经冠状静脉窦射频消融心外膜旁道

报道 13例左侧心外膜旁道的特点和经冠状静脉窦射频消融的结果。 13例左侧旁道患者先经心内膜标测和消融 ,如不成功改由经冠状静脉窦标测 ,记录到旁道电位或最早激动的V波或逆传A波即进行消融。结果 :13例患者全部成功 ,平均放电 1.5± 0 .6次 ,能量 2 1± 4W ,时间 2 1± 9s。成功消融靶点 :左侧游离壁 2例、左后间隔冠状静脉窦憩室 4例、心中静脉 7例。 11例有效靶点均标测到振幅较大的旁路电位 ,其振幅大于A波和V波 ,与二者之比均大于 1。结论 :冠状静脉窦标测到振幅较大的旁道电位是左侧心外膜旁道的重要标志 ;冠状静脉窦消融可以有效地阻断心外膜侧旁道     

四胺起搏的临床应用

患者男性,65岁,高血压病史4年,因间断性胸闷、心悸发作5年,加重并伴有乏力、食欲不振两周入院。患者5年前,因胸闷、心悸经检查发现血压高和左心室增大,诊断为“高血压病”、“冠心病”,给予硝酸甘油等药物治疗,但症状控制不满意。2个月前心悸症状加重,心电图发现心房颤动(房颤),阵发性发作,间隔1～2周不等,每次几十分钟到数小时,给予地高辛、硝酸异山梨酯、普罗帕酮等药物治疗,症状好转。近两周又感乏力和食欲不振加重,为进一步治疗住院。入院后心电图示窦性心律,阵发性房颤,P波增宽达160ms,PR间期220ms,完全性左束支阻滞(QRS时限170ms,…     

关于房室交界部位的重新解剖学定位和命名

“房室交界部位”是指房室瓣环以及周围的心脏组织结构 (包括间隔、间隔旁、Koch氏三角和房室传导系统 )。 70年代 ,外科手术是当时根治预激综合征的有效方法。在对房室旁路的标测和定位过程中 ,根据“后前”和“左右”轴向将房室瓣环和 Koch氏三角视为在同一个平面上 ,并对房室交界部位的解剖方位进行了详细的描述和命名。目前 ,电生理专业人员仍然袭用这一外科命名方法 ,尽管在与外科医师的交流上较为方便 ,但此命名方法是不准确的 ,不符合心脏在人体内的解剖关系。例如 :1认为主动脉瓣是位于冠状静脉窦口的前方 (实际应是位于冠状静脉窦…     

瓣膜病慢性心房颤动心房肌缝隙连接CX43和CX40的重构

目的　探讨人类瓣膜病慢性心房颤动 (房颤 )心房肌中缝隙连接通道蛋白Connexin 4 3(CX4 3)和Connexin 4 0 (CX4 0 )的重构及其与房颤的关系。方法　 (1)取 11例风湿性心脏瓣膜病 (风心病 )患者的右心耳心肌 (房颤 8例 ,窦性心律 3例 ) ,以Northernblot印迹法比较窦性心律和房颤者CX4 3和CX4 0mRNA表达量的变化 ;(2 )另取 2 0例风心病患者右心耳心肌 (窦性心律 8例 ,房颤 12例 ,房颤持续时间从 3个月至 15年 )制成冰冻切片 ,在激光共聚焦显微镜 (confocallaserscanningmi croscopy)下分别观察窦性心律和房颤心房肌CX4 3和CX4 0蛋白的荧光斑面积、空间分布及形态变化。结果　 (1)窦性心律和房颤CX4 3和CX4 0mRNA表达量差异无显著性 ;(2 )CX4 3和CX4 0荧光斑面积在窦性心律和房颤时差异也无显著性 ,但CX4 0在心肌纵切面上的数目明显多于横切面 (P <0 0 5 ) ,而CX4 3数目无变化。提示房颤时CX4 0通道在心肌空间上的分布发生了显著改变 ,即端 端连接大于侧 侧连接。结论　人类风心病慢性房颤时缝隙连接蛋白CX4 3和CX4 0的mRNA表达量和蛋白量均未发生显著改变 ,但CX4 0蛋白的空间分布发生了显著变化 ,端 端连接明显增多 ,侧 侧连接显著减少 ,提示房颤时CX4 0通道发生了空间排列上的重构 ,可能参与了房颤的     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

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.     

慢径消融或改良治疗房室交界区折返性心动过速远期疗效的评价

目的评价慢径消融或慢径改良对房室交界区折返性心动过速(atrioventricular junctionalreentrant tachycardia,AVJRT)远期复发的影响.方法231例AV.JRT患者进行常规慢径消融,比较慢径消融(慢径消失)或改良(慢径存在)者AVJRT的复发率和并发症以及各组消融前后的电生理参数变化.结果射频消融后142例慢径残存,53例慢径消失,房室结有效不应期延长,11房室和室房传导的最大频率减慢.36例消融前后均无AH间期跳跃现象.术后(25±4)个月的随访期内,慢径消融的89例中复发1例,4例发生二度Ⅰ型房室阻滞.慢径改良的142例复发2例,复发率无差别(P＞0.05).结论慢径消融或改良治疗AVJRT可以达到同样疗效.     

心脏电生理学新概念(3)心内多电极标测技术的进展

传统的心内电生理标测技术需要插入多根与心腔内膜相接触的导管电极并对心律失常逐点进行标测,这就意味着对于一些发生于心房或心室的、尤其是非持续性或血液动力学不稳定的心律失常,现有的心内标测技术存在着较大的局限性.除了操作时间和放射照射时间较长之外,其标测定位的准确性及可靠性均不能令人满意,其结果是导致对于这些心律失常射频导管消融治疗的失败率和复发率亦较高.另一方面,传统标测手段所获得的是二维心内电图,与心脏实际的电活动存在较大的差距,这也增大了对复杂心电活动进行准确理解的难度.     

实验犬经冠状动脉化学消蚀后电生理随访(论著摘要)

取健康杂种犬12条,分离冠状动脉前降支的对角支根部,用细针从根部注入96％乙醇1ml(10条犬)或生理盐水1ml(2条犬)。然后关胸,进行有关检查及监测。(1)每条犬分别于术后第1、2、3和第7天用动态心电图监测;(2)在注射前和注射后第7天进行电生理检查,以诱发室速;(3)用体表晚电位仪,于犬术前及术后第7天进行心室晚电位检查;(4)观察7d后,将犬处死,取心脏进行病理检查。 结果1条犬在注射1ml 96％乙醇时发生室颤,死亡;其余9条犬均出现室性心动过速及室性早搏。其中6条出现持续性室速,最长持续264s。室速的最快频率平均为230次/min。两条注射生理盐水的对