Swartz鞘管在射频消融术中的临床应用

应用Ｓｗａｒｔｚ导管对２６例（２８条旁道）房室折返性心动过速（ＡＶＲＴ）病人（Ａ组）进行射频消融术,右侧房室旁道１６条,左侧旁道１２条,并与５２例（５４条旁道）常规方法消融结果（Ｂ组）比较,结果显示,１６条右侧房室旁道消融均获成功,平均消融功率（２７．８±６．０）Ｗ（Ｐ＞０．０５）,平均有效放电次数（３．４±３．２）次（Ｐ＜０．０５）,Ｘ线照射时间１９～４６ｍｉｎ（２９．２±８．８ｍｉｎ,Ｐ＜０．００１）;左侧１２条旁道１１条消融成功（９１．７％）,平均消融功率（２６．７±７．１）Ｗ（Ｐ＞０．０５）,平均有效放电次数（２．６±１．７）次（Ｐ＜０．０５）,Ｘ线照射时间２０～４９分（２９．４±１４．１ｍｉｎ,Ｐ＜０．０５）,无手术并发症发生。随访６～３８个月无复发。结果表明Ｓｗａｒｔｚ鞘管可以减少复杂、疑难病例的射频消融放电次数、缩短Ｘ线照射时间。     

老年急性下壁心肌梗塞的临床分析

目的 探讨老年急性下壁心肌梗塞（ＡＩＭＩ）合并房室传导阻滞（ＡＶＢ）的临床意义及预后。方法 对１３６例老年急性心肌梗塞（ＡＭＩ）中的４５例ＡＩＭＩ进行临床分析。结果 老年ＡＩＭＩ合并ＡＶＢ发生率显高于前壁组（Ｐ〈０．００１）,老年ＡＩＭＩ合并ＡＶＢ组肌酸磷酶（ＣＰＫ）峰值（１４０７±８１００／Ｌ）明显高于ＡＩＭＩ有合并ＡＶＢ组（８０２±２２４Ｕ／Ｌ）,Ｐ〈０．０１,两组在死亡率、心源性休克、心律     

房室结折返性心动过速射频消融期间暂时性完全房室传导阻滞的预后意义

房室结折返性心动过速射频消融期间暂时性完全房室传导阻滞的预后意义［英］Ｇｕｉｌ－ｈｅｒｍｅＦ…／／Ａｍ　Ｊ　Ｃａｒｄ．１９９５；７５：６９８本文通过对房室结折返性心动过速（ＡＶＮＲＴ）射频消融的长期随访，探讨捎融期间出现暂时性完全房室传导阻滞（ＣＡＶ...     

心房起搏法在射频消融房室结折返性心动过速中的应用

将射频消融治疗的９４例房室结折返性心动过速（ＡＶＮＲＴ）病人按心房起搏法和常规法进行分组（分别为３９及５５例），回顾性比较两组病人的消融治疗结果，以评价这两种方法在射频消融治疗ＡＶＮＲＴ中的安全性、成功率和复发率。随访１０．８±４．５个月，总成功率为９６．８％、复发率为２．１％。与常规组相比，起搏组有效放电时间明显延长（１４５±３８ｓｖｓ８２±２６ｓ，Ｐ＜０．０１）、慢径阻断成功率高（６１．５％ｖｓ４０．０％，Ｐ＜０．０１）、一过性房室阻滞发生率低（２．６％ｖｓ１２．７％，Ｐ＜０．０５），但各种类型的永久性房室阻滞发生率和复发率无显著性差异（Ｐ＞０．０５）。表明ＡＶＮ－ＲＴ消融术中采用心房起搏法较常规法更为安全有效。     

射频导管消融治疗儿童室上性心动过速100例体会

经射频导管消融（ＲＦＣＡ）治疗３．５～１４岁儿童阵发性室上性心动过速（ＰＳＶＴ）１００例，探讨ＲＦＣＡ治疗儿童ＰＳＶＴ的安全性及疗效。１００例中房室折返性心动过速（ＡＶＲＴ）７９例，慢－快型房室结折返性心动过速（ＡＶＮＲＴ）２１例。首次消融成功９６例（９６％）。失败４例均为ＡＶＲＴ。平均Ｘ线曝光时间１９ｍｉｎ。除２例ＡＶＮＲＴ放置导管过程中发生一过性ＩＩ度房室阻滞（ＡＶＢ）外，余术中和术后均无并发症发生。术后随访１个月～４．５年，ＡＶＲＴ复发１例，ＡＶＮＲＴ复发４例（占２１例的１９％），总复发率５％。结论：①ＲＦＣＡ治疗儿童ＰＳＶＴ安全、有效。②因儿童的ＡＶＮＲＴ消融慢径易出现ＡＶＢ且复发率高，应严格掌握手术适应证。③术中Ｘ线曝光时间应＜４０ｍｉｎ。     

射频消融特发性室性心动过速对心室肌复极离散度的影响

目的 研究导管射频消融术（ＲＦＣＡ）对特发性室性惊动国过速速（ＩＶＴ）患者ＱＴ、ＪＴ离散度（ＡＴｄ、ＪＴｄ）的影响。方法 测量１５例ＩＶＴ患者ＲＦＣＡ术前、术后的ＱＴｄ、ＪＴｄ。结果 ＩＶＴ患者ＲＦＣＡ术关、术后ＱＴｄ、ＪＴｄ均无显著性差异（Ｐ〉０．０５）。结论 ＲＦＣＡ不影响ＩＶＴ患者心室肌复极离散度。     

急性心肌梗死不同时期发生的房室传导阻滞

目的：探讨急性心肌梗死病人不同时期发生的房室传导阻滞（ＡＶＢ）的临床特点、治疗及预后。方法：采用非创伤性心电监测法监测４６６例Ｑ波型心肌梗死病人ＡＶＢ的发生率和药物治疗反应及演变。其中６５例病人发生ＡＶＢ，按发生的不同时期分为两组：①早发组，１５例为发病８小时内出现ＡＶＢ；②晚发组，５０例为发病８小时后出现ＡＶＢ。结果：４６６例心肌梗死中，发生房室传导阻滞６５例（１４％）。晚发组比早发组死亡率高（Ｐ＜０．０５）；晚发组泵衰竭多于早发组（Ｐ＜０．０５）；用阿托品治疗后早发组比晚发组有效。结论：急性心肌梗死病人ＡＶＢ早发组比ＡＶＢ晚发组病情较轻，部分病人药物治疗有效，预后较好。     

高血压病患者血清脂蛋白、载脂蛋白异常与胰岛素抵抗的关系

目的：探讨高血压病患者血脂／载脂蛋白异常与胰岛素抵抗的关系。方法：以空腹胰岛素／空腹葡萄糖比值和口服葡萄糖负荷后胰岛素曲线下面积／葡萄糖曲线下面积比值作为胰岛素抵抗指标，与空腹血脂／载脂蛋白进行直线相关分析。结果：与正常对照组（ｎ＝２１）比较，高血压病组（ｎ＝３２）血清甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白（Ａｐｏ）Ｂ、空腹胰岛素、空腹胰岛素／空腹葡萄糖比值以及胰岛素曲线下面积、葡萄糖曲线下面积和胰岛素曲线下面积／葡萄糖曲线下面积比值均显著增加（Ｐ＜０．０５～０．００１），高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、ＨＤＬ２－Ｃ、ＡｐｏＡＩ及ＡｐｏＡＩ／ＡｐｏＢ比值均显著降低（Ｐ＜０．０５～０．００１）。高血压病组空腹胰岛素／空腹葡萄糖比值和胰岛素曲线下面积／葡萄糖曲线下面积比值均分别与甘油三酯、低密度脂蛋白胆固醇和ＡｐｏＢ呈正相关（Ｐ＜０．０５～０．０１），与ＨＤＬ２－Ｃ、ＡｐｏＡＩ和ＡｐｏＡＩ／ＡｐｏＢ比值呈负相关（Ｐ＜０．０５～０．００１）。正常对照组上述指标间则无相关（Ｐ＞０．０５）。结论：高血压病患者血脂／载脂蛋白异常与胰岛素抵抗密切相关。     

穿刺动脉逆行和穿刺房间隔途径射频消融左侧房室旁路比较

本组通过对穿刺动脉逆行法和穿刺房间隔法消融左侧房室旁路进行比较,探讨各自的优缺点。在我院进行导管射频消融术（ＲＦＣＡ）治疗的阵发性室上性心动过速（ＰＳＶＴ）左侧房室旁路２３３例患者,年龄７～７５岁,病程１～４８年。８６例显性左侧房室旁路中１例合并风湿...     

射频消融治疗儿童快速性心律失常100例

探讨射频导管消融（ＲＦＣＡ）在治疗儿童快速性心律失常中的临床价值，采用ＲＦＣＡ治疗儿童室上性心动过速（ＳＶＴ）９３例、特发性室性心动过速（ＩＶＴ）７例。结果：ＳＶＴ消融成功率为９１．４％，右侧旁道消融成功率低于左侧旁道及房室结慢径路消融的成功率（８１．８％ｖｓ９６．８％及９６．６％；Ｐ均＜０．０５）。随访３７．３±２０．７个月，８例复发，其中２例发作次数较术前减少，口服普罗帕酮可预防发作，另６例再次消融成功。ＩＶＴ首次消融均成功，随访１９．５±１０．３个月，２例复发，均再次消融成功。全组无并发症发生。结果提示ＲＦＣＡ治疗儿童快速性心律失常是有效的、安全的。     

Atrioventricular nodal Reentrant Tachycardia with Atrioventricular Block

Atrioventricular block (AVB) during atrioventricular nodal reentrant tachycardia (AVNRT) has been well documented [1-4], although it is not a common phenomenon. The mechanism for the initiation and resolution of AVB during AVNRT have been postulated [2,4]. However, the site of AVB and its implication on the reentrant circuit in AVNRT is not clear. We illustrate two examples of AVNRT with AVB and offer further clarification on the site and mechanism of AVB.     

Atrioventricular block

Clinical and electrophysiologic studies are presented to establish a practical classification of atrioventricular (A-V) block. Second degree and high grade A-V block with narrow QRS complexes (equal to or less than 0.11 second) were associated with a conduction delay within the A-V node. QRS complexes equal to or greater than 0.12 second were associated with conduction delay in the subjunctional regions of the A-V transmission system.     

Atrioventricular Nodal Reentrant Tachycardia with Advanced Infra-Hisian Atrioventricular Block

We report a case of 78-year-old man admitted to the hospital due to palpitations and lightheadedness. On EKG advanced atrioventricular block with ventricular rate of 37 beats per minute was noted. On electrophysiology study a common type of atrioventricular nodal reentrant tachycardia was inducible with maintenance of advanced AV block. Radiofrequency ablation of slow pathway followed by placement of a permanent pacemaker resulted in elimination of tachycardia and resolution of symptoms.     

Alternation of Atrioventricular Nodal Conduction Time During Atrioventricular Reentrant Tachycardia:

AV Nodal Conduction Time Alternation. Introduction: Alternation of atrial cycle length and AV nodal conduction time (NCT) is often observed during AV reentrant tachycardia. Both AV nodal dual pathway and rate-dependent function have been postulated to be involved in this phenomenon. This study was designed to determine the respective role of these two mechanisms in the alternation observed in an in vitro model of orthodromic AV reentrant tachycardia. Methods and Results: The tachycardia was produced by detecting each His-bundle activation and stimulating the atrium after a retrograde delay, thereby simulating retrograde pathway conduction, in six isolated rabbit heart preparations. After a 5-minute stabilization period at a fast rate, the retrograde delay was decremented by 2 msec every minute until nodal blocks occurred. We observed a sequential alternation of the cycle length and NCT in four preparations in the short retrograde delay range. The magnitude of the alternation gradually increased as the retrograde delay was decreased and reached 4.6 ± 0.5 msec during 1:1 conduction. The alternation increased further just prior to termination of the tachycardia by an AV nodal block. None of the preparations showed discontinuous AV nodal recovery curves. Moreover, an electrode positioned over the endocardial surface of the node showed that the alternation developed distally to the nodal inputs, which are believed to constitute a major component of dual pathways. A mathematical model predicted the alternation from known characteristics of rate-dependent nodal functional properties. Conclusions: NCT and cycle length alternation can arise during orthodromic AV reentrant tachycardia when the retrograde delay is sufficiently short. The characteristics of the alternation, presence of continuous recovery curves, intranodal location of the alternation, and mathematical modeling suggest that the alternation is predictahle from the known functional properties of the AV node without postulating dual pathway physiology.