非阵发性房性心动过速射频消融一例

非阵发性房性心动过速较少见,近年来未见报道。临床上多呈无休止状态,药物治疗效果差,且在心电图上与持续性交界性折返性心动过速（ＰＪＲＴ）、快－慢型房室结折返性心动过速（ＡＶＮＲＴ）、加速性交界性自主心律等难于鉴别。本例经心内电生理检查,诊断明确,并行射...     

房室结慢径区域消融对迷走神经功能及心房颤动易感性的影响

Objective Atrioventricular node reentrant tachycardia (AVNRT) ablation may effect the vagal response,which is indicated by sinus tachycardia. On the other hand,atrial fibrillation (AF) ,which was found to be associated with vagal irmervation, often coexists with AVNRT. However,little is known about the im-pact of slow pathway ablation on local vagal innervation to atria. Methods In 11 dogs, bilateral cervical sympa-thovagal trunks were decentralized and metoprolol was given to block sympathetic effects. Linear lesion was per-formed from coronary sinus (CS) ostium to the middle area of Koch triangle. Atrial effective refractory period(ERP) ,vulnerability window (VW) of AF, and sinus rhythm cycle length (SCL) were measured at high fight atrium (HRA),low right atrium (LRA), distal (CSd) and proximal CS (CSp) at baseline with and without vagal stimulation before and after ablation. The histological study was also performed. Results (1) SCL during vagal stimulation remained unchanged before and after ablation(107±19)bpm vs (108±8) bpm (P > 0.05). (2) After ablation, ERP during vagal stimulation remained unchanged at HRA (55±34) ms vs (69 ±37) ms (P >0.05),and decreased slightly at CSd (42±32) ms vs (55±30) ms (P =0.08). However,at LRA and CSp,ERP was significantly decreased after ablation (19±21) ms vs (66±24) ms (P <0.001) ; and (7± 18) ms vs (46±24) ms (P < 0.001), respectively. (3) AF was difficult to be induced at baseline before and after ablation in all sites (VW close to 0). While during vagal stimulation, after ablation VW of AF significantly decreased at LRA (1±3) ms vs (49±36) ms (P < 0.005) and CSp (10±12) ms vs (45±34) ms (P < 0.05) ,decreased slightly at CSd after ablation (35±37) ms vs (57±28) ms (P =0.07) ,and remained un-changed at HRA (63±31) ms vs (63±25) ms (P > 0.05). (4) The altered architecture of individual gan-glia was histologically observed. Conclusions The decreased ERP shortening to vagal stimulation in CS and LRA induced by slow pathway ablation indicates that ablation in such area may result in the vagal dennervation in LRA and CS,thereby attenuating the susceptibility to vagal mediated AF. While unchanged SCL,ERP short-ening and VW to vagal stimulation in sinus node area and HRA indicate that slow pathway ablation did not change the vagal innervation to these sites.     

强化培训,稳步推动心房颤动的导管消融治疗

心房颤动(房颤)的导管消融治疗技术是近年来心血管病治疗领域最重要的进展之一[1-2].这一技术目前在国内的临床应用已越来越广泛,能够开展这一技术的医生和单位也越来越多.     

导管射频消融术致急性心包填塞原因分析及处理方法

我院从 1 992年末开展导管射频消融术以来 ,发生 3例急性心包填塞 ,现总结、分析如下。　　临床资料　例 1　女性 ,6 0岁。 1 978年行乳腺癌根治手术 ,进行过放射治疗。 1 988年确诊甲状腺功能低下 (口服甲状腺素片 40 mg/ d)。高血压病史 2 0年 ,冠心病、不稳定性心绞痛 3年 ,心功能 级。心动过速病史 3年 ,有阵发性室上性心动过速 (paroxysmal superventricular tachycardia,PSVT)和心房扑动 ,心率 1 6 0～ 1 70次 / min,发作频繁 ,药物可终止发作 ,不能预防发作 ,心动过速时有心源性休克 ,心绞痛发作 ,心脏扇形扫描示左室向心性肥厚及…     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

经左主动脉窦消融反复性单形室性心动过速一例

右心室流出道是反复性单形室性心动过速 (repetitivemonomorphic ventricular tachycardia,RMVT )的常见起源部位 ,其电生理特点及导管射频消融治疗已被大多数医师所熟知 ,但起源于左心室流出道的 RMVT报道较少 [1 - 3 ] 。本文报告 1例经左主动脉窦成功消融的 RMVT,并结合近几年文献对其电生理特点及射频消融的方法进行分析。　　资料和方法　患者女性 ,19岁。有阵发性心悸病史半年 ,心悸发生时伴有头晕、乏力、活动受限。临床检查 (包括超声心动图、X线三位胸片、核磁共振、冠状动脉造影 )无器质性心脏病的诊断依据。心电图及动态心…     

立体心电图分析阵发性房颤患者心房的电生理特性

目的应用立体心电图(three-dimensional electrocardiogram,3D-ECG)分析阵发性房颤患者心房传导时间、心房除极角度和振幅的变化。方法入选在住院的阵发性房颤患者13例,对照组患者15例。分别应用立体心电图仪记录窦律下的立体心电图,分析后比较两组患者心房传导时间,P波除极振幅及角度。同时记录患者入院时超声心动图中左心房内径数值进行比较。结果两组患者比较左心房内径无显著差异。阵发性房颤组与对照组心房传导时间分别为123.75±11.67msvs.111.39±13.52ms,两组比较有显著性差异(p<0.05)。而在心房除极角度、振幅上,两组无显著差异。与对照组比较,阵发性房颤组患者P环初始部的运行方向与泪点疏密程度无明显变化,但在P环中间至终末部分,P环运行方向及泪点疏密出现明显变化,并且可看到明显的曲折、弯曲。但在除极末20ms的振幅,房颤患者较对照组明显降低(0.05±0.013mvvs.0.036±0.014mv,p<0.05),除极末30ms、40ms处两组振幅无显著差异。结论阵发性房颤患者可以出现心房传导时间延长、心房除极末振幅的改变和立体三维P环运行方向及泪点疏密程...     

房室结慢径区域消融对迷走神经功能及心房颤动易感性的影响

Objective Atrioventricular node reentrant tachycardia (AVNRT) ablation may effect the vagal response,which is indicated by sinus tachycardia. On the other hand,atrial fibrillation (AF) ,which was found to be associated with vagal irmervation, often coexists with AVNRT. However,little is known about the im-pact of slow pathway ablation on local vagal innervation to atria. Methods In 11 dogs, bilateral cervical sympa-thovagal trunks were decentralized and metoprolol was given to block sympathetic effects. Linear lesion was per-formed from coronary sinus (CS) ostium to the middle area of Koch triangle. Atrial effective refractory period(ERP) ,vulnerability window (VW) of AF, and sinus rhythm cycle length (SCL) were measured at high fight atrium (HRA),low right atrium (LRA), distal (CSd) and proximal CS (CSp) at baseline with and without vagal stimulation before and after ablation. The histological study was also performed. Results (1) SCL during vagal stimulation remained unchanged before and after ablation(107±19)bpm vs (108±8) bpm (P > 0.05). (2) After ablation, ERP during vagal stimulation remained unchanged at HRA (55±34) ms vs (69 ±37) ms (P >0.05),and decreased slightly at CSd (42±32) ms vs (55±30) ms (P =0.08). However,at LRA and CSp,ERP was significantly decreased after ablation (19±21) ms vs (66±24) ms (P <0.001) ; and (7± 18) ms vs (46±24) ms (P < 0.001), respectively. (3) AF was difficult to be induced at baseline before and after ablation in all sites (VW close to 0). While during vagal stimulation, after ablation VW of AF significantly decreased at LRA (1±3) ms vs (49±36) ms (P < 0.005) and CSp (10±12) ms vs (45±34) ms (P < 0.05) ,decreased slightly at CSd after ablation (35±37) ms vs (57±28) ms (P =0.07) ,and remained un-changed at HRA (63±31) ms vs (63±25) ms (P > 0.05). (4) The altered architecture of individual gan-glia was histologically observed. Conclusions The decreased ERP shortening to vagal stimulation in CS and LRA induced by slow pathway ablation indicates that ablation in such area may result in the vagal dennervation in LRA and CS,thereby attenuating the susceptibility to vagal mediated AF. While unchanged SCL,ERP short-ening and VW to vagal stimulation in sinus node area and HRA indicate that slow pathway ablation did not change the vagal innervation to these sites.     

人体肺静脉组织学观察12例

目的　研究肺静脉的组织学特性 ,以探讨肺静脉触发性阵发性心房颤动的解剖学基础。方法　通过HE染色、Masson染色和α Smoothmuscleactin的免疫组化 ,对 12例非心脏原因死亡的尸检标本肺静脉进行组织学研究。结果　共分析肺静脉标本 4 7支 ,其中 4 5支肺静脉可见有左心房心肌的延伸 :心肌袖。上肺静脉的心肌袖明显比下肺静脉延伸的距离长 [左上肺静脉 (12 6± 3 6 )mm ,左下肺静脉 (5 7± 3 2 )mm ,P <0 0 5 ;右上肺静脉 (10 2± 4 7)mm ,右下肺静脉 (4 4± 3 0 )mm ,P <0 0 5 ],右下肺静脉口的直径明显小于其余的肺静脉 [分别为 (12 2± 1 8、15 2± 3 1、15 3±1 9、15 0± 1 2 )mm ,P <0 0 5 ]。肺静脉内心肌纤维集合成束 ,走行不规则、方向各异 ,心肌束在肺静脉同一周径上的分布不均一。结论　非心脏原因死亡的人体肺静脉存在心房肌的延伸即心肌袖 ,其心肌纤维分布不均匀 ,走行方向各异 ,可能是产生触发性阵发性心房颤动的解剖学基础。     

特发性左室流出道室性心律失常的心电图特点

探讨特发性左室流出道室性心律失常患者的心电图特点。对 7例特发性左室流出道室性早搏 (简称室早 )、室性心动过速 (简称室速 )患者进行心电图分析 ,并行心内电生理检查及射频消融治疗 ,同时对 10例预激综合征患者成功消融房室旁道后行主动脉瓣上及瓣下起搏 ,记录同步 12导联起搏心电图。对比分析两组病例体表心电图QRS波图形特点。结果 :7例左室流出道室早、室速患者经心内电生理检查证实 6例起源于冠状动脉窦内 ,1例起源于左室流出道主动脉瓣右瓣下方 ,所有患者经射频消融成功治疗室性心律失常。对照组 10例在主动脉瓣下起搏(其中 6例同时在主动脉瓣上起搏 )获得同步 12导联起搏心电图。两组病例体表心电图共同特点为 :QRS波额面电轴向下 ,Ⅱ、Ⅲ、aVF导联主波向上 ,QRS波在V2 或V3 前移行为Rs或R型。结论 :左室流出道为特发性室早、室速发生部位之一 ,体表心电图有其独特性 ,导管射频消融治疗安全有效。