导管射频消融经验性电隔离心脏静脉治疗阵发性心房颤动的疗效评价

目的研究导管射频消融经验性电隔离肺或上腔静脉治疗阵发性心房颤动(房颤)的疗效. 方法选择连续收治的行射频消融经验性电隔离心脏静脉的房颤患者58例,所有患者在术中均不能确定诱发房颤的靶静脉.男性39例,女性19例,年龄22～75(54±11)岁.     

阵发性心房颤动肌袖电隔离后复发病例的分析及再消融的体会(摘要)

目的 :结合 4例先后两次肺静脉电隔离成功治疗的阵发性心房颤动 (房颤 )患者 ,探讨导管射频消融肌袖电隔离治疗阵发性房颤后复发的机制 ,并对再次肌袖电隔离治疗的结果进行分析与评价。资料与方法 :对 4例进行肌袖电隔离治疗后复发的阵发性房颤患者 ,在Lasso标测导管指引下进行再次肌袖电隔离治疗。结果 :4例患者共对 14根靶静脉 (12根肺静脉和 2根腔静脉 )进行了射频消融治疗 ,较第一次消融的靶肺静脉数 (9根 )明显增多 ,隔离了除右下肺静脉外所有的肺静脉 ,其中 5根靶静脉恢复袖房传导 ,予以再次电隔离。电隔离一根靶静脉平均需进行 2 .9± 1.3次消融。术后平均随访 7.5± 5 .0 7(1-12 )个月 ,3例无房颤复发 ,1例发作次数明显减少。结论 :袖房传导的恢复及多异位灶起源可能是房颤复发的原因 ,对于阵发性房颤导管射频消融后复发病例 ,再次射频消融治疗是安全、有效的 ,有望彻底根治房颤     

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.     

导管射频消融电隔离心脏大静脉治疗阵发性心房颤动93例

目的总结导管射频消融行心房-肺静脉和(或)上腔静脉电隔离(大静脉电隔离)治疗阵发性心房颤动(房颤)的疗效. 方法选择发作频繁,症状明显,药物治疗无效的阵发性房颤患者,年龄小于75岁,无瓣膜病等器质性心脏病依据.     

复杂先天性心脏病患者植入永存左上腔内导线起搏治疗成功一例

右旋心是一种少见的先天性心脏病(先心病),而右旋心合并单心房、永存左上腔静脉,经外科手术治疗存活患者则更为少见.本文报道了1例复杂先心病同时存在窦房结、房室结功能障碍而成功于上腔静脉内植入起搏电极导线的病例.     

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.     

阵发性心房颤动后心跳长间歇与窦房结恢复时间的关系及肺静脉隔离对其影响

目的 检测由于阵发性心房颤动反复发作导致心跳长间歇患者的窦房结恢复时间(SNRT),并分析肺静脉隔离对其影响. 方法 11例接受导管射频消融治疗的阵发性心房颤动患者,在4支肺静脉口外进行节段性肺静脉隔离,分析心跳长间歇与160次/min心房刺激测得的SNRT(SNRT160)及模拟心房颤动600次/min测得的SNRT(SNRT600)的关系及肺静脉隔离前后SNRT160及SNRT600的差异. 结果 11例患者均成功隔离所有肺静脉.12导联心电图或动态心电图提示与症状相关的心跳长间歇为(3464±918)ms.肺静脉隔离前测定的SNRT160为(1655±378)ms,SNRT600为(1682±419)ms;肺静脉隔离后测定的SNRT160为(1491±284)ms,SNRT600为(1518±218)ms.SNRT160及SNRT600肺静脉隔离前后比较差异无统计学意义.心跳长间歇与肺静脉隔离前后SNRT无相关性. 结论 阵发性心房颤动终止后发生的心跳长间歇与病态窦房结综合征所致的心跳长间歇的发生机制可能不尽相同.肺静脉隔离是治疗阵发性心房颤动诱发心跳长间歇安全有效的方法.     

心房肌的复极与阵发性心房颤动发生机制的实验研究

目的心房肌的复极对阵发性心房颤动(简称房颤)的诱发及维持起着重要的作用.本研究使用单相动作电位技术(MAP)对在体犬左、右房肌的复极时间及房颤的诱发进行研究,以探讨心房肌对阵发性房颤发生和维持的潜在机制.     

上腔静脉隔离对迷走神经功能及心房颤动易感性的影响

目的 通过分析迷走神经调节的心房电生理指标(心房有效不应期及心房颤动易感窗口)的变化,间接揭示上腔静脉(SVC)隔离对犬的心房迷走神经功能及心房颤动(房颤)易感性的影响.方法 9条成年杂种犬,全身麻醉下行颈交感-迷走神经干剥离术.经右颈内静脉穿刺放置冠状静脉窦导管,经股静脉穿刺放置右心室导管(行临时右心室起搏)、环状标测导管(Lasso导管)及消融导管.静脉应用美托洛尔阻断交感神经活性.分别于SVC隔离前后在基础状态及迷走神经刺激时测量右心耳(RAA)、冠状静脉窦近端(CSp)和冠状静脉窦远端(CSd)的不应期(ERP)、心房易感窗口(VW)及窦性周长(SCL).结果 (1)窦性周长的变化SVC隔离前迷走神经刺激明显缩短SCL[(65.78±28.49)次/min vs(142.67±15.42)次/min,P《0.001],SVC隔离后基础状态及迷走神经刺激下SCL差异无统计学意义[(134.89±19.19)次/min vs(114.33±31.41)次/min,P》0.05].(2)有效不应期的变化SVC隔离前,迷走神经刺激下测得的心房ERP较基础状态下明显缩短[右心耳(RAA)分别为(51.11±18.33)ms vs(101.11±27.59)ms;CSd分别为(56.67±22.36)ms VS(98.89±14.53)ms;CSp分别为(48.89±25.22)ms vs(101.11±12.69)ms,P《0.001].SVC隔离后,迷走神经刺激所致的心房ERP缩短的能力明显下降(RAA分别为(94.40±16.70)ms vs(94.44±16.67)ms;CSd分别为(89±15)ms vs(96.7±18.0)ms;CSp分别为(93.3±18.7)ms vs(98.9±20.3)ms,P》0.05].(3)心房易感窗口的变化 SVC隔离前后基础状态下测得的VW无变化.SVC隔离后迷走神经刺激时测得的VW较隔离前明显降低[RAA分别为(6.67±11.18)ms vs(21.11±20.88)ms,CSd分别为(8.89±14.52)ms vs(16.66±23.97)ms,CSp分别为(2.22±6.67)ms vs(22.22±18.55)ms,P《0.05].结论 SVC隔离能导致迷走神经介导的窦房结抑制、心房不应期缩短能力及房颤易感窗口增加能力明显下降.提示SVC隔离可导致心房局部去神经反应,抑制迷走神经介导的房颤发生.     

心房肌的复极与阵发性心房颤动发生机制的实验研究

目的　对在体犬左、右心房肌的复极时间进行研究 ,探讨阵发性心房颤动 (房颤 )发生与维持的潜在机制。方法　记录基础心律、非程序刺激及早搏刺激 (SR、S1 、S2 )时 1 4只犬左、右心房的单相动作电位 (MAP)和有效不应期 (ERP) ,测量每个动作电位的幅度和动作电位时程 [复极达90 %、80 %、5 0 %时的动作电位时程 (ms,APD90 、APD80 、APD50 ) ]。并在记录过程中同时观察房颤的诱发情况。结果　记录满意MAP信号 1 2例 ,共标测 2 6点 (右房 1 7点 ,左房 9点 ) ,MAP振幅平均(6 98± 1 76 )mV ,左心房APD90 和APD50 小于右心房 [(1 5 7 4± 4 3 5 0 )ms比 (1 70 9± 37 9)ms ,P <0 0 5 ;(88 4± 1 9 1 )ms比 (1 0 0 1± 2 1 2 )ms,P <0 0 5 )。其中左房刺激发作 38阵 ,明显多于右房 2 3阵 (P <0 0 5 )。由左房诱发房颤的早搏的偶联间期明显比在右房诱发的短 (P <0 0 5 )。起源于左房的房颤的早搏参数小于起源于右房的 (P <0 0 5 )。结论　左、右心房间具有MAP的异质性的复极特性 ,是诱发折返、发生和维持房颤的基质。