共查询到20条相似文献,搜索用时 31 毫秒
1.
T. Bauernfeind A. Kardos C. Foldesi A. Mihalcz P. Abraham T. Szili-Torok 《Journal of interventional cardiac electrophysiology》2007,19(3):195-199
Objectives We aimed to test the maximum voltage-guided cavotricuspid isthmus (CTI) ablation technique during ongoing atrial flutter.
Background Former pathological and electrophysiological studies clarified that the cavotricuspid isthmus is composed of distinct muscular
bundles, which are responsible for the conduction of electrical activation. Based on this observation, a maximum voltage-guided
ablation technique (MVGT) was developed. This technique was assessed during pacing from the coronary sinus and was reported
to be a feasible method to reach bidirectional isthmus block without the need for a complete anatomic ablation line.
Methods This was a prospective, randomized single center study. Twenty patients underwent CTI ablation during atrial flutter. In group
I (10 pts) CTI ablation was performed with complete anatomical ablation line. In group II (10 pts) ablation was guided by
the highest amplitude potentials on the CTI sequentially until bidirectional isthmus block was reached. The following parameters
were compared: acute success rate, procedure time, fluoroscopy time, number of radiofrequency (RF) applications and total
RF duration.
Results In all patients, atrial flutter terminated during ablation. Bidirectional isthmus block could be achieved in all pts. Procedure
time was shorter in group II (107 ± 40 vs 68 ± 19 min, p < 0.01). Significantly less fluoroscopy was used in group II (22.6 ± 10.6 vs 12.1 ± 3.8 min, p < 0.01). There were less RF applications in group II (27.1 ± 21.5 vs 5.9 ± 2.4, p < 0.001).
Conclusions (1) The major finding of this study is that MVGT is a feasible method even during ongoing atrial flutter. (2) Our data confirm
that MVGT is an effective technique for CTI ablation with considerable decrease in procedure and fluoroscopy times. 相似文献
2.
JEAN‐FRANCOIS SARRAZIN M.D. ERIC GOOD D.O. MICHAEL KUHNE M.D. HAKAN ORAL M.D. FRANK PELOSI M.D. AMAN CHUGH M.D. KRIT JONGNARANGSIN M.D. THOMAS CRAWFORD M.D. MATTHEW EBINGER D.O. FRED MORADY M.D. FRANK BOGUN M.D. 《Journal of cardiovascular electrophysiology》2010,21(9):1002-1008
Mapping of Post‐Infarction PVCs . Introduction: Premature ventricular complexes (PVCs) occur frequently in patients with heart disease. The sites of origin of PVCs in patients with prior myocardial infarction and the response to catheter ablation have not been systematically assessed. Methods and Results: In 28 consecutive patients (24 men, age 60 ± 10, ejection fraction [EF] 0.37 ± 0.14) with remote myocardial infarction referred for catheter ablation of symptomatic refractory PVCs, the PVCs were mapped by activation mapping or pace mapping using an irrigated‐tip catheter in conjunction with an electroanatomic mapping system. The site of origin (SOO) was classified as being within low‐voltage (scar) tissue (amplitude ≤1.5 mV) or tissue with preserved voltage (>1.5 mV). The SOO was confined to endocardial scar tissue in 24/28 patients (86%). The SOO was outside of scar in 3 patients and could not be identified in 1 patient. At the SOO, local endocardial activation preceded the PVC by 46 ± 19 ms, and the electrogram amplitude during sinus rhythm was 0.48 ± 0.34 mV. The PVCs were effectively ablated in 25/28 patients (89%), resulting in a decrease in PVC burden on a 24‐hour Holter monitor from 15.6 ± 12.3% to 2.4 ± 4.2% (P < 0.001). The SOO most often was confined to scar tissue located in the left ventricular septum and the papillary muscles. Conclusion: Similar to post‐infarction ventricular tachycardia, PVCs after remote myocardial infarction most often originate within scar tissue. Catheter ablation of these PVCs has a high‐success rate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1002‐1008, September 2010) 相似文献
3.
MICHAEL KÜHNE M.D. JEAN-FRANCOIS SARRAZIN M.D. THOMAS CRAWFORD M.D. MATTHEW EBINGER D.O. ERIC GOOD D.O. AMAN CHUGH M.D. KRIT JONGNARANGSIN M.D. FRANK PELOSI Jr. M.D. HAKAN ORAL M.D. FRED MORADY M.D. FRANK M. BOGUN M.D. 《Journal of cardiovascular electrophysiology》2010,21(1):42-46
Mapping of Idiopathic Ventricular Arrhythmias. Background: Termination of ventricular tachycardia (VT) by mechanical pressure has been described for fascicular and postinfarction VT. Mechanical interruption of idiopathic ventricular arrhythmias (VT/premature ventricular complexes [PVCs]) arising in the right ventricular outflow tract (RVOT) has not been described in systematic fashion. Methods: Eighteen consecutive patients (13 females, age 49 ± 13 years, ejection fraction 0.55 ± 0.12) underwent mapping and ablation of RVOT VT or PVCs. In 7 patients, 9 distinct VTs (mean cycle length 440 ± 127 ms), and in 11 patients, 11 distinct PVCs originating in the RVOT were targeted. Mechanical termination was considered present if a reproducibly inducible VT was no longer inducible or if frequent PVCs suddenly ceased with the mapping catheter at a particular location. Endocardial activation time, electrogram characteristics, and pace‐mapping morphology were assessed at this location. Radiofrequency energy was delivered if mechanical termination was observed. Results: All targeted arrhythmias were successfully ablated. In 7 of 18 patients (39%), catheter manipulation terminated the arrhythmia with the mapping catheter located at a particular site. Local endocardial activation time was earlier at sites of mechanical termination (?31 ± 7 ms) compared with effective sites without termination (?25 ± 3 ms, P = 0.04). The 10‐ms isochronal area was smaller in patients with mechanical interruption (0.35 ± 0.2 cm2) than in patients without mechanical termination (1.33 ± 0.9 cm2, P = 0.01). At all sites susceptible to mechanical trauma, the pace map displayed a match with the targeted VT/PVC. All sites where mechanical termination of VT or PVCs occurred were effective ablation sites. Conclusions: Mechanical suppression at the site of origin of idiopathic RVOT arrhythmias frequently occurs during the mapping procedure and is a reliable indicator of effective ablation sites. Mechanical termination of RVOT arrhythmias may be indicative of a more localized arrhythmogenic substrate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 42–46, January 2010) 相似文献
4.
E. Kevin Heist Jianping Chevalier Godtfred Holmvang Jagmeet P. Singh Patrick T. Ellinor David J. Milan Andre D’Avila Theofanie Mela Jeremy N. Ruskin Moussa Mansour 《Journal of interventional cardiac electrophysiology》2006,17(1):21-27
Objective Integration of 3-D electroanatomic mapping with Computed Tomographic (CT) and Magnetic Resonance (MR) imaging is gaining acceptance
to facilitate catheter ablation of atrial fibrillation. This is critically dependent on accurate integration of electroanatomic
maps with CT or MR images. We sought to examine the effect of patient- and technique-related factors on integration accuracy
of electroanatomic mapping with CT and MR imaging of the left atrium.
Materials and methods Sixty-one patients undergoing catheter-based atrial fibrillation (AF) ablation procedures were included. All patients underwent
cardiac CT (n = 11) or MR (n = 50) imaging, and image integration with real-time electroanatomic mapping of the aorta and left atrium (LA). CARTO-Merge
software (Biosense-Webster) was used to calculate the overall average accuracy of integration of electroanatomic points with
the CT and MR-derived reconstructions of the LA and aorta.
Results There was a significant correlation between LA size assessed by electroanatomic mapping (112 ± 31 ml) and average integration
error (1.9 ± 0.6 mm) (r = 0.46, p = 0.0003). There was also greater integration error for patients with LA volume ≥ 110 ml (n = 31) versus < 110 ml (n = 30) (p = 0.004). In contrast, there was no significant association between average integration error and paroxysmal versus persistent
AF, left ventricular ejection fraction, days from imaging to electroanatomic mapping, or images derived from CT versus MR.
Conclusions Patients with larger LA volume may be prone to greater error during integration of electroanatomic mapping with CT and MR
imaging. Strategies to reduce integration error may therefore be especially useful in patients with large LA volume. 相似文献
5.
《Archives of Cardiovascular Diseases》2023,116(2):62-68
BackgroundCatheter ablation is a first-line treatment for symptomatic right ventricular outflow tract (RVOT) premature ventricular complexes (PVCs). There is evidence of displacement of the ablation target site during PVCs relative to the location in sinus rhythm (SR).AimTo analyse the extent of displacement induced by RVOT PVCs and its effect on the ablation sites and the mid-term efficacy of ablation.MethodsIn this multicentre French study, we retrospectively included 18 consecutive adults referred for ablation of RVOT PVCs using a three-dimensional (3D) mapping system. PVC activation maps were performed conventionally (initial map), then each PVC activation point was manually reannotated considering the 3D location on a previous SR beat (corrected map). The ablation-site locations on the initial or the corrected area, including the 10 best activation points, were analysed. Mid-term efficacy was evaluated.ResultsThe direction of map shift during PVCs relative to the map in SR occurred along a vertical axis in 16 of 18 patients. The mean activation-point displacement for each of the 18 mapped chambers was 5.6 ± 2.2 mm. Mid-term recurrence of RVOT PVCs occurred in 5 (28%) patients. In all patients with recurrences, no significant ablation lesion was located on the corrected (true) site of origin.ConclusionsRVOT PVCs induce a vertical anatomical shift that can mislead physicians about the true location of the arrhythmia's site of origin. Our study highlights the association between mid-term PVC recurrence and the absence of spatial overlap between ablation points and the corrected site of origin. 相似文献
6.
目的:探讨EnSite Velocity系统指导单导管射频消融(RFCA)治疗右心室流出道(ROVT)室性期前收缩(PVCs)的可行性。方法28例药物未能控制的ROVT PVCs患者行单导管消融术,消融导管在EnSite Velocity系统指导下进行解剖标测重建RVOT模型,经激动顺序标测及起搏标测明确消融靶点。结果 RVOT建模时间及所需X线曝光时间为(6.6±2.2) min、(0.5±0.4)min。即刻消融成功率100%,异位起搏点起源自间隔部17例(60.7%)、前壁3例、后壁3例、游离壁5例。消融靶点较体表QRS波群起点提前(34.2±5.1)ms。手术总时间、总X线曝光时间、标测时间、消融时间分别为(56.2±13.9)min、(1.1±0.7)min、(15.5±8.2)min、(5.5±2.9)min,其中6例零X线曝光。术中、术后没有相关并发症出现,观察(19.7±8.6)d,复发1例。结论 RVOT PVCs多起源于间隔部,经EnSite Velocity系统指导的单导管消融安全有效。 相似文献
7.
《Revista portuguesa de cardiologia》2022,41(8):653-662
Introduction and ObjectivesAblation of multifocal premature ventricular complexes (PVCs) is challenging. Activation mapping can be performed for the predominant morphology, but may be useless for other less prevalent ones. We aimed to describe the efficacy of an automated pace-mapping software-based ablation strategy for ablating the site of origin of multiple PVC locations.MethodsConsecutive patients referred for ablation of multifocal PVCs were prospectively enrolled. Spontaneous PVC templates were recorded and a detailed pace-mapping map was generated to spot the site of origin of PVCs.ResultsA total of 47 PVCs were targeted in 21 patients (five and 16 patients with three or two PVCs morphologies each, respectively). Detailed pace-mapping comprising 73.5±41.6 different pacing locations was performed (best matching 97.2% [IQR 95.9-98.3%] similar to the clinical PVC). Activation points were acquired if possible, although ablation was only based on pace-mapping in 13 (27.6%) foci. Complete acute procedural success was obtained in 14 (66.7%) patients, while one PVC morphology was deliberately not ablated in five patients (23.8%). After 12.3±9.4 months of follow-up, PVC burden decreased from 24.4±10.4% to 5.6±5.0% (p<0.001). Interestingly, patients with acute procedural failures or with some PVCs deliberately not targeted during the procedure also experienced a significant decrease in PVC burden (30.0±8.9% to 11.9±3.5%, p=0.002).ConclusionQuantitative morphology-matching software can be used to obtain a detailed map identifying the site of origin of each single PVC, and successful ablation can be performed at these sites, even if activation points cannot be obtained due to the paucity of ectopic beats. 相似文献
8.
目的报道4例特发性右室流出道(RVOT)室性早搏(PVC)触发多形性室性心动过速/心室颤动(PVT/VF)的临床特点。方法 76例起源于RVOT的VT患者,其中4例为PVC触发PVT/VF,总结4例的临床资料并与另72例有关资料相比较。结果所有4例触发PVT/VF时的PVC与孤立PVC的形态一致,但2种PVC的联律间期发生了明显改变,其改变幅度均≥70 ms,其中2例缩短,2例延长。1例孤立PVC时的联律间期亦不恒定。72例PVC触发的单形VT患者每天PVC次数为15 427±1 109,QT间期为404±15 ms,孤立PVC联律间期为419±22ms。4例PVC触发PVT/VF患者中3例1天的PVC次数与72例PVC触发的单形VT患者平均PVC次数相当。4例患者的QT间期及孤立PVC联律间期与另72例患者相当。而4例PVT/VF的周长均小于280 ms,明显短于72例VT的平均周长(324±59 ms)。72例单形VT患者发生晕厥比率4.1%;4例PVT/VF患者中发生晕厥者2例。采用激动标测和起搏标测证实4例患者PVC均起源于RVOT间隔侧,经射频导管消融PVC取得成功。结论起源于RVOT的PVC触发PVT/VF具有PVC联律间期不恒定及PVT/VF的周长短的临床特征,射频导管消融治疗有效。 相似文献
9.
Yumiko Kanei M.D. Meir Friedman M.D. Naomi Ogawa M.D. Sam Hanon M.D. Patrick Lam M.D. Paul Schweitzer M.D. 《Annals of noninvasive electrocardiology》2008,13(1):81-85
Background : Recent case series have shown reversal of left ventricular (LV) dysfunction after catheter ablation of frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT). We conducted a retrospective study to evaluate the prevalence of patients with frequent RVOT PVCs (≥10 per hour) and LV dysfunction. Methods : RVOT PVC was defined as PVC with left bundle branch block morphology and inferior axis on a 12‐lead ECG. We included patients with frequent RVOT PVCs on 24‐hours Holter monitor who had a recent evaluation of LV function. Patients with structural heart disease, including obstructive coronary artery disease, were excluded. Patients were divided into three groups based on the number of PVCs (<1000/24 hour, 1000–10,000/24 hour, ≥10,000/24 hour), and the prevalence of LV dysfunction was evaluated in each group. Results : Our analysis included 108 patients: 24 patients had <1000PVCs/24 hour, 55 patients had 1000–10,000PVCs/24 hour, and 29 patients had ≥10,000PVCs/24 hour. The prevalence of LV dysfunction was 4%, 12%, and 34%, respectively (P = 0.02). With logistic regression analysis, non‐sustained ventricular tachycardia was an independent predictor of LV dysfunction with odds ratio of 3.6 (1.3–10.1). Conclusion : We demonstrated a significant association between frequent RVOT PVCs and LV dysfunction in patients without structural heart disease. 相似文献
10.
目的报道起源于左后分支的室胜早搏(PVC)的临床心电图特点及射频消融经验。方法8例无器质性心脏病且频发PVC的患者(男5例,女3例),其中5例伴有阵发性左心室室性心动过速(室速),年龄19—54(42.7±10.6)岁。其中3例患者行常规射频导管消融治疗,5例在三维电解剖标测系统(Carto系统)指导下行射频消融治疗。在左后分支标测到最早心室激动点处给予温度控制下射频导管消融。结果8例患者术前均以体表心电图定位起源于左后分支处区域,其PVC或左心室室速的体表心电图均为典型特发性左心室室速(ILVT)表现(QRS波呈右束支阻滞图形,心电轴左偏,QRS时限≤160ms)。其中,QRS波I导联6例呈rS,2例呈Rs;aVL导联呈qR;II、Ⅲ、aVF导联呈rs。胸前导联多在V,~V,处移形,由R转为Rs或rs。在消融成功部位(最早激动点)消融导管均记录到融合有浦肯野电位(PP)的V波,V波提前于体表心电图QRS波时限20—48(33.0±10.2)ms,8例患者行射频消融即时成功。术后3~15(8.1±4.2)个月复查,8例患者动态心电图的PVC均小于10000/24h。所有患者术中、术后无并发症发生。结论起源于左后分支处的PVC,在消融导管标测到PVC最早激动点并融合有PP时可成功消融PVC。 相似文献
11.
Dongjie Xu Bin Yang Qijun Shan Jiangang Zou Minglong Chen Chun Chen Xiaofeng Hou Fengxiang Zhang Wen-qi Li Kejiang Cao Hung-Fat Tse 《Journal of interventional cardiac electrophysiology》2009,25(3):171-174
Background A remote magnetic navigation system (MNS) has been developed for mapping and catheter ablation of cardiac arrhythmias. The
present study evaluates the safety and feasibility of this system to perform radiofrequency (RF) ablation in patients with
supraventricular tachycardias (SVT).
Methods A total of 32 patients (22 female; mean age 44 ± 16 years) with documented SVT underwent mapping and ablation using Helios
II (a 4-mm-tip magnetic catheter), under the guidance of the MNS (Niobe II, Stereotaxis, Inc.).
Results Catheter ablation procedure with MNS was successful in 30/32 (94%) patients including all patients (27/27, 100%) with atrioventricular
nodal reentrant tachycardia (AVNRT) and three of five patients (60%) with atrioventricular reentrant tachycardia (AVRT) without
any complication. The procedural successful rate in patients with AVNRT was significantly higher than those in patients with
AVRT (P < 0.001). Overall, the medium number of RF application using the MNS was 2 (mean 2.7 ± 1.6, range 1 to 7), and the medium
numbers of RF for AVNRT and AVRT were 2 and 3, respectively. There was no significant difference in the mean procedural time
between patients with AVNRT and AVRT (126.3 ± 38.6 vs. 138.0 ± 40.3 min, P = 0.54). However, the mean fluoroscopy time was significantly shorter in patients with AVNRT than those with AVRT (5.7 ± 3.0
vs. 16.5 ± 2.5 min, P < 0.001). Among those patients with AVNRT, the mean procedural time (139.3 ± 45.0 vs. 112.3 ± 24.9 min, P = 0.07) and fluoroscopic time (3.2 ± 1.0 vs. 8.0 ± 2.2 min, P < 0.001) were shorter for the later 13 patients than the first 14 patients, suggesting a learning curve in using the MNS
for RF ablation.
Conclusions The Niobe MNS is a new technique that can allow safe and effective remote-controlled navigation and minimize the need for
fluoroscopic guidance for ablation catheter of AVNRT. However, further improvement is required to achieve a higher successful
rate for treatment of AVRT.
Drs. Xu and Yang contributed equally to this work. 相似文献
12.
Idiopathic ventricular arrhythmias arising from the pulmonary artery: Prevalence, characteristics, and topography of the arrhythmia origin 总被引:1,自引:0,他引:1
Hiroshi Tada MD Kazuyoshi Tadokoro MD Kohei Miyaji MD Sachiko Ito MD Kenji Kurosaki MD Kenichi Kaseno MD Shigeto Naito MD Akihiko Nogami MD Shigeru Oshima MD Koichi Taniguchi MD 《Heart rhythm》2008,5(3):419-426
BACKGROUND: The characteristics of idiopathic ventricular tachycardias (VTs) or idiopathic premature ventricular contractions (PVCs) arising from the pulmonary artery (PA) have not been sufficiently clarified. OBJECTIVE: The purpose of this study was to clarify the prevalence, characteristics, and preferential sites of idiopathic VT/PVCs arising from the PA (PA-VT/PVCs). METHODS: Data obtained from 276 patients with idiopathic VT/PVCs who underwent radiofrequency (RF) catheter ablation were analyzed. RESULTS: Twelve VT/PVCs (4%) were PA-VT/PVCs, and their onset (34 +/- 14 years) was the youngest among all subgroups. Because those QRS morphologies were similar to VT/PVCs arising from the right ventricular outflow tract (RVOT-VT/PVC) and the earliest ventricular activation was from the RVOT, an initial ablation was performed in the RVOT in all patients. However, RF catheter ablation at the RVOT resulted in a QRS morphology change in all patients, so thereafter PA mapping and ablation was performed. A characteristic potential during sinus rhythm and/or the arrhythmia was recorded at the successful PA ablation site in all patients. A perfect or good pace map was obtained in 7 (70%) of 10 patients. The successful ablation site was the septal side of the PA close to the posterolateral attachment in 9 patients (75%) and the septal side close to the anterior attachment in the remaining 3 (25%). No PA-VT/PVCs recurred during follow-up of 27 +/- 13 months. CONCLUSION: PA-VT/PVCs should always be considered when the ECG suggests RVOT-VT/PVCs and RF catheter ablation in the RVOT results in both a failed ablation and a change in QRS morphology. PA-VT/PVCs often originate from the septal side of the PA. 相似文献
13.
非接触心内膜激动标测系统指导消融右室流出道室性心动过速 总被引:3,自引:0,他引:3
探讨非接触心内膜激动标测系统(NMS)指导消融右室流出道室性心动过速 (RVOT VT)的临床使用价值。选择 12例RVOT VT患者在NMS EnSite 3000TM指导下进行电生理标测和消融治疗, 经股静脉将 9F64极球囊电极(Array)和普通 7F消融电极送至RVOT采集信号,计算机将采集到的 3 360个点的实时心内膜电图通过逆运算法处理后显示分析RVOT三维立体图上彩色等电势图,确定心动过速时心内膜最早激动点。在脱离X线时,由导航和定位系统实时跟踪导管位置变化,并实施靶点消融。9例能诱发出持续性或非持续性VT, 3例仅能诱发RVOT早搏。与以往传统方法消融的 19例结果相比较,心内膜最早激动时间 (EEAT)较体表心电图QRS波的起点提前(29. 4±12. 3msvs18. 7±8. 1ms,P<0. 01),放电部位减少 ( 5. 7±3. 4vs8. 2±3. 1,P<0. 05 )个,手术时间延长(246. 9±53. 0minvs190. 2±74. 6min,P<0. 05);X线曝光时间(44. 3±17. 5minvs57. 5±20. 1min)、即刻成功率(100% vs84. 2% )、6个月随访成功率(100% vs73. 7% ),没有显著性差异,P均>0. 05。结论:NMS指导消融RV OT VT安全可靠,靶点定位准确,且在提高远期成功率方面有优于传统标测方法的趋势。 相似文献
14.
目的:观察单导管射频消融治疗右室流出道室性期前收缩(室性早搏,室早)的安全性和临床效果。方法: 经常规体检、生化检查、X线胸片、心脏彩超、长程心电图等各种检查后,入选65例患者,采用温控消融导管以起搏为主的方法进行标测,并对单导管射频消融的安全性和临床效果进行总结。结果: 消融即刻成功率97%(63/65),其中2例放弃消融术;随访15~40个月,有3例复发并再次手术,成功2例,总成功率为95%(62/65),无复发。电生理检测和消融时间:(50±27) min;曝光时间:(8.1±3.8) min,所有患者术中及术后均未发生消融相关并发症。结论: 单导管射频消融治疗右室流出道室早安全有效,并能减少消融操作及X线暴露时间。 相似文献
15.
目的:探讨右室流出道室性期前收缩(室性早搏,室早)的心电图特征和评价单导管法消融单形性右室流出道室性早搏的有效性、安全性和实用性。方法:对52例心脏结构正常的右室流出道单形性室早的心电图特征进行分析并行单导管射频消融。采用起搏标测法,以起搏时与自发室性早搏形态波形态完全相同点为消融靶点。结果:右室流出道的室性早搏体表12导联心电图特征,呈完全性左束支阻滞形态,Ⅰ导联呈rs、m、QS及R型,aVR、aVL均呈QS型,Ⅱ、Ⅲ、aVF、V5~6导联均呈单向R波型,胸前导联R波移行区常在V3、V4导联之后。成功消融结果显示26例室早起源右室流出道间隔部:其中前间隔7例、中间隔5例、后间隔14例,游离壁21例:其中前游离壁6例、后游离壁15例,希氏束附近1例,肺动脉瓣下1例。消融即刻成功率94%(49/52),未成功的3例。手术操作时间30~150 min,X线曝光时间5~29 min。术后随访2~48个月无复发。结论:起源于右室流出道的室性早搏有其独特的心电图表现,单导管射频消融可有效、安全地消融心脏结构正常的右室流出道单形性室性早搏。 相似文献
16.
目的 探讨射频导管消融(RFCA)治疗心室流出道特发性室性心动过速(室速)和室性早搏(室早)的临床效果、心电图及电生理特征。方法 58例患者中室速10例,室早48例。起源于右室流出道(RVOT)43例,左室流出道(LVOT)15例,其中起源于主动脉瓣上Valsalva左冠窦(LSV)12例。5例RVOT室速是在非接触标测系统Ensite3000指导下进行消融的。结果 (1)58例患者中55例成功,3例失败,9例复发。(2)其中1例患者术中出现急性心包压塞。(3)起源心室流出道的室速和室早具有典型的心电图特征,其中Ⅱ、Ⅲ、aVF导联单向R波是流出道室性心律失常的共同特点。(4)V1或V2导联的R波时限指数与R/S波幅指数可作为区别LSV与RVOT室速和室早的有效指标。结论 射频导管消融治疗心室流出道特发性室性心律失常是一种安全、有效的方法。非接触标测系统对于血流动力学不稳定的复杂性室性心律失常的标测与治疗具有重要的意义。 相似文献
17.
Del Carpio Munoz F Syed FF Noheria A Cha YM Friedman PA Hammill SC Munger TM Venkatachalam KL Shen WK Packer DL Asirvatham SJ 《Journal of cardiovascular electrophysiology》2011,22(7):791-798
PVCs and Left Ventricular Dysfunction. Background: Frequent premature ventricular complexes (PVCs) can cause a decline in left ventricular ejection fraction (LVEF). We investigated whether the site of origin and other PVC characteristics are associated with LVEF. Methods: We retrospectively studied 70 consecutive patients (mean age 42 ± 17 years, 40 [57%] female) with no other cause of cardiomyopathy undergoing ablation of PVCs. We analyzed the association of a reduced LVEF, defined by LVEF <50% on echocardiography, with features of PVCs obtained from electrocardiography, 24‐ or 48‐hour Holter monitor and electrophysiology study. Results: Patients with reduced LVEF (n = 17) as compared to normal LVEF (n = 53) had an increased burden of PVCs (29.3 ± 14.6% vs 16.7 ± 13.7%, P = 0.004), higher prevalence of nonsustained ventricular tachycardia (VT) [13 (76%) vs 21 (40%), P = 0.01], longer PVC duration (154.3 ± 22.9 vs 145.6 ± 20.8 ms, P = 0.03) and higher prevalence of multiform PVCs [15 (88%) vs 31 (58%), P = 0.04]. There was no significant difference in prevalence of sustained VT, QRS duration of normally conducted complexes, PVC coupling interval, or delay in PVC intrinsicoid deflection. Patients with fascicular PVCs (n = 5) had higher mean LVEF compared to others (66.2 ± 4.0% vs 53.0 ± 10.0%, P = 0.002). There was no association of LVEF with other PVC foci or with left‐bundle versus right‐bundle branch block morphologies. The threshold burden of PVCs associated with reduced LVEF was lower for right as compared to left ventricular PVCs. Conclusion: In addition to the PVC burden, other characteristics like a longer PVC duration, presence of nonsustained VT, multiform PVCs and right ventricular PVCs might be associated with cardiomyopathy. (J Cardiovasc Electrophysiol, Vol. 22, pp. 791‐798, July 2011) 相似文献
18.
A. S. Thornton P. Janse M. Alings M. F. Scholten J. M. Mekel M. Miltenburg E. Jessurun L. Jordaens 《Journal of interventional cardiac electrophysiology》2008,21(3):241-248
Objectives To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and
cryocatheters.
Methods Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was
performed to assess the isthmus. End point was bidirectional isthmus block on multiple criteria. A pain score was used and
the analgesics were recorded. Patients were followed for at least 3 months.
Results The acute success rate for RF was 83% vs 69% for cryo (NS). Procedure times were similar (mean 144 ± 48 min for RF, vs 158 ± 49 min
for cryo). More applications were given with RF than with cryo (26 ± 17 vs. 18 ± 10, p < 0.05). Fluoroscopy time was longer with RF (29 ± 15 vs. 19 ± 12 min, p < 0.02). Peak CK, CK-MB and CK-MB mass were higher, also after 24 h in the cryo group. Troponin T did not differ. Repeated
transient block during application (usually with cryoablation) seemed to predict failure. Cryothermy required significantly
less analgesia (p < 0.01), and no use of long sheaths (p < 0.005).
The isthmus tended to be longer in the failed procedures (p = 0.117). This was similar for both groups, as was the distribution of anatomic variations. Recurrences and complaints in
the successful patients were similar for both groups, with a very low recurrence of atrial flutter after initial success.
Conclusions In this randomized study there was no statistical difference but a trend to less favorable outcome with 8 mm tip cryocatheters
compared to RF catheters for atrial flutter ablation. Cryoablation was associated with less discomfort, fewer applications,
shorter fluoroscopy times and similar procedure times. The recurrence rate was very low. Cryotherapy can be considered for
atrial flutter ablation under certain circumstances especially when it has been used previously in the same patient, such
as in an AF ablation. 相似文献
19.
Shinya Yamada Fa-Po Chung Yenn-Jiang Lin Shih-Lin Chang Li-Wei Lo Yu-Feng Hu Tze-Fan Chao Jo-Nan Liao Chung-Hsing Lin Chin-Yu Lin Yao-Ting Chang Abigail Louise D. Te Ying-Chieh Liao Po-Ching Chi Shih-Ann Chen 《Journal of interventional cardiac electrophysiology》2018,53(2):175-185
Purpose
In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown.Methods
A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) <?50%, n?=?25 and LVEF ≥?50%, n?=?105, respectively). The 12-lead PVC morphologies were assessed.Results
Patients with RVOT PVC-CMP had a lower LVEF (42?±?5% vs. 60?±?7%, P?<?0.01) and higher PVC burden (24?±?14% vs. 15?±?11%, P?=?0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143?±?14 ms vs. 132?±?17 ms, P?<?0.01) and higher peak deflection index (PDI; 0.60?±?0.07 vs. 0.55?±?0.08, P?<?0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020–1.253, P?=?0.02) and PDI (OR 1.240, 95% CI 1.004–1.532, P?=?0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration >?139 ms and PDI >?0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP.Conclusions
The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.20.
Martin Martinek Hans-Joachim Nesser Josef Aichinger Gernot Boehm Helmut Purerfellner 《Journal of interventional cardiac electrophysiology》2006,17(2):85-92
Circumferential radiofrequency ablation around the orifices of the pulmonary veins is a curative catheter-based therapy of
paroxysmal and persistent atrial fibrillation (AF). Three-dimensional cardiac image integration is a promising new technology
to visualize the complex left atrial anatomy and neighbouring structures. This study aimed to validate the accuracy of integrating
multislice computed tomography (MSCT) into three-dimensional electroanatomic mapping (EAM) to guide radiofrequency catheter
ablation (CA) of AF. Forty consecutive patients (34 male, mean age 56 ± 10 years) with multidrug-resistant AF underwent 16-slice
MSCT 1 day before radiofrequency CA. MSCT data were processed and imported to the Carto™ EAM system. Using the CartoMerge™
Image Integration Module, the generated EAM was aligned with the MSCT images. An integrated statistical algorithm provided
information about the accuracy of the fusion process. In every single patient, MSCT images could be aligned with the EAM.
Mean distance between the EAM points (n = 63 ± 14) and the MSCT surface was 1.6 ± 1.2 mm with no difference between sinus rhythm versus AF (p = 0.145) and no distinction between patients in paroxysmal versus persistent/permanent AF despite a significant difference
in left atrial diameters. An average of 388 ± 81 radiofrequency ablation points were taken within the procedures resulting
in a mean distance of 2.3 ± 1.8 mm between the EAM points and the MSCT image after the ablation procedure. There was a significant
difference of alignment accuracy before and after radiofrequency CA (p < 0.001). MSCT images can be accurately integrated into three-dimensional EAM. Pre-interventional cardiac rhythm does not
influence the precision of fusion. Accuracy of fusion deteriorates after radiofrequency CA. 相似文献