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1.
目的:通过临床和射频导管消融治疗预激综合征合并心房颤动患者的急诊处理和导管消融预激旁道的研究,评价临床抗心律失常药物治疗、同步直流电复律、射频导管消融治疗预激综合症合并心房颤动患者的有效性与安全性。方法:28例经过心电图、动态心电图确诊的预激综合征合并心房颤动患者,经过临床抗心律失常药物、同步直流电复律等急诊复律治疗,随后接受射频导管消融治疗,消融预激旁道,达到根治或减少心房颤动,减少心律失常和猝死的风险。结果:28例患者接受药物及同步直流电复律,药物复律成功患者18例,同步直流电复律成功患者10例,无猝死事件发生;所有患者接受射频导管消融治疗,一次消融成功者24例,二次消融成功者3例,1例消融失败患者,拒绝再次手术,临床随访。结论:应用同步直流电复律,胺碘酮、普罗帕酮药物复律是治疗预激综合征合并房颤治疗的临床急诊处理的有效方法,导管射频消融预激旁道可以使患者长期获益。  相似文献   

2.
报告5例预激综合征(WPW)并心房纤颤(af)的射频治疗结果。5例中男4例,女1例,年龄40~65岁。4例无器质性心脏病,1例伴有室间隔肥厚型非梗阻性心肌病。4例术前诊断为WPW并发af,其中2例为显性左侧旁路,1例为显性右侧旁路,1例为隐匿性旁路,1例疑为房室结双经路。经心脏电生理检查及标测,5例均为左侧旁路,经射频导管消融(RFCA)治疗均获成功。  相似文献   

3.
报告5例预激综合征(WPW)并心房纤颤(af)的射频治疗结果。5例中男4例,女1例,年龄40 ̄65岁。4例无器质性心脏病,1例伴有室间隔肥厚型非梗阻性心肌病。4例术前诊断为WPW并发af,其中2例为显性左侧旁路,1例为显性右侧旁路,1例为隐匿性旁路,1例疑为房室结双经路。经心脏电生理检查及标测,5例均为左侧旁路,经射频导管消融(RFCA)治疗均获成功。  相似文献   

4.
单导管射频消融治疗频发房颤的预激综合征   总被引:2,自引:1,他引:1  
采用单导管射频消支治疗12例预激综合征(WPW)。12例中8例有反复快速性房颤史,3例须用同步直流以电复律,1例伴有晕厥。旁路分别为左侧8条,右后间隔2条,右后侧及右前间隔各1条,右侧者有1工存1条左侧隐匿旁路。全部旁践一次消融成功。术中未诱发房颤。随访5~17月未见复发。  相似文献   

5.
射频消融术(RFCA)已成为房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT)安全而有效的根治方法。房室结双径路的射频消融,从过去的快径路改良到目前提倡的慢径路改良,以达到安全有效的目的。作者报告25例AVNRT的RFCA结果,并对其消融方法及消融终点进行讨论。1 资料和方法1.1 一般资料 本组25例患者中男8例,女17例。年龄15~60岁,平均年龄(35±20)岁。发作时心电图呈窄QRS心动过速,频率150~220次·min1。常规检查未发现器质性心脏病。1.2 方法 经…  相似文献   

6.
目的观察慢性心房颤动射频消融术后口服氯沙坦联合胺碘酮治疗对心房颤动复发及心房结构的影响。方法拟行射频消融治疗的慢性心房颤动患者100例,随机分为射频消融组50例和射频消融+药物组(氯沙坦联合胺碘酮)50例。术后行动态心电图检查确定心律失常发作情况,超声心动图复查心脏结构和功能。结果电学隔离后15例患者转为窦性心律(射频消融组8例,射频消融+药物组7例),每组各有4例患者转为三尖瓣峡部相关心房扑动,消融三尖瓣峡部后转为窦性心律。其他患者通过进一步消融及电复律转为窦性心律。与射频消融组比较,射频消融加药物组术后1 a左心房前后径减小,而心功能无明显变化。随访过程中射频消融组心房颤动复发率为60.0%,射频消融加药物组心房颤动复发率为32.0%,2组比较差异有统计学意义(P<0.05)。结论慢性心房颤动射频消融术后口服氯沙坦联合胺碘酮可有效维持窦性心律,使左心房前后径减小。  相似文献   

7.
目的:对35例房室折返性心动过速射频消融术(RFCA)结果进行分析,总结经验,提高手术成功率,减少并发症,方法:对35例预激综合征进行导管射频消融方法进行分析和探讨。结果:房室旁路折返性心运过速35例,共36条旁路被消融,成功率97.2%,其中左侧旁路32条,31条(96.9%)被阻断,右侧4条,全部被阻断,无并发症发生,全部病例随访1~12个月,停用一切抗心律失常药物,无心动过速发作,结论:RF  相似文献   

8.
1 临床资料1.1 一般资料 5例患者,男4例,女1例,年龄30~57岁,心动过速病史5~15年。均无器质性心脏病。1.2 心电图 2例室上性心动过速(简称室上速)患者常规心电图呈典型A型预激综合征,室上速发作时QRS波<0.12s,室率分别为180/min、200/min;2例室上速患者常规心电图正常,室上速发作时QRS波<0.12s,室率分别为160/min、170/min;1例患者常规心电图正常,发作时室率150/min,QRS波0.14s,呈RBBB图形,食管心电图发现室房分离,提示为室…  相似文献   

9.
目的:探讨静脉应用胺碘酮对胸腔镜下持续性心房颤动(房颤)射频消融术后复律作用的影响。方法:选择2018年1月—2020年3月在南京医科大学第一附属医院行胸腔镜下持续性房颤射频消融术患者180例。随机分为胺碘酮组(n=90)和对照组(n=90),两组均采用负荷量加维持量给药方案,胺碘酮组在麻醉诱导后静脉应用胺碘酮负荷量150 mg,随后以1 mg/min泵速维持至手术结束;对照组则泵入等量生理盐水。结果:胺碘酮组消融完成后、电复律后、手术结束时房颤转复率均高于对照组(P < 0.05)。胺碘酮组术中心率和平均动脉压明显低于对照组(P < 0.05),术中心率和平均动脉压趋于稳定(P < 0.05),术中正性肌力药和缩血管药用量高于对照组(P < 0.05)。结论:胸腔镜下持续性房颤射频消融术中静脉应用胺碘酮,可提高消融完成后整体房颤转复率和术中电复律成功率,且更利于术中血流动力学的管理。  相似文献   

10.
应用心律平静脉注射治疗22例预激综合征(WPW)伴宽QRS型(QRS波群≥0.12)房性快速型心律失常。13例WPW伴房室折返性心动过速(AVRT)患者,1例房性心动过速患者及6例WPW伴心房颤动患者经静脉注射心律平后均恢复为窦性心律。2例WPW伴心房扑动患者静脉注射心律平后未能转复,后改用同步电复律才转复为窦性心律。  相似文献   

11.
Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54.00±10.44 years, and duration of AF was 23.66±14.93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced. Results The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given. The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%. Conclusions Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.  相似文献   

12.
目的研究食道超声心动图(TEE)在左侧和右侧房室旁路射频消融术中(RFCA)监测的意义。方法对31例房室旁路患者进行RFCA术的TEE检查。结果RFCA术全部成功。TEE食道留置时间为35±11min。TEE导引了全部患者的消融电极的放置和位置调整,诊断器质性病变3例,导引穿房间隔术和穿隔后的电极放置3例,发现2例消融过程中出现中度二尖瓣返流,及时调整消融电极位置后消失。结论在RFCA术中行TEE监测有助于电极的定位和防止电极脱位,及时发现并发症,以及导引冠状窦电极放置和穿房间隔消融。  相似文献   

13.
Background Radiofrequency catheter ablation (RFCA) has been established as an effective and curative therapy for ventricular tachycardia (VT) and severely symptomatic premature ventricular contraction (PVC) from the outflow tract in structurally normal hearts. This study aimed to investigate electrophysiologic characteristics and effects of RFCA for patients with idiopathic VT and symptomatic PVC originating from the valve annulus. Methods Characteristics of body surface electrocardiogram (ECG) and endocardiogram in a successful RFCA target were analyzed in 16 patients with idiopathic VT and symptomatic PVC originating from the valve annulus. Additionally, the ECG characteristics of VT or PVC were compared with those of manifest Wolff-Parkinson-White (WPW) syndrome originating from the same site of origin in 15 patients. Results Thirteen patients were successful, 2 recurrent and 1 failed. The recurrent cases underwent successful ablation the second time guided by the Ensite 3000 mapping system. In all patients with the WPW syndrome, the characteristics of QRS morphology were well matched with those of the VT and PVC that originated from corresponding sites of origin. Conclusions RFCA is an effective curative therapy for VT and There are specific characteristics in ECG and the ablation site accessory pathway's algorithm. symptomatic PVC originating from the valve annulus. could be located by means of the WPW syndrome  相似文献   

14.
目的 :总结射频消融右侧旁道治疗房室折返性心动过速的效果和经验。方法 :导管射频消融右侧旁道 42例 ,根据心内电生理检查 ,确定右侧房室折返性心动过速 ,采取左前斜位 30°透视下 ,细标消融导管沿三尖瓣环寻找靶点 ,即最短AV和VA间期且A/V比例≤ 1/ 4或AV或VA波融合处即可消融。结果 :除 1例右侧游离壁显性旁道未阻断、逆传阻断外 ,其余 41例旁道均被消融阻断 ,成功率 97 6 %。随访期 2 2± 3 6 ( 1~ 6 4)个月 ,未发现术后并发症。复发 7例 ,4例再次消融成功 ,复发率 2 2 8%。结论 :RFCA治疗右侧房室折返性心动过速安全、有效。  相似文献   

15.
目的探讨Carto merge技术指导永久性心房颤动射频消融的作用和优势。方法用Carto merge技术指导射频消融治疗永久性心房颤动15例。术中用Carto导管标测和构建左心房和肺静脉的电解剖图,然后与术前心脏核磁共振造影的三维图像进行数据整合形成二者的复合图形(Carto merge)。首先在Carto merge的指导下行双侧上下肺静脉环线消融,直到Lasso标测证实所有肺静脉均达到电隔离效果,如心房颤动不终止,依次进一步消融左房顶部线、二尖瓣峡部线及三尖瓣峡部线,如上述部位消融后心房颤动仍未终止,即行同步直流电复律恢复窦性心律。结果15例患者中2例在消融过程中心房颤动自行终止,13例均经直流电复律。3例患者分别于术后24h、1和5周时复发持续性心房颤动。其余患者经1~10个月随访,均维持窦性心律。近期手术成功率为80%。结论Carto merge技术可有效地指导永久性房颤的射频消融,结合单Lasso标测,可简化操作,提高消融手术的成功率。  相似文献   

16.
目的 探讨无逆传旁路的预激综合征患者的临床及电生理特征.方法 159例预激综合征患者均行心内电生理检查,结果提示为旁路逆向传导阻滞共13例(无逆传旁路组),旁路前传和逆传功能共146例(双向传导旁路组),均行导管射频消融术治疗.比较两组临床、电生理特征以及导管射频消融术的治疗效果.结果 与双向传导旁路组比较,无逆传旁路组患者年龄更大,存在房颤、晕厥病史者比例更高(P<0.05),而两组心房有效不应期、旁路前传有效不应期、房室节前传及逆传有效不应期等心内电生理参数比较,差异无统计学意义(均P>0.05).无逆传旁路组患者射频消融手术时间、射频消融术放电滴定时间、射线曝光时间均长于双向传导旁路组,术后并发症发生率、复发率高于双向传导旁路组(P<0.05).结论 与双向传导的预激综合征患者比较,无逆传旁路患者自发性房颤及晕厥为常见,且射频消融术后并发症发生率、复发率高.  相似文献   

17.
Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has developed rapidly,and is a commonly performed ablation in many major hospitals throughout the world,due to its satisfactory results.The aim of this study was to detect the effect of RFCA on C-reactive protein (CRP),brain natriuretic peptide (BNP),and echocardiograph in patients with persistent and permanent AF.Methods A total of 120 patients (71 males,mean age (50.8&#177;12.0) years) with persistent and permanent AF undergoing RFCA under guidance of the Carto merge technique were studied.Left atrial diameter (LAD),right atrial diameter (RAD),left ventricular ejection fraction (LVEF),CRP,and BNP were observed 3,6 and 12 months after RFCA and compared with results before RFCA.The recurrence of atrial arrhythmias was observed 3 and 12 months after the procedure.Results Compared with that before RFCA,LAD and RAD decreased and LVEF increased significantly after RFCA.Meanwhile,the levels of CRP and BNP were reduced significantly at 3,6,and 12 months after RFCA (P〈0.05).In the non-recurrent patients,LVEF was increased significantly compared with the recurrent patients at 3,6,and 12 months after RFCA (P〈0.05).CRP and BNP levels were decreased significantly in the non-recurrent patients compared with the recurrent patients at 3,6,and 12 months after RFCA (P〈0.05).After one or two applications of RFCA,during a follow-up of 12 months,12 patients (10.0%) had AF,10 patients (8.3%) had atrial flutter,and 5 patients had atrial tachycardia (4.2%).Conclusions Conversion of AF to sinus rhythm by RFCA,has been shown to reduce LA size and improve LVEF.It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure.  相似文献   

18.
目的:报道20例右侧房室折返性心动过速(AVRT)的射频消融疗效和体会。 方法:20例AVRT患者,其中显性右侧旁路15例,隐匿性右侧旁路5 例,均给予射频消融治疗。 结果:15 例右侧显性旁道13例消融成功,其中复发1例,再次消融成功;5 例隐匿性旁路全部消融成功,消融成功率为90% ,无并发症。 结论:射频消融是一种治疗右侧AVRT安全而有效的方法。  相似文献   

19.
目的:运用SPECT门控核素心肌灌注显像(ECG-gated myocardial perfusion SPECT imaging,GSPECT MPI)相位分析技术探讨Wolff-Parkinson-White syndrome(WPW)综合征患者左室机械收缩同步性.方法:入选WPW患者35例和正常对照13例,均行GSPECT MPI检查,其中WPW患者GSPECT MPI检查在导管射频消融(radiofrequency current catheter ablation,RFCA)术前进行,计算出LVEF,MPI数据通过相位分析生成定量指标相位直方图带宽(phase histogram bandwidth,PHB)来评估WPW患者左室机械收缩同步性.根据RFCA术中阻断旁道部位对WPW患者进行分类(间隔旁道组、左侧游离壁旁道组、右侧游离壁旁道组).结果:间隔旁道WPW患者组、左侧游离壁旁道WPW患者组、右侧游离壁旁道WPW患者组、正常对照组LVEF组间比较差异无统计学意义(P〉0.05);间隔旁道WPW患者组与正常对照组PHB比较差异有统计学意义(P〈0.05),间隔旁道WPW患者存在左室机械收缩不同步,左或右侧游离壁旁道WPW患者组与正常对照组PHB比较差异无统计学意义(P〉0.05),左或右侧游离壁旁道WPW患者左室机械收缩不同步不明显.结论:GSPECT MPI相位分析表明间隔部旁道WPW患者存在左室机械收缩不同步.  相似文献   

20.
目的;研究体表电位标测(dody surface potential mapping,BSPM)定位显性旁道(accessory pathway,AP)的准确性,进一步探索标测的方法学.方法:41例常规行射频消融术(radiofrequency catheter ablation,RFCA)的预激综合征(wolff-parkinson-white syndrome,WPW)病人,分别进行BSPM及同步12导联体表心电图(electrocardiography,ECG)检查.间歇性WPW和小δ波WPW食道调搏使δ波出现、增大时标测.采用BSPM程序法和马长生流程图法定位AP.其结果与成功消融靶点相对照.结果:BSPM与消融靶点完全符合率82.9%,ECG 64.4%,P<0.05.结论:(1)BSPM定位WPW显性AP的准确率高于ECG;(2)干预使间歇性WPW、小δ波WPW定位变成可能、更加准确.  相似文献   

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