桂蒌定心汤对快速性心房颤动心室率及房颤转复率的影响

目的:探讨桂蒌定心汤对快速性心房颤动患者心室率及房颤转复率的影响.方法:选择2018年6月～2020年6月收治的快速性心房颤动患者50例,采用随机数字表法分为对照组和观察组,各25例.对照组予以西医治疗,观察组在对照组基础上加用桂蒌定心汤治疗.比较两组中医证候积分、心室率、房颤转复率及用药安全性.结果:观察组治疗后中医...     

药物控制慢性心房颤动心室率121例患者临床观察

目的 研究三类不同药物在治疗慢性心房颤动时，降低心室率控制的有效性及其对心电图的影响。方法 121例患者随机分为三组，分别给予倍他乐克、异博定、地高辛，用药前和用药7d后分别做心电图、动态心电图检查，分析其变化，包括心室率控制的有效性，长R-R间距以及R波间相对均齐性。其所得数据用SPSS 10．0进行统计学处理。结果 心室率控制的有效性倍他乐克和异博定明显优于地高辛，P〈0．05；倍他乐克和异博定两组之间无差异（P〉0．05）。出现长R-R间歇其结果与上相同。R波间相对均齐性，倍他乐克优于异博定和地高辛，P〈0．05，异博定和地高辛两组之间无差异（P〉0．05）。结论 药物控制慢性心房颤动的心室率，β-受体阻滞剂（倍他乐克）为首选的药物。     

心房颤动导管消融治疗进展

导管消融转复并维持窦性心律可以改善心房颤动（简称房颤）患者的心功能和提高生活质量，本文主要介绍房颤发病与维持的机制，导管消融适应证、术式及其联合使用、术后复发、并发症、标测与影像学技术、消融能源以及发展趋势。     

导管消融治疗心房颤动的进展与评价

1 引 言 心房颤动是最常见的一种快速性心律失常,然而迄今仍无一种理想的治疗方法。经导管射频消融治愈心房颤动是1994年以后才发展起来的一种新的治疗手段,包括线性消融和局灶性消融两种方案。本文就近年来这一治疗的若干进展作一简要介绍,并对其结果进行评价。2 线性消融线性消融是Swarit于1994年首先报道的一种方法,目前主要包括右心房消融、左心房消融和双心房消融三种形式。对于阵发性心房颤动,右心房线性消融的即时成功率仅约40％,而远期成功率更降至10％左右。若术后再辅以药物治疗,维持窦性心律的比例可达到33％至56％。左…     

肺静脉口导管消融治疗心房颤动的研究进展

心房颤动是临床上常见的心律失常之一,发病率为0.15～1.0％,常导致较高的致残率和致死率。导管消融的目的在于对心律失常的起源部位造成一局限的、不可逆的组织损伤。临床上心房颤动的射频消融已成为心律失常导管消融的主要的治疗手段,但传统的肺静脉点状消融难以精确定点靶点,易导致肺静脉狭窄,而且传统的消融导管完成环状消融肺静脉开口部常有一定的困难,特别是在进行多静脉消融时更是如此。而超声可望克服点状消融的不足之处。国外He等研究证实,置于心导管顶端的超声换能器能造成适合于心内消融的损伤灶,特别是对消融起源部位较深的心律失常,而且单次消融成功率较高。     

比索洛尔与地高辛合用对心房颤动患者心室率的影响

目的：探讨比索洛尔与地高辛合用对慢性心房颤动心室率的影响。方法：将56例各种器质性心脏病并发慢性心房颤动患者单用地高辛及加用比索洛尔治疗前后心室率的变化进行比较。结果：患者静息和运动时心室率明显减低（P＜0．001），而一日间最慢心率无明显改变（P＞0．05）。结论：地高辛与比索洛尔合用治疗心房颤动，可有效控制静息及活动后心室率，且无明显副作用。     

快速型心房颤动患者的急诊控制心室率治疗

目的探讨急诊控制快速型心房颤动心室率之安全有效药物。方法将57例心房颤动、心室率〉120次／min的患者分为：A、美托洛尔,B、维拉帕米,C、普罗帕酮,D、毛花苷丙,E、胺碘酮5组。多参数生命体征监护下静脉注射给药;设定心室率100次／min以下为目标,观察达标时间。结果A组（4．0±1．62）min,B组（7．17±2．64）min,C组（9．90±3．59）min,D组（57．67±34．97）min,E组（107．40±49．98）min达到预定心室率范围。结论心房颤动就迅速控制心室率而言,美托洛尔、维拉帕米、普罗帕酮3者的速度依次减慢,但3者差别没有统计学意义;而毛花苷丙和胺碘酮速度显著慢于前3种,差别有统计学意义。     

心房颤动患者心室率变化特点临床分析

目的分析心房颤动（房颤）患者心室率在24 h中的变化特点,以指导临床治疗。方法入选30例持续性房颤患者,用动态心电图记录24 h心电图,在不同的时间段内采样,找出最大心率和最小心率的分布特点。结果持续性房颤患者最大心率及最小心率在白天及夜间分布有明显差异。结论持续性房颤患者心室率呈昼快夜慢的节律变化。     

经导管射频消融治疗心房颤动的护理

[目的]探讨经导管消融治疗心房颤动的护理方法。[方法]归纳总结62例心房颤动行射频消融术病人的观察及护理。术前做好准备工作及心理护理,术后密切观察病情及并发症的护理。[结果]62例病人除10例复发,其余在随访期间维持窦性心律。[结论]在导管消融治疗心房颤动过程中,规范化的护理是取得疗效的重要保障。     

导管消融治疗心房颤动合并器质性心脏病的护理

总结导管消融治疗115例心房颤动合并器质性心脏病的护理.护理重点为治疗前做好心理护理,维持患者血流动力学稳定,选择合适的导管消融时机,治疗时及治疗后加强监护,预防急性左心功能不全、血栓栓塞、左房食管瘘等严重并发症.平均随访6月,96%患者成功维持窦性心律,生活质量和运动耐量明显改善.     

Different clinical courses and predictors of atrial fibrillation occurrence after transisthmic ablation in patients with preablation lone atrial flutter, coexistent atrial fibrillation, and drug induced atrial flutter

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.     

心房颤动导管消融的地位和进展

心房颤动(房颤)是临床常见的心律失常之一,最大风险是血栓栓塞,常见是脑卒中。随着人口的老龄化,房颤人数持续增加,治疗问题也逐渐成为人们关注重点。房颤导管消融是其重要治疗方法之一,可明显改善房颤患者预后。且随着技术发展,消融方法也日趋成熟,故导管消融术治疗房颤地位正在逐步提升。但消融方法尚无固定术式,发生机制尚未完全明确,尤其对于持续房颤。因此房颤消融术仍存在一些问题有待进一步探索。     

Percutaneous catheter ablation of atrial fibrillation

Atrial fibrillation is the most common arrhythmia and is associated with important morbidity and mortality. Antiarrhythmic therapy is recommended as initial therapy but is associated with modest efficacy and significant side effects. Over the past several years, catheter ablation has been demonstrated to provide effective and safe curative therapy for atrial fibrillation. Future investigations will assess advances in catheter ablation technology and will help to define the precise role of catheter ablation relative to alternative therapies, such as rate-control and antiarrhythmic therapy.     

Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation

The use of blanking periods, the immediate period postablation during which transient tachyarrhythmia episodes are not considered recurrences, has been predicated on the assumption that not all early recurrences of atrial tachyarrhythmias (ERAT) will lead to later recurrences and, as such, does not necessarily represent treatment failure. While ERAT can be expected to occur in approximately 38% of patients within the first 3 months of atrial fibrillation (AF) ablation, only half of these patients will manifest later recurrences. Clinical features related to the patient's history of AF, the index ablation procedure, and particularities of the ERAT can help identify patients at higher risk of later recurrence in whom aggressive attempts to control rhythm, including early cardioversion and reintervention, may be justified.     

Antiarrhythmic therapy following ablation of atrial fibrillation

Antiarrhythmic drugs (AADs) are often used after ablation for atrial fibrillation (AF); the drugs employed vary, but most common are the drugs that were unsuccessful prior to ablation since it seems that the efficacy of AADs might substantially increase after catheter ablation of AF. AADs reduce early recurrences of atrial tachyarrhythmias after AF catheter ablation, whereas they did not prevent arrhythmia recurrences occurring later. Several upstream therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids and colchicine) have been tested with conflicting results. To date, there is no sufficient evidence to support the use of any upstream therapy after AF catheter ablation. Larger registries and controlled clinical trials in well-defined patient groups and with well-defined outcome parameters are required to further elucidate the role of AADs after AF ablation.     

Catheter ablation as first-line therapy for patients with symptomatic atrial fibrillation

Atrial fibrillation (AF) is a common clinical problem that is associated with an impaired quality of life, thromboembolism, heart failure and death. Medical treatment of AF remains suboptimal and is associated with potentially serious side effects. The disappointing outcomes with medical therapy have spurred the age of catheter ablation of AF. In the last 10 years, catheter ablation of AF has evolved dramatically and has been shown to be superior to medical therapy in multiple studies. As a result, catheter ablation may be offered to the symptomatic patient as first-line therapy in lieu of antiarrhythmic medications, which have limited efficacy and are associated with significant toxicity.