心房纤颤的治疗

心房纤颤 (ａｔｒｉａｌｆｉｂｒｉｌｌａｔｉｏｎ ,ＡＦ)是临床最常见的心律失常之一 ,根据国外报道在 40岁以下人群发病率为 0 2 %～0 3 % ,且随年龄增长而明显增加 ,60～ 90岁年龄组 ,ＡＦ发病率为 5 %～ 9% [1 ] 。在国内没有准确的统计数据。ＡＦ机制的研究虽已进一步深入 ,但尚无定论。ＡＦ有一定的致残率和病死率 ,特别是有器质性心脏病的患者 ,发生ＡＦ后循环系统功能迅速恶化 ,故一直是临床心律失常学治疗关注的焦点。1　ＡＦ的分类ＡＦ的分类对采取的治疗对策有极重要的意义。尽管分类方法繁多 ,各有千秋 ,对临床较有意义的分类…     

老年人心房纤颤临床分析

心房纤颤(AF)在老年人的心律失常中最常见,文献报导占第二位[1],为探讨其临床特点,本文对5年来收住院AF患者60例,分析如下:     

心房纤颤100例临床分析

本文对100例心房纤颤（Af）患者进行回顾性分析，以了解Af的病因分布特点与临床类型。     

心房纤颤的外科治疗

目前已有的心脏外科手术消融能源主要包括:射频、微波、冷冻、超声、激光.除冷冻外,其他绝大多数的能量源都是通过热能来进行消融的.这些方法的侵入性伤害明显少于Cox-maze手术,操作简便,降低了并发症率.但这些能量源及其装置具有各自的特点.同时在评价能量源效能时需要考虑的标准:能否能够制造有效阻断心房组织的电传导;能否有效穿透心外膜脂肪;消融是否迅速;是否会造成并发损伤;能否应用于任何所需要消融的解剖部位等.     

急性酒精中毒与心房纤颤

近年来我们先后遇到急性酒精中毒并发心房纤颤8例,现报道如下。 1 临床资料 1.1 一般资料 8例均为男性,年龄28～     

心房纤颤患者血小板变化的观察

心房纤颤 (Ａｆ)是成年人最常见的心律失常 ,其发病率随年龄的增长而增加 ,超过 6 0岁的人群其发病率为 2～ 4%。Ａｆ除引起血流动力学障碍外 ,也是引起脑栓塞最常见的心脏疾病。Ａｆ是否会导致血小板增生活跃呢 ?还很少见文献报道 ,为此 ,我们检测了 35例Ａｆ患者外周血大血小板率 ,以探讨Ａｆ对血小板增生的影响 ,现报告如下。1　方法与结果(1)对象 :Ａｆ组 :35例 ,均为持续性房颤的住院患者 ,男19例 ,女 16例 ,年龄 36～ 86岁 ,平均 5 6 7± 11 2岁 ,其中风心病 14例 ,冠心病 13例 ,高血压性心脏病 5例 ,扩张型心肌病 2例 ,老年性瓣膜病…     

心房纤颤的治疗新进展

心房纤颤（atrial fibrillation，AF）是临床最常见的心律失常之一。国外文献报道，一般群体内有29／5的发作趋势，在40岁以下人群发病率为0．2％～0．3，随年龄增长发病率升高，65岁以上发病率为5％～9%[1]。有器质性心脏病者AF发病率更高，AF也见于正常心脏，5％～15%的AF无器质性心脏病依据。本文结合国内外文献，就心房纤颤的研究新进展作一综述。     

心房纤颤的病因分析

心房纤维性颤动简称房颤。是临床上最常见的心律失常之一。房颤时,心房发生350～600次/分不规则的冲动,使心房失去了协调一致的有效收缩。而房室传导系统仅能接受部分心房兴奋的下传。引起心室搏动快而不规则。常常在120～180次/分之间。导致心室的排血功能减退,引起一系列的临床症状及心电图特有的表现。     

伊布利特静脉注射转复心房扑动、心房颤动116例分析

目的：分析Ⅲ类抗心律失常药物富马酸伊布利特（伊布利特）转复心房扑动（房扑）、心房颤动（房颤）的安全性及有效性.方法：顺序入选符合条件的116例房扑、房颤患者,使用伊布利特药物转复,先予1 mg（体质量≥60 kg）或0.01 mg/kg（体质量〈60 kg） 稀释后静注,观察10 min,如无效则给予相同剂量重复应用.用药后心电监护4 h,观察复律效果及安全性.结果：21例房扑患者中11例首剂转复窦性心律（窦律）,6例重复剂量转复窦性,有效率80.9%;95例房颤患者中首剂转复窦律37例,重复剂量转复窦律22例,有效率62.1%.房扑组不良反应发生率9.5%;房颤组不良反应发生率10.5%.结论：伊布利特是转复房扑、房颤快速有效的药物,尤其对房扑疗效显著,充分准备及心电监护下用药具有较高的安全性.     

孤立性房颤与非孤立性房颤患者临床特征及二维超声心动图结果分析

目的 分析孤立性房颤与非孤立性房颤患者临床特征及二维超声心动图相关数据,探究相应患者临床特点。方法 本研究为单中心回顾性性研究。连续入选2016年1月至2018年1月于首都医科大学附属北京友谊医院就诊的年龄≤60岁的房颤患者159例,依据患者是否合并心肺疾病、高血压、糖尿病等疾病分为孤立性房颤与非孤立性房颤两组,探究二者临床特征及二维超声心动图结果差异。进一步将孤立性房颤患者依据左心房内径男性是否大于4.0 cm,女性是否大于3.8 cm,分为左心房增大组与左心房正常组进行对比分析,探究两组患者临床特征及二维超声心动图结果差异。并通过二分类Logistic回归进行进一步分析。结果 孤立性房颤与非孤立性房颤两组相比,脑卒中发生率、左心室射血分数、左心室收缩末期内径、左心房内径等差异有统计学意义（P均<0.05）,年龄、性别、左心室舒张末期内径等差异无统计学意义（P均>0.05）。进一步多因素Logistic回归分析表明,两组患者出现脑卒中事件差异无统计学意义（OR：3.781,95% CI：0.832~17.179,P=0.085）。孤立性房颤患者中左心房增大组与左心房正常组患者相比,年龄、左心室舒张末期内径、左心室收缩末期内径等差异有统计学意义（P均<0.05）,性别、体质量指数、吸烟史、饮酒史、脑卒中病史、左心室射血分数、右心室内径、房颤持续时间、升主动脉内径等差异均无统计学意义（P均>0.05）。进一步多因素Logistic回归分析表明,两组患者年龄差异有统计学意义（OR：1.176,95% CI：1.007~1.372,P=0.040）。结论 孤立性房颤患者与非孤立性房颤患者相比,左心房内径较小,左心室射血分数较高,脑卒中等心脑血管事件发生率较低,矫正后脑卒中事件差异无统计学意义。孤立性房颤男性发病率较高,患者年龄与左心房内径呈正相关,左心房内径增大与脑卒中事件无明显相关性。     

Electrical remodeling in human atrial fibrillation

Atrial fibrillation is the most common clinically important cardiac arrhythmia accounting for 20％ to 25％ of strokes and is a common cause of congestive heart failure.1,2 With the aging population and changing demographics,atrial fibrillation has become an epidemic affecting 2.66 million people in the United States.The prevalence of atrial fibrillation is estimated to increase by 5 fold to 12 million by 2050.3 The diagnosis and treatment of atrial fibrillation represent a significant health care burden of $15.7 billion per year.4 Treatment of atrial fibrillation using antiarrhythmic drugs has been disappointing,while radiofrequency ablation approaches have limitations,including unclear long-term efficacy.Innovation in treatment is needed and pursuit of novel modalities of therapy requires fundamental knowledge in the molecular mechanisms that lead to atrial fibrillation,including electrical remodeling in atrial fibrillation.     

心房颤动电生理重构的实验研究

目的 :研究心房颤动 (atrialfibrillation ,AF)时心房肌的电生理重构。方法 :快速持续起搏犬右心房 8～ 10周 ,制备持续性AF模型。比较对照犬 ( 8只 )与起搏犬 ( 10只 )的有效不应期 (effectiverefractoryperiod ,ERP)和心房颤动波周长 (atrialfibrillationcyclelength ,AFCL)的变化来分析心房肌的电生理重构。结果 :起搏组P波时间和PA间期比起搏前明显延长 (P波时间 90 5± 10 5对 5 3 6± 8 3ms ;PA间期 5 9 6± 8 8对 3 8 6± 11 4ms ,P <0 0 5 )。经程序刺激ERP较对照组明显缩短 (S1S13 0 0ms 115± 2 3对 15 0± 2 1;S1S14 0 0ms 10 5± 2 7对 15 4± 2 4ms ,P <0 0 5 )。同一心房不同部位的ERP和AFCL也存在差异。结论 :心房率的长期变化可引起ERP和AFCL的变化 ,即心房肌发生电生理重构 ,而且不同部位心房肌电生理重构是不同的。     

白藜芦醇干预对慢性心房纤颤猪心房组织中去乙酰化酶1表达的影响

目的探讨白藜芦醇（resveratrol,RES）干预对快速右房起搏诱发的慢性心房纤颤（atrial fibrillation,AF）猪心房组织中去乙酰化酶（SIRT）1表达的影响。方法18头小家猪（雌雄不拘）随机分为3组（n=6）：起搏组（ATP组）、假手术组（sham组）和白藜芦醇干预组（RES组）。采用Seldinger血管穿刺技术穿刺右或左侧颈内静脉送入双极电极至右心房并连接至实验用起搏器（AOO）,快速起搏心房（500次/min）2周（假手术组猪不起搏）制备慢性AF实验模型。RES组猪于起搏前1周开始服用RES（2.5 mg.kg-1.d-1）。RT-PCR分析SIRT1mRNA表达情况,Western blot法检测SIRT1蛋白表达水平的变化。结果RES组SIRT1 mRNA和蛋白的表达较ATP组和sham组均明显增加（P〈0.05）,ATP组稍高于sham组但差异无统计学意义（P〉0.05）。结论RES干预可以明显增强快速起搏右房诱发的慢性AF猪心房组织中SIRT1的表达。     

Implementation of antithrombotic management in atrial fibrillation

The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fibrillation into high, moderate, or low risk of stroke according to the individual stroke risk factors. For patients at high risk, the correct treatment is warfarin unless there are specific contraindications. For patients at moderate risk, the correct management is aspirin unless there are specific contraindications. Patients at low risk should receive no thromboprophylaxis. The clinical risks of stroke and thromboprophylaxis on discharge from hospital were recorded. An extensive education programme on stroke prevention in atrial fibrillation was undertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%) of patients were at high risk of stroke. In the initial audit, antithrombotic management was correct in 89 patients (48%). In the follow up audit, antithrombotic management was correct in 135 patients (73%) (p < 0. 00001). If this improvement in management were extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atrial fibrillation remains imperfect, with many patients exposed to unnecessarily high risk of stroke.     

Changes in microRNAs expression are involved in age-related atrial structural remodeling and atrial fibrillation

Background Small noncoding microRNAs regulate gene expression in cardiac development and disease and have been implicated in the aging process and in the regulation of extracellular matrix proteins.However,their role in age-related cardiac remodeling and atrial fibrillation (AF) was not well understood.The present study was designed to decipher molecular mechanisms underlying age-related atrial structural remodeling and AF.Methods Three groups of dogs were studied:adult and aged dogs in sinus rhythm and with persistent AF induced by rapid atrial pacing.The expressions of microRNAs were measured by quantitative real-time polymerase chain reaction.Pathohistological and ultrastructural changes were tested by light and electron microscopy.Apoptosis index of myocytes was detected by TUNEL.Results Samples of atrial tissue showed the abnormal pathohistological and ultrastructural changes,the accelerated fibrosis,and apoptosis with aging and/or in AF dogs.Compared to the adult group,the expressions of microRNAs-21 and -29 were significantly increased,whereas the expressions of microRNAs-1 and-133 showed obvious downregulation tendency in the aged group.Compared to the aged group,the expressions of microRNAs-1,-21,and-29 was significantly increased in the old group in AF; contrastingly,the expressions of microRNA-133 showed obvious downregulation tendency.Conclusion These multiple aberrantly expressed microRNAs may be responsible for modulating the transition from adaptation to pathological atrial remodeling with aging and/or in AF.     

114例老年房颤临床特点分析

目的针对老年房颤特点,制定针对性的诊疗方案。方法对114例老年住院患者的临床资料进行分析。结果本组资料有基础性疾病78.07%,前三位是:冠心病,高血压,老年性瓣膜病;房颤发病率随年龄有明显的增加,男性的发病率明显高于女性;症状方面主要表现为:心悸、心慌、脉律不齐、乏力、胸闷等,本组无明显症状者为21.93%。结论应根据老年房颤临床特点制定不同的治疗方案。无明显症状者因其隐蔽性,其并发卒中的危险性增加,更应引起临床的警惕性。     

房间隔缺损并发的心房颤动的治疗探讨

目的:探讨房间隔缺损(atrial septal defect,ASD)并发的心房颤动(atrial fibrillation,AF)的临床特点和治疗AF的不同方法的效果?方法:分析641例行ASD封堵术患者的AF发生率和危险因素,比较药物或者导管消融治疗AF的疗效?结果:641例ASD患者的AF发生率为4.8%,其中年龄≥40岁的AF发生率为8.4%,年龄≥60岁的患者的AF发生率高达25%?与无AF的患者相比,AF者中男性多见?年龄大?右心房平均压力高?肺动脉平均压力高?左心房内径大?左室舒张末内径大以及左室射血分数低,进一步分析发现,男性?年龄≥40岁和左房内径增大是ASD并发AF的高危因素?AF转复及维持窦性心律治疗,导管射频消融优于药物治疗?结论:ASD患者中AF的发生率高于正常人群,男性?年龄≥40岁和左房内径增大是ASD并发AF的高危因素,导管射频消融在AF转复及维持窦性心律治疗上优于药物?     

Catheter ablation of atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac dysrrhythmia encountered in the clinical practice.1 The Framingham Heart Study reported the lifetime risks for AF development are 1 in 4 for men and women 40 years of age and older with a doubling of the overall mortality.2,3 Therefore,it carries a significant risk to the patients and also brings a tremendous economic burden to the social and health care systems.