P波形态改变和消融部位双电位与下腔静脉-三尖瓣环峡部完全性阻滞

目的 探讨下腔静脉一三尖瓣环峡部(简称峡部)完全性双向阻滞的心电图和电生理表现。方法对18倒心房扑动患者的峡部进行线性射频消融，峡部发生完全性阻滞后．起搏刺激冠状静脉窦口和右房下侧壁，观察分析I导联P波形态和消融部位双电位。结果18倒患者均消融成功并发生蛱部完全性双向阻滞，并且I导联P波呈负正双向；对12例患者标测消融部位，均记录有特征性双电位，其敏感性为100％。结论心电图I导联P波形态改变和消融部位特征性双电位是判定蛱部完全性阻滞的可靠标志。     

典型心房扑动消融术后峡部计时间期的变化预测双向阻滞的价值

典型的心房扑动(房扑)是右心房内的大折返所致已成共识，下腔静脉、三尖瓣环峡部是折返环的一部分。因此，射频消融下腔静脉、三尖瓣环峡部并产生峡部双向阻滞，是成功消融典型房扑和减少复发的可靠标志。目前，多采用心房激动顺序或消融部位的双电位技术确定峡部双向阻滞的存在。通过比较房扑成功消融前、后右心房峡部传导时间，从而提出峡部传导时间的延长程度对峡部完全性     

对比观察射频消融右房后位峡部和间隔峡部治疗 …

对比观察射频消融右房后位峡部和间隔峡部治疗心房扑动（简称房扑）两种方法的疗效。４１例房拟患者随机分为后位峡部组（１８例）和间隔峡部组（２３例），消融线径分别为三尖瓣环一下腔静脉和三尖瓣环一欧氏嵴。成功消融绺为房扑不能诱发和峡部呈完全性双向阻滞。结果：４０例消融成功（９７．６％），无并发症。后位峡部组３例和间隔峡部组２例在首选消融方法和后，秘国一种消融方法获得成功。两组患者的放电次数和手术时间均显著     

差异性起搏法对典型心房扑动消融后峡部完全传导阻滞的预测价值

目的探讨一种简单的方法用以鉴别峡部消融线是完全阻滞还是存在缓慢传导,以降低典型心房扑动(简称房扑)消融后的复发率。方法前瞻性研究30例典型房扑患者消融后峡部的传导,放置20极Halo电极,使最远端的两对电极靠近阻滞线,分别起搏这两对电极并在消融线上标测局部双电位或多电位,我们假设局部电位的初始成分和终末成分分别代表消融线两侧的激动,当起搏部位由离消融线较近的电极对转为较远电极对起搏时,刺激信号到局部电位初始电位成分的时间将会延迟,而刺激信号到局部电位终末成分的时间变化取决于阻滞线是否完整。终末电位提前或不变提示完全阻滞,终末电位延迟提示阻滞线上有传导缝隙。结果用传统判断峡部阻滞的方法做参照标准,选取位点进行差异性起搏共54次,峡部完全阻滞前18次,峡部完全阻滞后36次。当起搏部位转为较远电极对时,初始电位均延迟,平均18±9ms,峡部不全阻滞时,终末电位延迟13±7ms,峡部完全阻滞后,终末电位提前12±8ms。差异性起搏对预测峡部完全阻滞的灵敏度达100%,特异度达88.9%。结论差异性起搏可准确鉴别峡部形成完全阻滞还是存在缓慢传导。     

左侧房室旁道消融过程中伴发的二尖瓣峡部阻滞

目的评估房室旁道消融过程中二尖瓣峡部阻滞的发生率,并探讨其电生理特性。方法以2003年7月至2011年1月本中心接受射频消融治疗的左侧房室旁道患者为研究对象,分析旁道分布特点、手术方法、手术时间、成功率及术中峡部阻滞的影响因素,探讨不同类型峡部阻滞的电生理特性。结果在402例患者中共有8例出现峡部阻滞现象(2.0%)。峡部阻滞多数出现于左侧游离壁旁道消融过程(87.5%);多于房间隔穿刺法消融术中出现(87.5%);其手术时间更长[(213.6±36.5)min vs(76.4±23.5)min,P0.05],更可能是再次接受射频消融治疗患者(62.5%vs 1.5%,P0.05)。术中峡部阻滞时可出现冠状窦电极VA间期延长或心房激动顺序改变,但局部His束电极上VA间期及心动过速周长不变;旁道附近的VA间期不变。结论左侧旁道消融过程中可伴发二尖瓣峡部阻滞,并有其相应电生理特性。     

Swartz鞘支撑下射频消融治疗心房扑动经验初步探讨

目的　了解８ ＦＳＡＦＬ型Ｓｗ ａｒｔｚ长鞘在心房扑动消融中的作用。方法　左前斜４５度影像定位下，在三尖瓣环５～６ 点处划线消融三尖瓣环与下腔静脉开口之峡部。结果　１１ 例普通型心房扑动患者全部消融成功，随访４～１８个月，１ 例复发，再次消融获得成功。结论　在峡部消融中应用Ｓｗａｒｔｚ长鞘能使大头导管良好固定，并使峡部组织与大头接触密切，较易做到峡部线性消融，达到相当于完全性双向阻滞的满意消融效果，且缩短透视和操作时间     

欧氏瓣对老年人Ⅰ型心房扑动射频消融的影响

目的探讨欧氏瓣对Ⅰ型心房扑动(简称房扑)导管射频消融即刻效果的影响。方法28例老年Ⅰ型房扑患者(呈逆钟向折返18例,顺钟向折返10例)在透视解剖标志和Halo电极三尖瓣环标测电图指引下,在房扑发作或冠状窦口起搏时以温控方式消融位于三尖瓣口和下腔静脉口之间的后峡部,消融方向从三尖瓣叶右室侧到下腔静脉开口。预设温度70℃,每点消融30s,每次移动消融电极3～5mm。观察下列指标:①房扑终止和后峡部阻滞时消融电极在消融线上所处的位置;②房扑终止后峡部残存传导间隙在消融线上所处的位置;③房扑终止后继续消融致后峡部完全阻滞的最终消融部位。结果根据右前斜位30°透视影像测得后峡部平均弧长(即消融线)为38.6±9.7mm。28例全部达到后峡部完全阻滞的消融终点,无并发症。与欧氏瓣有关的房扑终止率为100%(17/17),与欧氏瓣有关的后峡部完全阻滞发生率为92.9%(26/28)。结论欧氏瓣是Ⅰ型房扑后峡部消融线终点的重要标志,线性消融时欧氏瓣心室侧易残存传导间隙,消融该部位的残存传导间隙是Ⅰ型房扑后峡部消融的重要环节。     

低右房电图极性改变评价典型心房扑动射频消融结果

目的　在典型心房扑动 (房扑 )射频消融中观察临近峡部的低位右房心内电图极性改变 ,来迅速判断是否形成峡部双向阻滞。方法　对 10例典型房扑患者 ,沿三尖瓣环放置Halo电极 ,Halo远端紧邻峡部消融线 ,房扑发作中消融在房扑终止后行冠状窦起搏 ,窦性心律下消融则同时行冠状窦电极起搏 ,观察紧邻消融线低右房侧的心房电极电图起始部分的主波方向 (H电位 )的极性表现 ,并与最终双向阻滞评价结果比较。结果　 8例在窦性心律下行冠状窦电极起搏时消融 ,2例在房扑发作中消融。 10例患者最终消融结果均为双向阻滞。 2例房扑发作时H电位极性均为负向 ,8例窦性心律下H电位极性均为正向 ,峡部缓慢传导时该极性仍为正向 ,形成双向阻滞后H电位极性变为负向。结论　典型心房扑动行峡部线性消融时 ,行冠状窦起搏观察到紧邻峡部消融线低右房侧H电位的极性改变可能是峡部消融成功的新指标。该指标简单、快速、可靠性高。     

对比观察射频消融右房后位峡部和间隔峡部治疗典型心房扑动的疗效

对比观察射频消融右房后位峡部和间隔峡部治疗心房扑动 (简称房扑 )两种方法的疗效。 41例房扑患者随机分为后位峡部组 ( 18例 )和间隔峡部组 ( 2 3例 ) ,消融线径分别为三尖瓣环—下腔静脉和三尖瓣环—欧氏嵴。成功消融终点为房扑不能诱发和峡部呈完全性双向阻滞。结果 :40例消融成功 ( 97.6 % ) ,无并发症。后位峡部组 3例和间隔峡部组 2例在首选消融方法失败后 ,改用另一种消融方法获得成功。两组患者的放电次数和手术时间均无显著性差异。平均随访 12 .4± 6 .8个月 ,在后位峡部消融成功者中 ,有 2例房扑复发。结论 :射频消融右房后位峡部和间隔峡部治疗房扑均安全有效 ,两种方法互补可以提高消融的成功率     

导管射频消融1型心房扑动的方法学评价

比较在心房扑动 (AFL)时、冠状静脉窦口 (CSO)或低外侧右房 (LRA)起搏下和窦性心律 (简称窦律 )下消融Ⅰ型AFL的优缺点。 48例阵发性AFL随机分为AFL消融组、起搏消融组和窦律消融组 ,对下腔静脉口和三尖瓣环之间的后峡部作线性消融 ,终点为后峡部双向传导阻滞。比较三组患者的电生理参数、急性成功率和远期效果。结果 :三组均达到后峡部双向阻滞 ,随访 2 1.8± 5 .6个月无AFL复发。AFL消融组在AFL终止后均不能达到后峡部双向阻滞 ,需继续在起搏下消融。起搏消融组的操作和曝光时间、放电能量和次数小于其他两组 (P <0 .0 5 )。三组在后峡部双向阻滞后记录局部心房双电位的阳性率为 37.5 %。结论 :①对Ⅰ型AFL采用窦律消融法、起搏消融法和AFL消融法都能取得满意的近远期疗效。②后峡部双向传导阻滞是保证近远期疗效的重要消融终点。③在消融部位标测到双电位可作为消融有效的指标 ,但不能代替后峡部双向阻滞作为消融终点。④起搏消融法的操作和曝光时间、放电能量和次数明显少于在AFL和窦律下消融 ,可作为常规方法使用     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

Inhibition of intimal thickening of the carotid artery of rabbits and of outgrowth of explants of aorta by probucol.

The effect of administration of probucol in preventing intimal thickening of rabbit carotid artery after balloon catheter injury and the mechanism of action of the drug were studied. Groups of 6 male New Zealand-White rabbits were given normal diet (Group I), high cholesterol diet (Group II) or high cholesterol diet plus probucol (Group III) for 4 weeks. Balloon catheter injury was made in week 2 and animals were killed in week 4. No significant differences in the total cholesterol levels in Groups II and III were found in week 4. The medians of areas of the intimal layer in cross-sections of the carotid arteries of Groups I, II and III were 0.237, 0.475 and 0.309 mm2, respectively. Thus high-cholesterol diet increased the thickness of the intimal layer and probucol reduced its effect. There were no significant differences in the areas of the medial layers in these 3 groups. For the examination of the mechanism of the effect of probucol, rabbits were given chow containing 0.5% cholesterol with and without 0.5% probucol (7 rabbits each) and then the numbers of explants from their aortas showing outgrowth were compared. The plasma total cholesterol levels of these two groups were the same. The probucol concentrations in the plasma and aorta of the former group were 18.6 +/- 13.2 micrograms/ml and 7.3 +/- 5.4 micrograms/g wet tissue, respectively. The number of explants showing outgrowth on day 14 was suppressed by 34% in the probucol-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)