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。     

实用临床诊疗规范——心血管系统疾病（一）

第一节 心律失常 窦性心律失常 正常的窦性心律是整齐的，其频率在成年人为60～100次／min。窦性心律的频率因年龄、性别、体力活动等的不同而有显著差异，故所谓正常范围对个人来说只具有相对意义。一般说来，经常体育锻炼或体力劳动的人心率偏慢、长期静坐工作者心率多较快。     

特发性右室流出道室速的昼夜发作规律及临床意义

目的：探讨特发性右室流出道室速的昼夜发作规律及临床意义,方法：对12例特发性右室流出道室速患者在基础状态进行动态心电图（Holter)监测,分别记录24h中每小时内心律失常发作频数及平均心率,了解室速,室早发作的昼夜规律,结果：基础状态下,室速,连发室早,平均心率在24h内呈不均一分布（P＜0．001）,其发作规律呈白天多,夜间少,单个室呈不均一分布,但整个差异无显著性,平均心率与室速,连发室早互正相关,单个室早与平均心率无相关性,结论：左室流出道室速患者24h内室速,连发病早呈明显的昼夜节律变化,提示特发性右室流出道室速的发生与交感迷走神经平衡失调有关。     

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

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。     

心脏再同步化治疗中腋静脉径路植入左室导线的临床应用评价

目的:观察慢性心力衰竭患者腋静脉的解剖特征,并探讨心脏再同步化治疗(CRT/CRTD)中经腋静脉途径植入左室导线的可行性和安全性?方法:选择2013年1月—2015年2月行心脏再同步化治疗(CRT或CRTD)患者59例,根据左室导线植入径路分为腋静脉组(n=23)和锁骨下静脉组(n=36),比较两种径路左室导线植入时间?参数及相关并发症;同期选择新植入双腔起搏器(DDD)患者67例,所有患者术前行腋静脉造影,比较慢性心力衰竭和正常心脏结构患者腋静脉内径的差异?结果:所有患者均成功植入CRT/CRTD和DDD装置?心脏再同步化治疗组和双腔起搏器组腋静脉解剖结构相似,两组间腋静脉内径无统计学差异[(10.77 ± 2.19)mm vs (10.11 ± 2.02)mm,P > 0.05];心脏再同步化治疗经腋静脉径路和经锁骨下静脉径路植入左室导线的时间?植入并发症无统计学差异(P > 0.05);右房?右室?左室导线的阈值?感知?阻抗两组间无统计学差异(P > 0.05)?结论:慢性心力衰竭患者腋静脉内径无明显异常,心脏再同步化治疗中经腋静脉径路植入左室导线安全可行?     

血清N-末端脑钠肽与心脏再同步化治疗慢性心衰患者预后的相关研究

目的:探讨术前血清N-末端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度与心脏再同步化治疗(cardiac resynchronization therapy,CRT)术后慢性心衰(chronic heart failure,CHF)患者心功能以及预后的关系?方法:选择2012年3月—2014年10月在本院植入CRT或CRT-D的CHF患者60例,术前测定血浆NT-proBNP水平;术前以及术后6个月测定超声心动图测定左心室射血分数(left ventricular ejection fraction,LVEF)?依据CRT植入后6个月随访时LVEF绝对值较基线增加≥5%为标准,分为有反应组和无反应组?随访期间观察CHF患者主要不良心血管事件(major adverse cardiovascular events,MACE)?结果:CRT术后有反应组术前NT-proBNP?随访MACE发生率明显小于CRT无反应组(P < 0.01)?以NT-proBNP 2 354.5 pg/mL为最佳分界点,预测CRT术后无反应的敏感度为95.0%,特异度为92.5%?以NT-proBNP 2 254.5 pg/mL为最佳分界点,预测发生心血管事件的敏感度95.2%,特异度92.3 %?Kaplan-Meier生存曲线显示NT-proBNP≤2 254.5 pg/mL患者生存时间高于NT-proBNP≥2 254.5 pg/mL者(P < 0.01)?结论:术前血清NT-proBNP水平与CHF患者CRT术后反应程度以及心血管不良事件相关?     

16例心肌致密化不全的临床特征

目的 分析16例心肌致密化不全(NVM)患者的临床特征和心脏彩超特点.方法 分析来自4个家系的9例NVM患者以及7例散发性NVM患者的临床表现、心电图、超声心动图等资料.结果 16例NVM患者,男12例,发病年龄17-74岁.7例患者有心悸症状;7例散发性NVM患者和2例家族性NVM患者有不同程度的心力衰竭;6例家族性NVM患者无明显症状.心电图异常者12例:室性期前收缩5例,非持续性室性心动过速3例,持续性房颤2例,阵发性房扑房颤1例,ST段压低伴T波改变9例.所有患者均通过心脏超声检查确诊,患者病变均局限于左心室;其中,累及心尖部14例,左心室扩大10例,左心室射血分数减低8例,左心室内见多发血栓1例.结论 NVM男性患者多见,有家族遗传倾向;其临床表现主要为心力衰竭、心律失常,超声心动图是确诊的主要方法.     

沉默型动脉导管未闭的血流动力学特征及治疗探讨

目的　探讨沉默型动脉导管未闭 (patentductusarteriosus ,PDA)的血流动力学特征及治疗。方法　对临床结合超声心动图诊断的 7例沉默型PDA病人进行心导管检查 ,术后 3个月、6个月及每年随访一次。结果　 7例病人肺动脉平均压平均为 (16 0± 2 4 )mmHg ,肺循环和体循环血流量比 (Qp/Qs)为 1 0 8± 0 0 2 ,左向右分流量平均为 (0 32± 0 0 8)L/min ,左向右分流量占肺循环血流量比例平均为 0 0 98± 0 0 2 4。PDA最窄处平均直径为 (0 9± 0 2 )mm。 7例病人均未行外科手术和介入治疗。平均随访 9 5个月 (临床、心电图、超声心动图 ) ,未发现房室腔增大、肺动脉压增高 ,无感染性动脉内膜炎和心内膜炎发生。结论　沉默型PDA的左向右分流量很少 ,对病人的血流动力学影响小。沉默型PDA病人是否需要治疗尚无定论。