特发性室性心动过速的射频消融治疗

发生在正常结构心脏 ,更恰当的提法是目前的诊断技术未能发现明确器质性心脏病临床证据的室性心动过速 (室速 ) ,临床统称为特发性室速。发生率约占全部室速的 10 %左右。根据起源部位不同 ,分为右室特发性室速和左室特发性室速。绝大多数右室特发性室速起源于右心室流出道 (Ｒ     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

射频消融治疗顽固性快速房性心律失常一例

射频消融术是一种新的治疗快速心律失常的有效方法。我们使用该方法治疗顽固性快速房性心律失常患者1例,疗效满意。患者,男性,59岁,1986年开始反复发作心房纤颤,心房扑动、室上性心动过速,曾用普萘洛尔、维拉帕米、普罗帕酮、胺碘酮、奎尼丁、普鲁卡因胺、阿替洛尔、地高辛等多种药物治疗无效。1989年以来,病情日趋严重、发作间歇期很短,心律基本为心房纤颤,心房扑动,药物不能复律,也不能满意控制心率,心室率     

房室旁路射频消融术对预激综合征患者心房颤动发生率的影响

目的观察房室旁路射频消融术对伴有阵发性心房颤动(PAF)的预激综合征患者PAF发生情况的影响.方法对75例(男59例,女16例),年龄41±8(14～71)岁,伴有PAF的预激综合征(WPW)患者进行显性房室旁路的射频消融术,其中左侧旁路35例,右侧旁路40例.全部患者均经射频消融消除显性旁路并定期通过症状和心电图随访判定有无PAF再发.结果除9例患者失访外,51例无PAF再发,15例有PAF再发,再发的15例PAF中有5例转为永久性心房颤动.有PAF再发的患者均无阵发性心动过速再发的证据.结论房室旁路射频消融术后可显著减少预激综合征患者PAF的再发率.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

以室性心动过速为首发临床表现的心脏肿瘤五例

目的 总结以室性心动过速为首发表现的心脏肿瘤的临床和心电图特点，以利及时诊断。方法 对１９９２年１２月～１９９９年７月收治的５例以室性心动过速为首发表现，后经影像学检查发现并经手术和病理证实的心脏肿瘤患者的临床和心电图特点进行分析。结果 本组５例均以室性心动过速为首发临床表现。心室率１６０～２０００次／ｍｉｎ，其中，伴一过性头晕３例，黑Ｍｅｎｇ２例，临床无其他症状和体征。既往均无心脏病史，而且肿瘤的所在实际部位与心电图所显示的室性期前收缩，乃至室性心动过速起源部位基本一致，其中１例经心内电生理证实，结论 对临床上以室性心动过速为主要表现的患者，应考虑到有心脏肿瘤的可能。应行影像学检查确诊。常规心电图所显示的室性心动过速的起源部位对心脏肿瘤有一定的定位价值。     

温度控制系统在射频消融治疗室上性心动过速的应用

本文介绍应用新型的自动温度控制射频消融系统的临床应用体会。一、病人和方法32例室上性心动过速（SVT）患者，男18例，女14例，平均年龄31．6岁。16例应用温度控制RF系统，SVT类型如下，左侧旁路折返性心动过速7例，其中5例为隐匿性旁路，2例为显性分路；右侧分路折返性心动过速4例，均为显性旁路；另外5例为房室结折返性心动过速。另16例患者采用普通的能量输出控制RF方式作为对照，其中6例为左侧旁路，5例为右侧旁路，房室结折返性心动过速5例。射频消融仪采用MedtronicATAKR自动温度控制系统，此系统可自动调节输出功率（0．5～…     

九例射频消融术导致的血栓栓塞并发症

回顾性分析 4 0 32例射频消融术 (RFCA)后发生的血栓栓塞并发症。共 9例发生了术后血栓栓塞并发症(0 .2 % ) ,其中股动脉血栓形成 3例 ,肺栓塞 2例 ,肾小动脉栓塞 1例 ,脑栓塞 1例 ,外周动脉栓塞 1例 ,血栓性静脉炎 1例 ,心律失常类型 88.9% (8/ 9)为左侧旁道 ,术中都使用过肝素抗凝治疗。结论 :应重视预防RFCA术后的血栓栓塞并发症 ,尤其是进行左侧心腔消融时。仅靠术中肝素抗凝预防血栓栓塞并发症可能是不够的。     

慢径消融或改良治疗房室交界区折返性心动过速远期疗效的评价

目的评价慢径消融或慢径改良对房室交界区折返性心动过速(atrioventricular junctionalreentrant tachycardia,AVJRT)远期复发的影响.方法231例AV.JRT患者进行常规慢径消融,比较慢径消融(慢径消失)或改良(慢径存在)者AVJRT的复发率和并发症以及各组消融前后的电生理参数变化.结果射频消融后142例慢径残存,53例慢径消失,房室结有效不应期延长,11房室和室房传导的最大频率减慢.36例消融前后均无AH间期跳跃现象.术后(25±4)个月的随访期内,慢径消融的89例中复发1例,4例发生二度Ⅰ型房室阻滞.慢径改良的142例复发2例,复发率无差别(P＞0.05).结论慢径消融或改良治疗AVJRT可以达到同样疗效.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.