心房颤动的诊断和治疗近况

心房颤动(简称房颤,Af),其发病机理可能为心房内多灶微折返的快速心律失常,其发生率为10％～20％,仅次于窦性心律失常和早搏而居于第三位,Af多见于器质性心脏病,各种病因的百分比因不同时代、不同地区、不同年龄而不同,尤其是后者和Af的发生有明显的关系。     

心房颤动对心房肌细胞电生理的影响

阵发性心房颤动(房颤)常会发展为慢性房颤,其发生率与基础疾病显著相关[1],同时有18%的特发性房颤会发展为持续性房颤[2]。阵发性房颤的持续时间也很重要,房颤持续时间短于2天的患者中,有31%的患者转变为慢性房颤,而房颤持续时间超过2天的患者,有46%转为慢性房颤[1]。从这些流行病学资料可以看出,不依赖于基础心脏病,房颤本身就是一种进行性疾病。　　临床上发现当房颤存在时间较短时,药物转复或直流电转复的成功率较高。在新近出现的房颤(<24h),静脉注射氟卡胺的转复率为76%～93%,而持续时间较长时转复成功率为0%～83%[3,4]。胺碘酮对于持…     

电与结构重构在心房纤颤合并心力衰竭中的作用

心房纤颤（房颤）与慢性充血性心力衰竭（心衰）常合并存在导致心房结构和功能的改变，称之为心房重构。由于血流动力学和神经体液的影响，房颤可能是慢性心衰的结果，也可能是心衰的原因。我们回顾2者所致心房重构的实验和临床资料，对其相互关系做进一步探讨。     

71例老年人阵发性心房颤动的长期观察

７１例老年人阵发性心房颤动的长期观察侯军伍建宇钱贻简一、对象与方法７１例为１９７５年初至１９９１年底住我院老年病房的患者。男６７例，女４例。发病年龄６０～９３岁，平均７２．９岁。病程＜５年２６例，５～９年２８例，１０～１９年１７例。７１例３８７次心房...     

心房颤动的电学治疗进展

本文介绍心房颤动的电学治疗新进展，包括ＡＦ的起搏治疗，植入心房除颤器和ＡＦ的射频导管消融治疗。     

心房颤动病人的起搏器治疗

起搏是心房颤动（Ａｆ）治疗学的一个进展。为此，本文综述了房颤病人常见与少见的起搏指征，并提出房颤房人起搏的优选形式：慢性房颤应选用频率调节起搏（ＶＶＩ或ＶＶＩＲ）；阵发生房颤应以双腔起搏（ＤＤＤ或ＤＤＩ）为优选。此外，起搏也可用于预防阵发性房颤的发生。抗心律失常药物对接受起搏的病人可产生不同影响，特别是ＩＡ和ＩＣ类药物可消极影响起搏效能，需行起搏治疗者不宜使用此二类药物。安装永久性起搏器的病人还可     

糖尿病并发心房颤动机制的研究进展

<正>除心脏本身原因如心脏瓣膜病及心力衰竭外,经典的心血管危险因素如高血压、糖尿病均可促进心房颤动的发生。糖尿病是心房颤动发生的危险因素,糖尿病患者心房颤动的发生风险较非糖尿病患者高约40%~([1])。糖尿病患者常合并心房颤动,在有研究显示13%糖尿病患者合并有心房颤动~([2])。ADVANCE研究也表明糖尿病患者中心房颤动的发生率明显增高,且接近8%糖尿病患者合并有心房颤动,同时其相关全因死亡风险增加61%,心血管事件增加77%,脑血管事件增加68%,心力衰竭风险增     

糖尿病与心房纤颤研究进展

糖尿病和心房纤颤是我国常见的疾病,根据流行病学资料,两者的患病率高,随年龄增长而增长,且相互并存、相互影响,导致心脑血管意外发生率及病死率的升高,加重社会公共卫生负担。本研究就糖尿病与心房纤颤两者的相互影响以及治疗策略进行综述。     

心房电重构及其在心房纤颤发生和维持中的作用

心房纤颤 (AF)是临床上仅次于过早搏动的最常见的心律失常。在一般人群中 ,它的发病率可以达到0 .4 %以上 [1] 。房颤也是一种危害性较大的疾病 ,它使心房有效收缩消失 ,减少心排血量。同时 ,它的持续存在 ,也将增加循环栓塞的危险。近年来 ,随着对房颤临床和基础研究的不断深入 ,有不少新概念被提出 ,心房电重构即是其中之一。1　概述早有四十多年前 ,一些学者就已发现部分心房纤颤的病人没有明确的心脏器质性改变 ,他们将之称为孤立性房颤 (L one Fibrillation) [2 ] 。此后 ,随着各种心脏检查设备的发展 ,越来越多的证据支持这一观点 […     

The role of rotors in atrial fibrillation

Despite significant advances in our understanding of atrial fibrillation (AF) mechanisms in the last 15 years, ablation outcomes remain suboptimal. A potential reason is that many ablation techniques focus on anatomic, rather than patient-specific functional targets for ablation. Panoramic contact mapping, incorporating phase analysis, repolarization and conduction dynamics, and oscillations in AF rate, overcomes many prior difficulties with mapping AF. This approach provides evidence that the mechanisms sustaining human AF are deterministic, largely due to stable electrical rotors and focal sources in either atrium. Ablation of such sources (Focal Impulse and Rotor Modulation: FIRM ablation) has been shown to improve ablation outcome compared with conventional ablation alone; independent laboratories directly targeting stable rotors have shown similar results. Clinical trials examining the role of stand-alone FIRM ablation are in progress. Looking forward, translating insights from patient-specific mapping to evidence-based guidelines and clinical practice is the next challenge in improving patient outcomes in AF management.     

The role of alcohol in new-onset atrial fibrillation

Forty cases of new-onset atrial fibrillation (AF) were reviewed to establish the frequency of various causes. Alcohol intoxication caused or contributed to 14 cases (35%). Coronary artery disease (22.5%) and pulmonary disease (22.5%) were also common causes of acute AF. Among patients less than 65 years old, alcohol caused or contributed to approximately two thirds (63%) of the cases of AF. Thyrotoxicosis was uncommon (one case in 40); no patient had a diagnosis of mitral stenosis, pulmonary embolism, or pericarditis. There were no complications of AF in alcoholic patients; the majority (88.9%) converted spontaneously to a normal sinus rhythm within 24 hours. Alcohol intoxication should be considered early in the differential diagnosis of new-onset AF in young patients. Many patients may not require admission to an intensive care unit or a costly battery of diagnostic tests.     

The role of transesophageal echocardiography in atrial fibrillation

Transesophageal echocardiography (TEE) is very useful in the evaluation and management of selected patients with atrial fibrillation, primarily by clear visualization of left atrial appendage thrombus. Insights gained from two-dimensional and Doppler interrogation of the appendage include recognition of the association of dense spontaneous contrast and reduced mechanical appendage function with increased risk of thromboembolism. TEE-guided cardioversion has been shown to be safe and effective for a subset of patients, provided it is performed by experienced operators familiar with imaging the appendage and recognizing artifacts.     

The potential role of thiazolidinediones in atrial fibrillation

Thiazolidinediones (TZDs) represent insulin sensitizing drugs that are being increasingly used for the treatment of type 2 diabetes. These agents have also pleiotropic properties that possibly contribute to their favorable cardiovascular effects. In particular, TZDs have anti-inflammatory and anti-oxidant potential while they modulate cardiovascular remodeling. On the other hand, atrial electrical and structural remodeling constitutes the substrate for atrial fibrillation (AF) development and perpetuation. Of note, inflammation and oxidative stress have been recently implicated in the pathogenesis of AF while non-channel blocking drugs with pleiotropic properties, including anti-inflammatory and anti-oxidant, seem to favorably affect atrial remodeling. It is therefore reasonable to assume that TZDs may have a role in the management of AF. Despite some limited observations, no study to date has examined the effect of TZDs therapy on AF development. In addition, the role of these agents in atrial remodeling has not been clarified yet.     

The role of atrial ectopics in initiating paroxysmal atrial fibrillation.

AIMS: To characterize the nature and timing of atrial ectopics preceding clinical episodes of paroxysmal atrial fibrillation. METHODS AND RESULTS: Holter recordings (n= 177, 60 patients, 58% male, mean age 61.7 +/- 11.5 years) were performed on patients with paroxysmal atrial fibrillation. These were subjected to standard analysis and recordings containing atrial fibrillation episodes suitable for analysis were identified (n = 74). Beat interval files differentiating sinus rhythm from atrial fibrillation were generated and atrial ectopics were identified. Atrial ectopics preceding atrial fibrillation were found to be more frequent (5.07 +/- 7.39 min(-1)) and more premature (ratio of coupling interval to that of surrounding sinus cycles = 0.56 +/- 0.08) compared to ectopics occurring remote from atrial fibrillation episodes (frequency = 3.60 +/- 7.32 min(-1) P = 5 x 10(-24), prematurity ratio = 0.60 +/- 0.10, P = 2 x 10(-73)). Atrial ectopic coupling interval frequency histograms were generated and analysed visually and by an automated statistically based test. Many ectopics were seen to occur at one coupling interval in 27 recordings (in eight this occurred only preceding atrial fibrillation onset, while in a further 19 cases this was also seen remote from atrial fibrillation onset). Overall 45% of ectopics preceding atrial fibrillation episodes occurred in isolation, 13% as part of a bigeminal rhythm, 22% as couplets and 20% as runs. This pattern did not differ from that seen remote from atrial fibrillation episodes. CONCLUSION: Paroxysmal atrial fibrillation is preceded by ectopics of a fixed coupling interval in a significant proportion of patients. If, as seems likely, this is a marker of 'focally mediated' atrial fibrillation, then Holter techniques may provide a useful screening tool with which to identify patients suitable for fuller electrophysiological assessment.     

炎症在老年性心房颤动中的作用

目的探讨炎症在老年性心房颤动（AF）、心房重构的发生及持续中的作用。方法选择88例老年患者,其中持续性房颤组30例,阵发性房颤组30例,窦性心律组28例。所有入选患者进行心脏超声心动图检查,并检测患者外周血高敏C-反应蛋白（hs—CRP）、血管紧张素转换酶（ACE）水平。结果外周血hs—CRP、ACE水平持续性房颤组为（8．9±2．6）mg／ml、（89．7±11．3）U／L,阵发性房颤组为（4．7±2．3）mg／ml、（39．6±10．6）U／L,窦性心律组为（1．9±0．7）mg／ml、（36．8±10．5）U／L。持续性房颤组外周血ACE、hs—CRP水平高于阵发性房颤组和窦性心律组（P〈0．05）,阵发性房颤组外周血hs—CRP水平高于窦性心律组（P〈0．05）,阵发性房颤组ACE水平与窦性心律组相比差异无统计学意义（P〉0．05）。结论外周血hs—CRP、ACE水平增高与心房颤动的发生和持续可能相关。