年龄≥60岁的房间隔缺损患者的介入封堵治疗

目的:探讨年龄≥60岁的房间隔缺损(atrial septal defect,ASD)患者介入封堵治疗的安全性和有效性?方法:分析51例拟行ASD介入封堵术的年龄≥60岁患者的临床资料特征及手术效果,并与其他年龄段的成人ASD进行比较?结果:年龄≥60岁的ASD患者(60ASD)占成人ASD的7.9%(51/647例)?60ASD的房颤发生率(27.45%)明显高于18~60岁的ASD患者(59ASD)(3.52%)?60ASD与59ASD患者相比:心脏结构的重构改变更加明显,包括心房和心室增大更多,心腔内压力和肺血管阻力明显增高?但相关性分析显示,ASD患者年龄与肺动脉压力?左房内径?右房内径?左室舒张末内径?右室舒张末内径和肺阻力仅有较弱相关性(r分别为:0.263?0.500?0.215?0.174?0.153?0.335)?60ASD与59ASD患者的手术成功率和主要并发症发生率无差别?不论任何年龄段的患者,术后右心重构均明显改善,表现在右房右室过度充盈减轻,内径缩小;但是60ASD患者心脏重构的改善程度小于59ASD?结果:介入封堵治疗年龄≥60岁的ASD患者安全有效,术后患者心脏重构改善?     

阵发性心房颤动导管消融术后房速一例

<正>心房颤动(atrial fibrillation,AF)是最常见的心律失常之一,发病率随年龄增加而升高,79岁以上可达10%~30%[1]。AF患者的病死率约为窦性心律的2倍,栓塞和中风的发生率则是相同人群的4~6倍[2]。治疗目标:节律控制、室率控制、抗栓治疗。节律控制方法:药物复律、电复律、导管消融、外科手术等。导管消融是近年来进展迅速的治疗手段。现对本院1例阵发性AF导管消融术后复发及     

房间隔缺损合并心房颤动同期行迷宫Ⅳ手术的近中期疗效分析

目的：研究房间隔缺损（atrial septal defect,ASD）修补术同期行迷宫手术（maze procedure）的近中期疗效。方法：回顾性分析2014年2月—2019年5月ASD合并心房颤动（atrial fibrillation,AF）且同期行ASD修补术和迷宫Ⅳ手术的28例患者资料,观察近中期随访AF射频消融的窦性心律转复率及手术并发症发生率。结果：28例患者均完成随访,中位随访2年,随访期间无死亡,手术后6、12及24个月的窦性心律转复率分别为85.7%、78.5%、78.5%,无患者因房室传导阻滞而装置起搏器,期间也无脑卒中发生。结论：ASD合并心房颤动在行外科ASD修补时应当同期行迷宫Ⅳ手术,不增加手术风险,近中期窦性心律转复率较为满意,远期结果需进一步观察随访。     

不同左房内径对外科射频消融治疗房颤效果的影响

目的探讨术前不同左房内径对外科射频消融治疗房颤效果的影响。方法选取因心脏瓣膜病合并房颤在郑州大学人民医院接受手术治疗的患者100例,所有患者行瓣膜手术同时行房颤射频消融术,根据左房内径大小不同将患者分为两组,A组66例左房内径<60 mm,B组34例左房内径≥60 mm。通过收集18导联心电图分别对比术后即刻、出院时、术后3个月、术后6个月、术后1 a的窦性心律恢复情况。结果两组患者术后即刻、出院时、术后3个月、术后6个月和术后1 a窦性心律恢复率差异均有统计学意义(P<0.05),术后半年及术后1 a A组的窦性心律恢复率分别为90.74%、90.32%,B组的窦性心律恢复率分别为63.64%、59.37%。结论左房内径大小≥60 mm是影响房颤射频消融术后恢复窦性心律的负性因素。     

危重冠心病OPCABG后房颤发生率及危险因素分析

目的 探索危重冠心病患者在非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)后心房颤动(atrial fibrillation,AF)的发生率并分析其相关因素.方法选择OPCABG后患者319例,其中非危重冠心病168例,危重冠心病128例,比较二者AF的发生率.危重冠心病患者OPCABG后发生AF37例,为病例组,未发生AF 91例,为对照组,采用病例对照研究策略,比较两组临床资料,引入Logistic多元回归方法筛选其AF发生的相关危险因素.结国 OPCABG后,危重冠心病患者AF的发生率为28.90%,明显高于非危重冠心病患者AF的发生率19.05%.其中危重冠心病OPCABG后患者,年龄≥70岁、左室射血分数≤40%、左房内径≥40 mm、AF病史和术前应用胺碘酮为其AF发生的相关因素.结论 危重冠心病患者单纯OPCABG后AF的发生率较非危重冠心病患者高;危重冠心病OPCABG后AF发生的危险因素有年龄≥70岁、左室射血分数≤40%、左房内径≥140 mm和AF病史;而术前使用胺碘酮为其保护因素.     

射频消融治疗持续性房颤合并心衰患者的预后评估

目的研究射频消融术治疗持续性房颤合并心力衰竭患者的预后。方法回顾性分析2017年2月至2018年2月期间入住郑州大学第一附属医院心内科的101例持续性房颤合并心力衰竭患者的临床资料,其中接受射频消融治疗的40例患者为射频消融组,接受药物治疗的61例患者为药物治疗组,对所有患者进行1 a的随访,收集心脏彩超、6 min步行试验(6MWT)、明尼苏达心衰量表评分、N端前脑钠肽(NT-pro BNP)、NYHA心功能分级等评价指标,记录窦性心律维持、心衰再住院、血栓栓塞等相关事件的发生情况。结果 1 a后射频消融组左室射血分数(LVEF)高于药物治疗组,左室收缩末期容积(LVESV)小于药物治疗组,左房内径(LAD)小于药物治疗组,6MWT大于药物治疗组,明尼苏达心衰量表评分低于药物治疗组,NT-pro BNP小于药物治疗组,差异有统计学意义(P<0.05)。射频消融组维持窦性心律人数多于药物治疗组,心衰再住院率低于药物治疗组,差异有统计学意义(P<0.05)。Kaplan-Meier分析显示,两组无心律失常事件生存率比较,差异有统计学意义(P<0.05)。结论射频消融术较药物治疗能有效地恢复和维持持续性房颤合并心衰患者的窦性心律,改善心功能,提高生活质量,降低心衰再住院率,改善患者的预后。     

房间隔缺损同期行迷宫IV手术近中期疗效分析

【摘要】目的 研究房间隔缺损（atrial septal defect ,ASD）修补术同期行迷宫手术（maze procedure）的中期疗效。 方法 回顾性分析自2014年2月至2019年5月,28名房间隔缺损合并心房颤动（atrial fibrillation,AF）患者的资料,在我院均同期行ASD修补术和迷宫IV手术,其中男6例,女22例,平均年龄（56.0±9.39）岁,观察近中期随访AF射频消融的窦性心律转复率及手术并发症发生率。 结果 所有28名患者均完成随访,中位随访2年,随访期间无死亡,手术后6月,1年及2年的窦性心律转复率分别为85.7%,78.5%,78.5%,无患者出现因房室传导阻滞而装置起搏器,期间也无脑卒中发生。 结论：房间隔缺损合并心房颤动在行外科房缺修补时应当同期行迷宫手术,不增加手术风险,近中期窦性心律转复率较为满意,远期结果需进一步观察随访。 关键词：房间隔缺损,心房颤动,迷宫IV手术     

心脏直视手术同期射频消融迷宫术治疗心房纤颤

 [目的]探讨外科直视射频消融治疗心房颤动的方法及疗效.[方法]回顾性分析25例接受心脏直视手术患者,同期用单极冲洗式射频消融行改良迷宫术治疗心房纤颤（atrial fibrillation,AF）.[结果]术毕转为窦性心律（sinus rhythm,SR）18例,结性心律5例,2例仍为AF,无Ⅲ°房室传导阻滞和死亡.随访3～25个月后,20例为SR（总有效率80%,其中有2例经电转复律）,2例为房扑,3例房颤,左房比术前明显缩小.射频消融时间短和心功能Ⅳ级,为术后3月AF复发的危险因素.[结论]单极冲洗式射频消融治疗心房纤颤是一种简易、安全、有效的方法.     

西宁地区瓣膜置换术中双极射频消融治疗风湿性心脏病合并心房颤动18例分析

目的:探讨对西宁地区风湿性心脏病合并心房颤动患者同期行瓣膜置换术及双极射频消融迷宫术的近期疗效及安全性。方法:选取2011年3月—2012年3月在青海省心脑血管病专科医院心外科住院的风湿性性心脏瓣膜病合并心房颤动患者36例,分为消融组和对照组(各18例),消融组同期行瓣膜置换术及双极射频消融迷宫术,对照组仅行瓣膜置换术。对两组患者的近期手术疗效及并发症进行分析。结果:消融组18例患者术后恢复窦性心律16例,房颤心律1例,结性心律1例;随访8个月,15例维持窦性心律,3例阵发性房颤心律。对照组12例术中心脏复跳后即为房颤心律,6例心脏复跳后为窦性心律,术后24h～3天内均转为房颤心律,应用胺碘酮不能恢复窦性心律。两组术后左房内径均较术前显著降低(P<0.01),消融组术后左房内径小于对照组(33.06±2.88)mm比(36.16±2.43)mm,P<0.05。结论:高原地区风湿性心脏瓣膜病合并慢性房颤患者同期行瓣膜置换术及双极射频消融治疗近期疗效确切,安全简便。     

左房消融与双心房消融治疗持续性和永久性房颤的前瞻性、随机对比研究

目的:本研究旨在比较左房消融和双心房消融对持续性和永久性房颤(AF)患者的有效性和安全性。背景:虽然左房导管消融对阵发性AF非常有效,但对持续性和永久性AF患者的疗效不佳。方法:80例症状明显、抗心律失常药物治疗无效的A F患者(年龄58.6±8.9岁,持续性A F43例,永久性A F37例     

导尿管引导双极消融钳技术在瓣膜置换同期房颤治疗中的应用

目的探讨心脏瓣膜置换术中应用双极射频消融治疗房颤更安全、简洁的操作技术。方法建立导尿管引导双极射频消融钳技术,观察在163例瓣膜置换同期消融治疗房颤患者中应用疗效,其中,男性55例,女性108例,年龄27～70岁,平均47.6岁,房颤病史均超过1年,最长15年,左心房最大内径45～80 mm,左心室内径43～74 mm,左心室射血分数40%～70%。本技术在常规体外循环下进行,体外循环转流后依次分离左、右肺静脉,先套过普通尿管,再以导尿管作为牵引,引导双极射频钳通过肺静脉后壁并完整包绕肺静脉,先进行左、右肺静脉消融隔离,再进行左侧上、下肺静脉,上、下肺静脉与左心耳之间的消融,缝闭左心耳,经左房或房间隔径路完成瓣膜置换手术,最后进行右心房消融。结果本技术在163例瓣膜置换术同期双极射频消融患者中应用,手术操作顺利,无组织撕裂,无术中意外出血,以及手术后再止血患者,死亡1例(0.6%),其余均顺利出院。结论该技术简化常规双极射频隔离肺静脉的手术操作技术,有效降低常规双极射频方法的手术风险,减少手术并发症,是一种有效的技术方法。     

慢性心房颤动射频消融术后应用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

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。     

Efficacy of catheter ablation of atrial fibrillation beyond HATCH score

Background  HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF). The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF.

Methods  The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins (PV) ablation were retrospectively analyzed. Of these patients, 250 (51.2%) patients had HATCH score=0, 185 (37.9%) patients had HATCH score=1, and 53 (10.9%) patients had HATCH score ≥2 (28 patients had HATCH score=2, 23 patients had HATCH score= 3, and 2 patients had HATCH score=4).

Results  The patients with HATCH score ≥2 had significantly larger left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction. After a mean follow-up of (823±532) days, the recurrence rates were 36.4%, 37.8% and 28.3% from the HATCH score=0, HATCH score=1 to HATCH score ≥2 categories (P=0.498). Univariate analysis revealed that left atrium size, body mass index, and failure of PV isolation were predictors of AF recurrence. After adjustment for body mass index, left atrial size and PV isolation, the HATCH score was not an independent predictor of recurrence (HR=0.92, 95% confidence interval=0.76–1.12, P=0.406) in multivariate analysis.

Conclusion  HATCH score has no value in prediction of AF recurrence after catheter ablation.

     

阵发性心房颤动两种射频消融术式的随机对照研究

目的:比较优化导管射频消融术(optimized radiofrequency catheter ablation,ORFCA)和环肺静脉隔离术(circumferential pulmonary vein isolation,CPVI)治疗阵发性心房纤颤(atrial fibrillation,AF)的有效性、安全性。方法:2009年3月至2010年3月于郑州市第七人民医院心内科行射频消融术(radiofrequency cather ab-lation,RFCA)治疗的阵发性AF患者随机分为CPVI组(n=40)和ORFCA术(n=44)。两组采取不同的消融术式,观察患者的左心房直径、房颤持续时间、左心室功能,成功率、并发症发生情况、消融点数、手术时间、曝光时间等数据,并比较两组之间的差别。结果:通过对CPVI组和ORFCA组基本情况的比较我们发现两组的性别组成、年龄、发作病史、左心房直径、左心室功能、应用抗心律失常药物种类方面无差别。CPVI组在消融点数、手术时间、曝光时间、成功率上均小于ORFCA组,差异有统计学意义(P<0.05)。两组在并发症发生率上无差别。结论:ORFCA术具有和CPVI术相似的安全性,和相对较高的有效性。     

Single dose of ibutilide for conversion of persistent atrial fibrillation after radiofrequency ablation

Background  Patients with persistent or permanent atrial fibrillation (AF) often need direct current cardioversion after radiofrequency ablation. The aim of this study was to investigate the effectiveness and safety of ibutilide for cardioversion of persistent or permanent atrial fibrillation after radiofrequency ablation and the factors related to conversion.

Methods  Patients with persistent or permanent atrial fibrillation were treated with combined ablation strategy including circumferential pulmonary vein isolation, linear ablation and CAFÉ potential ablation. If AF was not terminated after ablation, ibutilide was used for cardioversion (1 mg, intravenous injection in 10 minutes). These patients were divided into a conversion group and a non-conversion group according to whether AF was converted to sinus rhythm within 30 minutes after administration. ECG monitoring was performed during the injection of ibutilide. Atrial waves recorded by coronary sinus electrodes were measured for calculating average wavelength of AF waves in six seconds. The QT interval was measured immediately after conversion and 2 hours after injection of ibutilide.

Results  Forty patients whose AF was not converted to sinus rhythm after radiofrequency ablation were given an intravenous injection of ibutilide. Of the 40 patients, 29 cases were converted to sinus rhythm, with a conversion rate of 72.5%. The average conversion time was (13.2±5.5) minutes. Compared with the conversion group, patients in the non-conversion group had a longer history of AF (9.4±5.3) years vs. (4.3±2.8) years, P <0.05), and a markedly enlarged left atrium (47.3±2.9) mm vs. (42.1±4.5) mm, P <0.05). There were no significant differences in gender, age, body mass index and left ventricular function between the two groups. Ibutilide significantly prolonged the average wavelength of the AF wave (171.8±29.5) ms vs. (242.0±40.0) ms, P <0.001). Two hours after ibutilide treatment, the QT interval was significantly shortened (421.0±24.7) ms vs. (441.0±37.4) ms, P <0.05). No cases of serious arrhythmias or other adverse reactions were found.

Conclusions  A single dose of ibutilide for conversion of persistent or permanent AF after radiofrequency ablation is safe and effective.

     

环肺静脉电隔离消融和药物治疗阵发性心房颤动对患者左心房大小的影响

目的了解环肺静脉电隔离消融与抗心律失常药物治疗阵发性心房颤动的疗效和对患者左心房大小的影响。方法101例阵发性心房颤动患者分别采用环肺静脉电隔离消融与抗心律失常药物治疗,其中消融组56例,药物治疗组45例,应用超声心动图观察治疗前及治疗后12个月左房大小的变化。结果平均随访（14．6±2．3）个月,消融组维持窦性心律47例,成功率为83．9％;药物治疗组维持窦性心律22例,成功率为48．8％,消融组窦性心律的维持率明显高于药物治疗组,差异有统计学意义（P〈0．05）。治疗前左心房大小相似,药物治疗成功组患者左房内径虽较治疗前有所减小,但差异无统计学意义（P〉0．05）;消融成功组患者治疗后12个月左房内径较术前及药物治疗成功组均明显减小,差异有统计学意义（P〈0．05）。结论环肺静脉电隔离消融是治疗阵发性心房颤动的有效方法,与药物治疗相比,有较高的窦律维持率,能更有效逆转左房结构重构。     

Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation: a randomized, controlled short-term trial

Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation （PAF） or not. This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF. Methods From March 2008 to March 2012, 138 consecutive patients with PAF were randomly assigned to receive either video-assisted thorecoscopic surgery ablation （thoracoscopy group, n=66） or the traditional catheter ablation （catheter group, n=72）. Results No patient died during the study and all were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between the two groups. All patients were evaluated at 1 week, 1 month, 3 months, 6 months, and 12 months after discharge by physical examination and related laboratory tests. Preoperative left atrium dimensions （LADs） of the recurrent AF were （47±4） mm in the thoracoscopy group and （46±8） mm in the catheter group, whereas the LADs were （40±5） and （39±9） mm, respectively, in non-recurrent PAF. Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation. The larger left atrium diameter is related to the recurrence of atrial fibrillation. Chin Med J 2014;127 （14）： 2567-2570     

Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after

Background  Atrial tachycardia or flutter is common in patients after orthotopic heart transplantation. Radiofrequency catheter ablation to treat this arrhythmia has not been well defined in this setting. This study was conducted to assess the incidence of various symptomatic atrial arrhythmias and the efficacy and safety of radiofrequency catheter ablation in these patients.
Methods  Electrophysiological study and catheter ablation were performed in patients with symptomatic tachyarrhythmia. One Halo catheter with 20 poles was positioned around the tricuspid annulus of the donor right atrium, or positioned around the surgical anastomosis when it is necessary. Three quadripolar electrode catheters were inserted via the right or left femoral vein and positioned in the recipient atrium, the bundle of His position, the coronary sinus. Programmed atrial stimulation and burst pacing were performed to prove electrical conduction between the recipient and the donor atria and to induce atrial arrhythmias.
Results  Out of 55 consecutive heart transplantation patients, 6 males [(58±12) years] developed symptomatic tachycardias at a mean of (5±4) years after heart transplantation. Electrical propagation through the suture line between the recipient and the donor atrium was demonstrated during atrial flutter or during recipient atrium and donor atrium pacing in 2 patients. By mapping around the suture line, the earliest fragmented electrogram of donor atrium was assessed. This electrical connection was successfully ablated in the anterior lateral atrium in both patients.  There was no electrical propagation through the suture line in the other 4 patients. Two had typical atrial flutter in the donor atrium which was successfully ablated by completing a linear ablation between the tricuspid annulus and the inferior vena cava. Two patients had atrial tachycardia which was ablated in the anterior septal and lateral donor atrium. There were no procedure-related complications. Patients were free of recurrent atrial tachyarrhythmias after a follow-up of (8±7) months.
Conclusions  Four electrophysiological mechanisms have been found to contribute to the occurrence of symptomatic supraventricular arrhythmias following heart transplantation. Radiofrequency catheter ablation in patients with atrial flutter/tachycardia is feasible and safe after heart transplantation.

     

Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation

Atrial arrhythmias are common phenomena after orthotopic heart transplantation.1,2 Atrial tachycardia or flutter originating from the donor heart is well recognized.3,4 Although it has been assumed that the recipient atrial myocardium is electrically isolated from that of the donor atrium by the atrioatrial anastomosis, some reports have demonstrated that clinical arrhythmias can arise from the recipient atrium due to the recipient-donor electrical conduction.5-15 Radiofrequency catheter ablat…     

肾移植病史心房颤动患者导管消融的安全性及有效性分析

目的 本研究讨论有肾移植病史的心房颤动（以下简称房颤）患者行导管消融的安全性及有效性。方法 以7例因抗心律失常药物治疗效果不佳而进行射频消融的有肾移植病史的房颤患者为病例组,按照1：6配对原则（年龄、性别和房颤类型）选择对照42例。对比分析复发率、围术期合并症和造影剂肾病发生率。结果 两组患者中均无围术期合并症和造影剂肾病的发生。在随访12个月时,有肾移植病史的房颤患者复发率更高（时序检验,P=0.027）。结论 有肾移植病史的房颤患者可以安全地施行射频消融术,但这类患者进行消融术后更容易复发。