到6例患者出现胸闷、晕厥等症状,其中5例患者明确为心律失常性事件引起,1例为非心律失常性事件引起。1例无症状发作。提示ILR诊断复发原因的效率为85.71%。根据ILR监测结果明确病因的6例患者得到进一步治疗,症状发作好转或减少。结论 ILR用于诊断心房颤动射频消融术后复发具有安全、高效、监测时间长、信息量大等优点,动态优化ILR系统,将进一步提高ILR在临床诊断、疗效追踪、指导治疗等方面的临床应用价值。     

心房颤动导管射频消融对心脏起搏器安全性影响的临床研究

目的评价植入起搏器患者经导管射频消融治疗慢性心房颤动(房颤)的安全性。方法18例永久性心脏起搏并房颤患者,其中男性12例,女性6例,年龄55～78岁,平均年龄68.67岁(标准差8.72岁)。分析其接受导管射频消融术中全程记录的心电信息,判断有无感知、起搏功能不良及房室失夺获、噪声反转等现象,并用起搏器程控仪于导管射频消融术前及术后第1天观察房室感知、起搏阈值及电极阻抗等参数的变化。结果18例患者均顺利完成导管射频消融,肺静脉前庭电学隔离率为100%。导管射频消融前后起搏器感知、起搏阈值及阻抗的变化无统计学意义(P>0.05)。导管射频消融过程中,3例(17%)出现噪声反转,3例(17%)出现感知不良,1例(6%)出现起搏功能不良致心室失夺获,均于停止放电后恢复正常。3例(17%)慢性持续性房颤患者在电复律后出现一过性感知不良。结论射频电流和电复律可引起一过性感知、起搏功能的障碍,但一般不引起起搏、感知阈值及电极阻抗的改变。对于已植入心脏起搏器的慢性房颤患者,在需行导管射频消融术时是安全的。     

Long-term results of low-speed irrigated radiofrequency catheter ablation of atrial flutter

The authors studied long-term results of low-speed (10 ml/min) irrigated radiofrequency catheter ablation (RFA) of the lower isthmus (LI) in patients with typical atrial flutter (AF). This treatment was based upon combined use of local and indirect criteria of the block of isthmus conduction. The influence of RFA LI on quality of life (QL), echocardiographic parameters and cardiac rhythm variability (CRV) was studied. Low-speed irrigated RFA LI, based upon combined use of local and indirect criteria for verification of complete bidirectional blockade in this area, is an effective and safe method of treatment of patients with different variants of clinical course of typical AF which makes it possible to significantly improve QL characteristics and central hemodynamic parameters, and normalize CVR parameters as well. Self-organization of chaos, which realizes according to RR interval time rows, in patients with typical AF after RFA LI may be considered an additional criterion of the effectiveness of this operative intervention and a prognostic sign that predicts maintenance of sinus rhythm in this category of patients.     

特殊左侧房室旁路的射频导管消融策略

目的探讨特殊左侧旁路射频导管消融中的策略。方法行射频消融手术治疗房室旁路引起的房室折返性心动过速合并永存左上腔静脉患者3例,其中男性2例,女性1例,年龄51、42和48岁。经主动脉逆行途径在二尖瓣心室侧、穿间隔途径在二尖瓣心房侧行射频消融。随访4~12个月,观察患者有无室上性心动过速复发及心电图检查有无显性旁路恢复。结果具有一定特殊性左侧旁路的3例患者均消融成功,手术成功率100%,无并发症发生。3例患者合并永存左上腔静脉,其中1例经房间隔穿刺途径在二尖瓣心房侧消融时出现迷走神经反射,心率、血压下降,广泛导联ST-T改变,经冠状动脉造影证实非冠状动脉病变,为完全性左束支传导阻滞。术后随访4~12个月,3例患者均无室上性心动过速发作。结论左侧房室旁路导管射频消融存在特殊情况时,需仔细鉴别,通过不同的方法及途径消融,仍可获得较高的成功率。     

Cardiac parasympathetic modulation in the setting of radiofrequency ablation for atrial fibrillation

The cardiac autonomic nervous system plays an important role in the genesis and maintenance of atrial fibrillation. Although, pulmonary vein isolation is the cornerstone in today’s approach to atrial fibrillation ablation, a considerable proportion of patients will recur with atrial arrhythmias following this procedure, especially in the non-paroxysmal forms. The pulmonary vein isolation indirectly targets and ablate the ganglionated plexi. This might ultimately enhance the efficacy of the procedure, but an optimal ablation strategy and a reliable method to confirm and quantify the efficacy of vagal denervation following the procedure might be necessary, thus leading to significantly better results.     

Cerebrovascular accidents differ between patients with atrial flutter and patients with atrial fibrillation

IntroductionFew studies have explored the potential impact of atrial flutter (AFl) on ischaemic stroke (IS) outcome. The aim of the present study was to compare the clinical course of IS in patients with AFl and patients with atrial fibrillation (AF).Material and methodsA retrospective analysis of patients consecutively admitted to a tertiary care centre between 2013 and 2015 due to IS or transient ischaemic attack with permanent AFl or permanent or persistent AF was performed.ResultsThe study groups consisted of 528 patients, including 490 (92.8%) patients with AF and 38 (7.2%) patients with AFl. The mean age and prestroke CHA2DS2-VASc scores were similar between the patients with AFl and those with AF. Most IS cases in the AF group were classified as cardioembolic strokes (74.9% vs. 39.5% in AFl, p < 0.01), and lacunar strokes were the most common in the AFl group (47.4% vs. 14.3% in AF, p < 0.01). The multivariable analysis revealed that the presence of AF (OR = 8.6, 95% CI: 1.2–57, p = 0.02), lacunar stroke (OR = 0.1, 95% CI: 0.03–0.31, p < 0.001), baseline Rankin scale score (OR = 16.6, 95% CI: 9.8–28), lack of prestroke therapeutic anticoagulation (OR = 6.1, 95% CI: 1.1–33), diabetes (OR = 2.9, 95% CI: 1.3–6.5, p < 0.01), chronic heart failure (OR = 14.2, 95% CI: 5.8–34, p < 0.001), and current smoking (OR = 0.92, 95% CI: 0.39–0.99, p < 0.01) were significantly associated with the stroke outcome.ConclusionsDisabling or fatal IS was observed less often in patients with AFl than in patients with AF. This finding can possibly be explained by the more frequent occurrence of lacunar strokes in the AFl group compared with that in the AF group.     

Pathomorphological changes after radiofrequency ablation in the liver

Radiofrequency ablation (RFA) has become a widespread treatment option for liver carcinoma. There is limited knowledge regarding the macroscopic and histomorphological changes of induced lesions. Twelve domestic pigs underwent RFA using a Starburst XL device with ablation diameter of 3 cm. One animal died within 24 h, two animals were killed after 2 weeks, and nine after 4 weeks. Their livers were used for macroscopic and histological investigation. Six human liver resection specimens after previous treatment with RFA were also investigated. In pig samples, acute RFA change showed a necrosis zone demarcated by resorption zone with granulocytes and hyperemia. In subchronic and chronic RFA change, the zone of thermofixation was followed by a fibrous capsule and a liver reaction zone. Small blood vessels in the lesions showed damage involving endothelial destruction and thrombosis. Larger vessels within the lesions were observed with intact vessel walls, surrounded by a rim of vital hepatocytes. In the human samples, tumor‐infiltrating lymphocytes were reduced (CD3+ cells: 8.4 ± 3.7/10 high‐power fields (HPF); CD4+ cells: 4.2 ± 1.9/10 HPF), whereas the number of histiocytes was found to be increased (CD68+ cells: 15.5 ± 9.02/10 HPF). The recognition of thermofixation and the process of resorption of the RFA lesion is important for the interpretation of biopsies and surgical resection specimens.