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1.
目的探讨中性粒细胞与淋巴细胞比值(NLR)对阵发性和持续性心房颤动(房颤)导管射频消融术后复发预测价值的比较。方法选取2014年6月至2016年6月于大连医科大学附属第一医院心内科首次行导管射频消融术的554例房颤患者为研究对象,其中阵发性房颤394例,持续性房颤160例。根据血常规结果计算NLR值。阵发性房颤行环肺静脉电隔离(CPVI),持续性房颤在CPVI基础上加行线性消融。房颤复发定义为消融3个月空白期后,发生的任何快速性房性心律失常,且持续时间≥30 s。结果平均随访(13.2±3.6)月,阵发性房颤87例(22.1%)复发,持续性房颤51例(31.9%)复发。在阵发性和持续性房颤中,复发组NLR均显著高于非复发组,差异有统计学意义(P0.05)。经多因素Cox回归和ROC曲线分析显示,NLR对持续性房颤患者消融术后复发的预测价值优于阵发性房颤患者[HR=2.421(95%CI:1.688~3.472),P0.05 vs. HR=2.071(95%CI:1.682~2.551), P0.05;AUC=0.721(95%CI:0.633~0.809),P0.05 vs. AUC=0.688(95%CI:0.625~0.751),P0.05]。在阵发性房颤中,NLR预测的最佳临界点为2.07。在持续性房颤中,NLR预测的最佳临界点为2.11。结论 NLR是阵发性和持续性房颤消融术后复发的独立预测因素,并且在持续性房颤中的预测价值优于阵发性房颤。当NLR≥2.07时阵发性房颤消融术后复发的概率明显增加;当NLR≥2.11时持续性房颤消融术后复发的概率明显增加。  相似文献   
2.
目的:探讨持续性心房颤动(房颤)射频消融术空白期后继续应用抗心律失常药物能否降低术后心房扑动、房性心动过速等房性心律失常的发生率。方法:在空白期结束后,将空白期后心律仍为窦性心律的患者分为试验组(应用抗心律失常药物胺碘酮或普罗帕酮至术后12个月)和对照组(停止应用胺碘酮及其他Ⅲ类和Ⅰ类抗心律失常药物),随访1年,对两组患者的远期成功率、房颤负荷和生活质量评分等进行比较。结果:试验组远期成功率与对照组相比无统计学差异(62.5%∶58.3%,P=0.534),但房颤负荷及生活质量评分在两组间有统计学差异(P0.05)。房颤病史为房颤射频消融术后复发的危险因子(HR:1.013,95%CI:1.004~1.023,P=0.003)。结论:空白期后抗心律失常药物强化应用对持续性房颤术后复发影响甚微,但可降低房颤负荷及提高患者生活质量。房颤病史是持续性房颤射频消融术后远期复发的独立预测因子。  相似文献   
3.
正1病例资料患者,女,61岁,2015年12月以"活动后胸闷、气促3年余,再发加重1个月"为主诉入院。既往体健。患者3年前无明显诱因反复出现活动后胸闷、气促,不影响日常生活。1年前出现胸骨后及心前区胀痛,可放射至后背,伴心悸、乏力、多汗,持续半小时缓解。半年前胸闷、气促症状较前加重,轻微活动后即可出现,夜间不能平卧,伴咳嗽、咳白痰。入院后体检:双肺呼吸音粗,可闻及散在湿性  相似文献   
4.
目的观察心脏不同部位起搏时体表心电图评价心室肌复极指标的变化,了解不同部位起搏对心室肌整体复极离散的影响。方法 10只健康猪,分别在右心房(RA)、右心室心尖部心内膜(RVEndo)及左心室心外膜(LVEpi)起搏,记录并测量体表心电图12个导联的T波峰-末间期(Tpe)和QT间期,计算Tpe平均值(Tpe-AVE)、Tpe最大值(Tpe-MAX)以及QT间期离散度(QTd),比较不同部位起搏时上述各参数的差异,进一步评价不同起部位对心室整体复极离散的影响。结果 LVEpi、RA、RVEndo起搏时的QT间期分别为(328±24)ms、(295±13)ms、(304±17)ms,LVEpi起搏时的QT间期明显长于RA及RVEndo起搏时的QT间期(P<0.05),RA与RVEndo起搏时QT间期没有明显差别。LVEpi、RA、RVEndo起搏的QT离散度(QTd)分别为(33±6)ms、(17±3)ms、(18±3)ms,LVEpi起搏时的QTd明显大于RA及RVEndo起搏时的QTd(P>0.05),RA与RVEndo起搏时QTd没有明显差别(P>0.05)。RA起搏时Tpe-AVE及Tpe-MAX分别为49±6ms及58±8 ms,与RVEndo起搏相近(49±8)ms及(60±8)ms,P>0.05);LVEpi起搏时Tpe-AVE及Tpe-MAX明显增大(63±7)ms及(71±8)ms,与RA、RVEndo起搏时比较两者(P<0.05)。结论与RA及RVEndo起搏时比较,LVEpi起搏时的QT间期、QTd、Tpe-AVE及Tpe-MAX均明显增大,LVEpi起搏可能会增加心室整体复极离散。  相似文献   
5.
目的 观察心房颤动(房颤)射频导管消融术中经验性抗凝活化凝血时间(ACT)达标情况及短期术后血栓并发症发生情况.方法 顺序入选2011年我院行射频导管消融治疗的阵发性或持续性房颤患者87例,术中均依据经验肝素抗凝(即首次穿刺房间隔后予负荷量肝素100 U/kg,术中每小时追加1000 U),术中定时监测ACT,如ACT≥250 s即为抗凝达标,ACT≥300 s则抗凝效果较好.观察ACT达标情况.随访终点:术后1个月脑卒中及严重出血情况(颅内出血、穿刺口血肿、皮肤黏膜出血).结果 87例患者测定ACT总体达标率为74.1%,未达标25.9%.ACT全程达标患者共45例,达标率为51.7%.术中术后无血栓及出血事件发生.结论 虽然房颤消融术中经验性抗凝多数患者可以全程达标抗凝,但仍有部分患者部分时间ACT未达到抗凝标准,存在潜在血栓及出血不良事件发生风险,建议遵循指南进行术中ACT监测指导抗凝.大体重的阵发性房颤患者,术中经验性抗凝不易达标,需要加强抗凝,提高达标率.  相似文献   
6.
7.
Objective Electrical restitution was believed to be a determinant responsible for the stability of heart rhythm. Although numerous studies focused on the role of action potential duration restitution (APDR) in the initiation and maintenance of ventricular fibrillation (VF), the relationship between atrial APDR and atrial fibrillation (AF) has not been fully understood. This study aims to investigate the characteristics of APDR of left atrium (LA) and right atrium (RA) in canines and the relevance to induction of AF. Methods Monophasic action potential (MAP) was recorded from LA and RA in 14 canines using the MAP recording-pacing combination catheter. APDR, plotted as action potential duration (APD) on the preceding diastolic interval (DI), was assessed by use of programmed stimulation with a single extrastimulus (S_1S_2) at LA and RA. Episodes of AF were recorded and analyzed. Results APD_(90) was significantly shorter in the LA than that in the RA [( 157.4 ± 43.5 ) ms vs. ( 170. 9 ± 37. 9)ms, P < 0. 05]. The mean slope of the APDR curve by S_1S_2 in the LA was significantly greater than that in the RA ( 1.3 ±0. 4 vs. 0. 9 ± 0. 3, P < 0. 05 ). The incidence of induced AF was significantly higher in the LA than in the RA (11/18 vs. 7/18, P < 0. 05). Conclusions The APDR and MAP characteristics are not uniform between atriums, which may be one of the important mechanisms responsible for the initiation of AF. Heterogeneity of APDR between LA and RA might create critical gradients or a dispersion of repolarization and subatrate for re-entrant arrhythmias and vulnerability to AF.  相似文献   
8.
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.  相似文献   
9.
Objective The ablation of the atrioventricular node slow pathway may reduce the inducibility of atrial fibrillation (AF) ,but the mechanisms remain unknown. We tried to investigate the impact of ablation on atria refractory period, and to elucidate the underlying mechanism. Methods Thirty-two patients with atrioventricular node reentrant tachycardia (AVNRT) were enrolled in the study. Atria effective refractory period (ERP) and vulnerable window (VW) at high right atrium (HRA),inferior right atrium (IRA),distal (CSd) and proximal CS (CSp) ,as well as sinus rate (SR) and effective refractory period of fast pathway (FERP) were measured before and after ablation. Results ( 1 ) After ablation, the ERP at HRA did not change:(214. 4 ± 35. 1 ) ms, (213.4 ± 37. 3) ms, P = 0. 6, on the other hand, the ERPs at following sites were significantly prolonged:CSp(218. 1 ±21.8)ms, (235.3 ± 23.6) ms,P <0. 0001 ;CSd(230. 9 ±21.0) ms, (244. 7 ±25. 1)ms,P<0. 01;IRA(198.8 ±26.7)ms,(219.7 ±28. 7) ms,P < 0.005,respectively. (2) The VW of HRA remained unchanged after ablation, while the VWs of CSp, CSd and IRA trended to decline despite no statistic significant. (3)SR showed a little increasing but without statistic significant after ablation (P = 0. 17 ).(4) ERP of fast pathway was significantly decreased after ablation: ( 391 ± 55 ) ms, ( 369 ± 78 ) ms, P < 0. 01.Conclusions The decrease of ERPs at CS and IRA, as well as F-ERP after ablation may decline the inducibility of atrial fibrillation and indicates regional vagal denervation to the atrium.  相似文献   
10.
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.  相似文献   
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