单纯碎裂电位指导心房颤动消融的初步临床观察

Objective To evaluate the feasibility of mdiofrequency catheter ablation of atrial fibrilla-tion (AF) guided by complex fractionated atrial electrograms (CFAEs). Methods Twenty-two patients with drug refractory and symptomatic AF(16 paroxysmal, 6 persisten) were enrolled. Using Carto, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identi-fied. Radiofrequency ablation at the site with CFAEs was performed and the end points were to eliminate CFAEs or convert to sinus rhythm. Results Thirteen patients(59%)were converted to sinus rhythm, (7 cases conver-ted directly to sinus rhythm, and 6 via the intermediate atrial tachycardia(AT) or atrial flutter (AFL). The re-maining nine patients required cardioversion with D. C. shock or drug. Repeat ablation was performed in 6 pa-tients (5 AT/AFL, 1 paroxysmal AF). During(10.9 ±4.8) months follow-up, 16 patients (73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, left atrial roof. CFAEs ablation prolonged AFCL[(157 ± 18) ms vs (211 ± 32) ms, P < 0.05]. Only one patient had pericardial tamponade that required pericardiocentesis. Conclusion Radiofrequeney catheter abla-tion of atrial fibrillation (AF) guided by CFAEs is safe and effective.     

心房颤动与炎症及慢性幽门螺旋杆菌感染相关性研究

目的探讨心房颤动(简称房颤)与炎症及慢性幽门螺旋杆菌(Hp)感染的关系。方法选取66例房颤患者为房颤组(其中阵发性房颤44例,慢性房颤22例),另取同期住院的阵发性室上性心动过速(简称室上速)患者67例作为对照组,用间接ELISA法测定血清Hp-IgG抗体,速率散射免疫比浊法测定C反应蛋白(CRP),比较两组Hp-IgG抗体,CRP的差异并分析HP抗体滴度与房颤及其它相关因素的关系。结果房颤组与对照组的Hp-IgG阳性率Hp-IgG对数值均无差异(P均>0.05)。房颤组CRP中位数较对照组高(1.17mg/dlvs0.65mg/dl,P<0.05)。结论房颤与慢性Hp感染不相关,与炎症相关。     

成年人牙畸形矫治的临床体会

牙牙合畸形不仅影响颌面与口腔的正常生长发育 ,而且对患者的身心健康、社会适应性、生活幸福和事业成功都有重要的影响 ,随着经济文化生活的提高 ,要求矫治的成年人患者日益增多。近年来 ,笔者对 49例成人错牙合畸形进行正畸 ,现谈一些体会。1　临床资料1.1　一般资料　 49例中男 2 0例 ,女 2 9例 ,年龄在 19～ 45岁之间 ,其中 19岁～ 38例 ,2 8岁～ 8例 ,41岁～ 3例。 49例中前牙拥挤 2 1例 ,前牙间隙 10例 ,前牙反牙合 5例 ,个别牙错位 8例 ,个别牙缺失 3例 ,上颌前突 2例 ,疗程最短 3个月 ,最长 2 0个月。2　矫治方法2 .1　前牙拥挤或个…     

Efficacy and Mechanism of Intravenous Sotalol for Termination of Paroxysmal Supraventricular Tachycardia

ＳＶＴ ,ｉｎｃｌｕｄｉｎｇＡＶＲＴａｎｄＡＶＮＲＴ ,ｉｓａｋｉｎｄｏｆａｒｒｈｙｔｈｍｉａｏｆｔｅｎｓｅｅｎｉｎｃｌｉｎｉｃａｌｐｒａｃ ｔｉｃｅ .Ｓｏｔａｌｏｌ,ａｃｌａｓｓⅢａｎｔｉ ａｒｒｈｙｔｈｍｉｃｄｒｕｇｗｉｔｈａｄｄｉｔｉｏｎａｌβ ｂｌｏｃｋｉｎｇａｇｅｎｔｐｒｏｐｅｒｔｉｅｓ ,ｈａｓｂｅｅｎｗｉｄｅｌｙｕｓｅｄｔｏｔｒｅａｔｖａｒｉｏｕｓａｒｒｈｙｔｈｍｉａ(ｓｕｐｒａ ｖｅｎｔｒｉｃｕｌａｒａｎｄｖｅｎｔｒｉｃｕｌａｒ)ｅｆｆｉｃｉｅｎｔｌｙｉｎｗｅｓｔｅｒｎｃｏｕｎｔｒｉｅｓ[1 9]…     

实用临床诊疗规范——心血管系统疾病(四)

第三节晕厥1概述晕厥是指突然的、短暂的、通常能自行恢复的意识丧失,常伴肌张力消失,但无神经定位体征。晕厥是临床上常见的综合征,社会人群中30%~50%的人曾经发生过1次或1次以上的晕厥。占急诊室就诊人数的1%~6%、住院病人数的0·6%~1·0%。晕厥有两个发病高峰时期:青少年期(     

肺移植围手术期的监测和护理

20年来。肺移植已在实验成功的基础上发展成为治疗终末期肺病的唯一有效方法。我院自2005年4月起成功进行了2例同种异体单肺移植手术和1例体外循环下序贯式双肺移植手术，现将围手术期的监测与护理回顾如下。     

心律转复除颤器植入术后电风暴的发生及其对预后的影响

目的调查单中心心律转复除颤器（ICD）植入术后电风暴（ES）的发生率、发作特征和危险因素，并探讨其对患者预后的影响。方法对本中心123例植入ICD的患者进行随访。Es定义为24h内出现3次或3次以上的快速室性心律失常（VA）导致ICD治疗，或ICD监测到持续30s以上的VA但未发放治疗。结果在（26．9±21．3）个月的随访期间，共有41（33．3％）例患者（ES组）发作139次ES（3．4±3．9）次／例，其中29（70．7％）例患者的首次发作在植入后1年内出现，Es发作呈现出6：00—10：00和14：00～17：00两个高峰。多因素Logistic回归分析表明植入ICD作为心脏性猝死二级预防是ES发生的独立危险因素（OR=4．797，P=0．044）。本组共15（12．2％）例患者死亡，Es组死亡率较无Es组（24．4％对6．1％，P=0．003）显著增高，Kaplan—Meier生存曲线分析显示Es组累计生存概率明显低于无Es组（Log—rank检验P〈0．001）。结论Es发作表现为上午和下午两个高峰，可导致死亡率增高，其首次发作多在ICD植入后1年内。植入ICD作为心脏性猝死二级预防是Es发生的独立危险因素。     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.