射频消融治疗阵发性室上性心动过速37例报告

射频消融术 (RFCA)已成为治疗各种原因的阵发性室上性心动过速的重要的非药物性治疗方法之一 [1— 3] 。我院于 1 999年 1月至 2 0 0 2年 4月用 RFCA方法治疗 3 7例阵发性室上性心动过速病人 ,现将治疗结果及点滴体会报告如下 :1　资料和方法1 .1　一般资料 :3 7例中男 2 0例 ,女 1 7例 ,年龄 2 1～ 79岁 (平均 44± 5 )岁。阵发性室上性心动过速病史 2～ 4年 ,虽经多种药物治疗仍发作频繁 ,无器质性心脏病。消融治疗前电生理检查证实房室结双径路 (A2— H2跳跃≥60 ms) 1 5例 ,房室旁路 2 4例 (左侧旁道 1 6例 ,右侧旁道8例 )。其中 2…     

老年人心动过速的导管射频消融治疗

射频消融治疗心动过速是一种有效的根治性方法。本文报告自1993年3月～1999年2月以来我院收治的47例老年人心动过速的射频消融(RFCA)治疗,重点讨论房室结折返性心动过速(AVNRT)与房室折返性心动过速(AVRT)消融体会。1　材料和方法1.1　临床资料在已完成RFCA的420例心动过速病人中,年龄≥60岁的老年人47例,男24例,女23例,平均年龄63±2(60～71)岁。冠心病2例,冠心病合并高血压4例,高血压合并糖尿病3例,心肌病1例,风心病1例,其余36例无其他心血管异常。4例伴有糖尿病,3例心动过速发作时伴有心绞痛,1例伴有左心衰。1.2　电生理标测和RF…     

射频消融对血小板活化的影响

目的 :探讨射频消融 （RFCA）损伤血小板活化的关系。方法 :对 30例连续接受 RFCA治疗的患者在插管前、电生理标测后、放电后及术后 40～ 48h,血小板 GMP- 140表达情况进行检测。结果 :在标测后、放电后及术后 48h,血小板活化率依次明显增高 ,与插管前基线值比较 ,均 P<0 .0 1。结论 :射频消融可激活血小板而使血凝状态发生改变 ,射频损伤具有血栓源性。     

导管射频消融对36例心动过速的治疗

近年,导管射频消融术(RFCA)已成为根治心动过速的一种安全有效方法,本文报告我院1年来采用RFCA对36例心动过速病人的治疗,着重探讨术前无创性检测的价值。1　资料与方法1.1　临床资料心动过速36例。其中特发性左室室速(LVVT)4例,阵发性室上性心动过速(PSVT)32例,房室折返性心动过速(AVRT)23例,房室结折返性心动过速(AVNRT)9例。男28例,女8例;年龄14～61(平均37)岁。有反复心悸、胸闷2个月～25年,其中4例心动过速发作时伴有头晕、出汗、血压下降。常规检查均未发现器质性心脏病。1.2　方法全部病人术前行常规心电图,食道心房调搏,…     

射频消融治疗折返性房性心动过速

射频消融治疗折返性房性心动过速吴书林，郑祥生，欧阳非凡，钱卫民，李海杰，孙家珍，尹滔业，冯建章作者单位：广东省人民医院，广东省心血管病研究所（５１００８０）本文报告射频消融成功治疗折返性房性心动过速一例，并对有关电生理结果和定位标测略加讨论。临床资料...     

房性心动过速的导管射频消融治疗

对４例房性心动过速（房速）患者进行心内电生理标测和导管射频消融治疗，探讨房速的电生理特点。其中男性２例、女性２例，年龄２４～５６岁，均有明确的房速发作史（１０个月～１０年），发作时心室率１５０～２２０ｂｐｍ，食管起搏均能诱发与终止房速。心动过速时食管...     

川崎病血管内皮功能与血小板激活的相关性及复方丹参滴丸的影响

目的:研究川崎病(Kawasaki disease,KD)患儿血管内皮功能与血小板激活状态的相关性及复方丹参滴丸的影响。方法:KD患儿60例,随机分为丹参治疗组(32例)和普通治疗组(28例)。另35名正常小儿作为对照组。用流式细胞仪检测血小板膜糖蛋白CD62p、CD63的表达,同时用超声诊断仪测定肱动脉直径,计算肱动脉内径舒缩百分率(D％)。结果:KD患儿治疗前、后其CD62p、CD63的表达及D％均分别明显高于,低于对照组(P均<0.01);用复方丹参治疗3个月后CD62p、CD63的表达及D％均分别明显低于,高于治疗前(P<0.01),而普通治疗组治疗前、后各指标均无显著差异(P>0.05)。结论:KD患儿在恢复期血小板活化程度仍明显增高,仍有血管内皮功能障碍;复方丹参滴丸能有效改善之。     

射频消融对血小板活性的影响

为探讨射频消融（RFCA）术后外周血管栓塞发生机理，以28例室上性心动过速为对象，在术前、术后即刻分别采股动脉、静脉血标本观察血小板半峰值聚集时间（T1／2），最大聚集率（Ma％）及血小板膜糖蛋白Ⅳ（GPⅣ），凝血酶敏感蛋白（TSP）的变化。结果表明消融术后即刻与术前比较：ADP和胶原诱导的股静、动脉血小板T1／2均缩短；ADP和胶原血小板Ma％均明显增高；静急状态下血小板膜上GPⅣ、TSP分子数无统计学差异；凝血酶诱导后血小板膜GPⅣ明显增高和TSP数量明显增多。术前、术后股动脉与股静脉标本之间上述各项指标均无差异。提示RFCA可引起血小板活性增高，且为全身系统性改变，它在一定程度上增加了外周血管栓塞的危险性。     

氨氯地平对射频消融术后血小板聚集率的影响

目的探讨射频消融术(RFCA)对血小板聚集率(PAG)的影响及氨氯地平的防治效果。方法采用Bom比浊法,观察96例患者射频消融术前、后PAG的变化及氨氯地平的干预效果。结果对照组PAG由术前的(57.17±11.08)%升高到术后的(70.25±11.89)%,差异有统计学意义(P<0.05)。结论射频消融术使血小板聚集率增加,氨氯地平有预防作用。     

氨氯地平对射频消融术后血小板聚集率的影响

目的探讨射频消融术(RFCA)对血小板聚集率的影响及氨氯地平的防治效果。方法采用Born比浊法,观察60例患者射频消融术前后血小板聚集率(PAG)的变化及氨氯地平的干预效果。结果对照组PAG由术前的(56.72±11.28)%升高到术后的(69.33±12.20)%,差异有统计学意义(P<0.05);试验组术后为(38.45±6.73)%,较术前(36.92±6.26)%也有所增高,但差异无统计学意义(P>0.05)。结论射频消融术使血小板聚集率增加,氨氯地平有预防作用。     

Transvenous cryoablation reduces platelet activation during pulmonary vein ablation compared with radiofrequency energy in patients with atrial fibrillation

BACKGROUND: Radiofrequency (RF) ablation procedures for atrial fibrillation (AF) are associated with potential risks of thromboembolism, which may be minimized by the use of cryoablation that preserves the integrity of endocardium. The objective of this study was to compare the thrombogenic potential of transvenous cryoablation versus RF ablation during pulmonary vein (PV) isolation. METHODS AND RESULTS: Thirty consecutive patients with paroxysmal AF were randomized to undergo segmental PV isolation procedure using 4-mm tip RF ablation (n = 15) or cryoablation (CryoCor, San Diego, CA, USA) (n = 15). Blood samples were drawn after sheath insertion (baseline), after transseptal puncture, before ablation (after heparin administration), and after isolation of a superior PV. Activation of coagulation was measured with plasma levels of prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), and platelets by plasma level of beta-thromboglobulin (beta-TG) and flow cytometric enumerating of P-selectin (CD62)-positive platelets. In both groups, the plasma level of beta-TG, F1 + 2, and TAT were elevated after sheath insertion. The percentage changes in plasma level of beta-TG, F1 + 2, and TAT and CD41/62-positive platelets from baseline after transseptal puncture and before ablation were similar (P > 0.05). However, the percentage changes in CD62-positive platelets from baseline were significantly higher in patients treated with RF ablation (82 +/- 20%) than with cryoablation (22 +/- 14%, P = 0.02), although their plasma levels of beta-TG, F1 + 2, and TAT were not different (P > 0.05). CONCLUSIONS: Significant platelet and coagulation activations were observed during PV ablation procedures, and heparin administration only prevented activation of coagulation but not platelets. Persistent platelets activation was observed during RF energy application, but not during cryoablation.     

超声消融与射频消融对血凝状态影响的实验研究

目的通过观察超声与射频环状消融入心静脉口对血凝状态的影响,评价超声消融入心静脉口的安全性,为超声消融肺静脉口治疗局灶性心房颤动提供实验依据.方法选用健康成年杂种犬11只,随机分成两组5只行上、下腔静脉口超声消融,6只行上、下腔静脉口射频环状消融.分别在插管前、插管后、消融后即刻、消融后30 min及48 h取外周静脉血5 ml,用流式细胞仪动态检测血小板α-颗粒糖蛋白(GMP-140)阳性表达活化血小板百分率的变化,用发光底物法测定组织型纤溶酶原激活剂(t-PA)及组织型纤溶酶原激活剂抑制物-1(PAI-1)的变化.结果超声消融组与射频消融组GMP-140阳性表达活化血小板百分率,在插管后较插管前明显升高,消融后即刻明显升高,且继续升高至消融后48 h.两组比较,消融后即刻、30 min及48 h,射频消融组GMP-140阳性表达活化血小板百分率均高于超声消融组.两组t-PA及PAI-1在插管后较插管前无明显变化,t-PA于消融后即刻达高峰,至消融后30 min开始下降,PAI-1于消融后30 min达高峰,两者均于消融后48 h恢复正常,两组t-PA与PAI-1差异无显著性.结论超声消融与射频消融均可激活血小板,使血液处于高凝状态,但超声消融对血小板激活程度低于射频消融,说明与射频消融相比,超声消融入心静脉口不易形成血栓,较射频消融安全.     

血压盐敏感者早期血管内皮功能改变研究

目的 盐敏感者较早出现靶器官功能损害,其心血管风险增加.本研究探讨血压正常或血压轻度偏高的盐敏感者血管内皮功能改变.方法 选99例年龄16～60岁、血压正常或血压轻度偏高者参与为期2周的慢性盐负荷试验,检测盐敏感性.试验包括基线3 d,低盐饮食、高盐饮食各7 d的研究.基线时采用彩色多普勒超声检测血流调节的血管扩张性,反映内皮依耐性血管舒张功能.试验各个阶段测量体重、血压,并收集血、尿标本.结果 盐敏感者检出率17.2%,盐敏感与盐不敏感者基线尿钠、钾排泄量无差异,而血浆NO浓度盐敏感者低于盐不敏感者[(61. 2±13.3)μmol/L比(82.5±14.6)μmol/L,P＜0.05];盐敏感者血流介导的肱动脉扩张性低于盐不敏感者[(10.2±2.5)%比(14.5±1.6)%,P＜0.05].结论 盐敏感者尽管尚处在血压正常或血压轻度偏高阶段已存在内皮功能损伤.

Abstract：

Objective Salt-sensitivity is associated with more severe target organ injury and higher mortality in patients with essential hypertension. We compared the vascular endothelial function between saltsensitive subjects(SS)and non-salt-sensitive subjects(NSS)with normal or mildly increased blood pressure. Methods Ninety-nine subjects(aged 16-60 years)with normal blood pressure or mild hypertension(degree 1)were enrolled. The test program included 3 days baseline investigation, 1 week lowsalt loading phase and 1 week high-salt loading phase. Endothelial function was assessed by measuring the flow mediated dilatation(FMD)of the brachial artery using high resolution ultrasound. Results There was 17. 2% SS. Plasma NOx level[(61.2 ± 13. 3)μmol/L vs(82. 5 ± 14. 6)μmol/L, P ＜ 0. 05]and FMD [(10.2±2.5)%vs(14.5 ± 1.6)%, P ＜0.05]were significantly lower in SS subjects than in NSS subjects. Conclusion Vascular endothelial dysfunction was evidenced in SS subjects with normal blood pressure or in the early stage of hypertension.     

Efficacy and safety of radiofrequency catheter ablation in the elderly

Introduction Radiofrequency (RF) catheter ablation has not been widely undertaken in elderly patients. The aim of our study was to compare the success rate of radiofrequency ablation and the incidence of severe procedural complications in young-adult and elderly patients. Methods We enrolled all patients undergoing radiofrequency catheter ablation procedures for supraventricular and ventricular arrhythmias at our Cardiology Department from January 2000 to December 2005. The patients were divided into two groups according to age: patients aged <70 years (group A) and those aged ≥70 years (group B). Group B was then divided into two subgroups: B1 (age 70–79 years) and B2 (age ≥80 years). We recorded the incidence of procedural complications and the long-term efficacy (mean follow-up 46 ± 20 months). Results We studied 605 patients, 69% in group A and 31% in group B (24% in subgroup B1 and 7% in B2). The prevalence of structural heart disease was higher in elderly patients than in young adults (83 vs 37%, p < 0.01). The rate of procedural complications was 1.3%; no differences emerged between groups A and B (1.2 vs 1.5%, p = NS) or among groups A, B1 and B2 (1.2 vs 1.4 vs 2%, p = NS). The success rate of catheter ablation was 91%, with no differences between the age-groups (92 vs 88%, p = NS) or among groups A, B1 and B2 (92 vs 88 vs 88%, p = NS). Conclusion Catheter ablation in elderly and very elderly patients is as effective and safe as in young-adult subjects, at least in cases which do not require left heart catheterization.     

射频消融术治疗阵发性室上性心动过速48例临床分析

目的：分析经导管射频消融术（RFCA）治疗阵发性室上性心动过速（PSVT）的疗效和合并症。方法：入选48例PSVT患者，均根据心内电生理检查结果诊断，而后行射频消融术，对射频消融术方法及术中、后并发症进行总结分析。结果：46例（95．83％）治愈，2例（4．17％）失败，4例（8．33％）出现合并症。2例复发再次行RFCA，其后随访6月，均未再发作心动过速。结论：射频消融术治疗阵发性室上性心动过速疗效颇佳。