多层螺旋CT在房颤导管射频消融术前的应用研究

目的：评估多层螺旋CT在房颤导管射频消融术前的应用价值。方法：收集52例[男27例，女25例，平均年龄（68±11）岁]经导管射频消融术治疗的房颤病人的术前多层螺旋CT资料，进行回顾性分析，观察肺静脉的变异程度、开口形状及开口直径。结果：39例（75%）左心房右侧有两个开口，9例（17%）右侧有3~4个开口（由于有右中叶肺静脉）。4例（8%）右侧有一个开口（共干）。44例（85%）左心房左侧有两个开口，8例（15%）有一个开口（共干）。各肺静脉开口平均直径不同：右上肺静脉（12.5±2.4）mm；左上肺静脉（11.6±2.1）mm；右下肺静脉（13.2±2.0）mm；左下肺静脉（10.6±2.1）mm。左下肺静脉在汇入左房时通常变细。右侧肺静脉开口比左侧圆（肺静脉开口指数0.89±0.20 vs 0.74±0.16，P<0.05）。结论：多层螺旋CT可在导管射频消融术治疗房颤前提供有价值的肺静脉解剖路线图。肺静脉的引流方式、开口形状和直径存在不同。     

64层螺旋CT在肺静脉解剖学研究中的应用

目的：研究肺静脉开口大小、形状、第一分支距肺静脉开口距离及肺静脉主干大小和形状随走行的变化。方法：分析103例影像资料的肺静脉与左心房连接类型,测量肺静脉口及主干长短径、第一分支距肺静脉口距离,计算肺静脉口指数。结果：标准4支肺静脉81例（78.6％）,上肺静脉口径大于下肺静脉,右上、下肺静脉口径分别大于左上、下肺静脉（P<0.05）;右侧肺静脉口指数大于左侧;男性肺静脉口较女性大（P<0.05）;男女肺静脉口指数差异无统计学意义。各支肺静脉第一分支距肺静脉口距离不同,左右、上下间具有显著差异（P<0.05）;肺静脉口支出现率以右下最高（74.7%）,左上最低（3.2%）。肺静脉主干汇入左房时部分（55.6%）左下肺静脉口径逐渐减小,其它3支逐渐增粗,形状都是逐渐变扁。结论：肺静脉解剖变异较大,各支肺静脉大小、形状及口支出现率不同,部分左下肺静脉汇入左房时其口径逐渐变小,在评价其狭窄时应特别注意。     

64排螺旋CT冠状动脉成像122例分析

目的探讨64排螺旋CT冠状动脉成像的临床应用价值。方法对122例行冠状动脉CTA检查者采用多种后处理方法重建图像,回顾性分析总结64排螺旋CT冠状动脉成像诊断冠心病的临床价值。结果发现不同类型粥样斑块310处;并与同期的常规冠状动脉造影对照了14例147节段,统计学结果为:64排螺旋CT冠状动脉成像诊断管腔内径狭窄≥50%的敏感性95.5%,特异性92.2%,阴性预测值97.9%,阳性预测值82.7%。总符合率93.2%。结论 64排螺旋CT冠状动脉成像是冠心病的有效筛查手段,具有较高的临床应用价值,是常规冠状动脉造影的重要补充。     

64排螺旋CT冠状动脉成像100例分析

目的 探讨64排螺旋CT冠状动脉成像对指导临床治疗意义.方法 回顾性分析100例临床诊断或疑似冠状动脉粥样硬化性心脏病(冠心病)患者的CTA图像,与临床治疗采取方法相比较,来分析冠脉成像的临床意义.结果 100例患者,73(73/100)例患者轻中度狭窄采用药物保守治疗,取得良好效果,重度患者22例建议支架术,5例未成功(5/100),17(4/100)例搭桥术,均成功.结论 冠脉成像在指导临床治疗有一定意义,在指导是否放支架术时应该结合冠脉造影.     

婴幼儿肺炎支原体肺炎46例64排螺旋CT表现分析

目的总结婴幼儿肺炎支原体肺炎的CT表现。方法回顾总结2009-01-2010-10在北京市房山区良乡医院治疗有64排螺旋CT扫描资料的婴幼儿病例共46例。结果所有患儿肺内病灶均有CT表现,其肺内病灶呈多叶段分布有40例(86.9%),右肺下叶出现病灶的有32例(32/46,69.6%),有支气管壁增厚及小叶间隔增厚的有35例(35/46;76.1%)。结论64排螺旋CT对肺炎支原体肺炎可有特异表现,有助于临床诊断。     

64排螺旋CT诊断主动脉弓术后动脉瘤1例

假性动脉瘤多由感染及外伤所致,瘤壁无动脉壁全层结构,血液从破口流出并与周围组织粘连,形成瘤壁,常造成周围组织或器官的压迫。目前64排螺旋CT血管造影应用于心血管外科越来越广泛,但在儿童血管病变畸形中的报道并不多见。本科最近应用64层螺旋CT血管造影诊断1例主动脉弓离断（Interruption of the aortic arch,IAA）术后7年出现吻合口假性动脉瘤,并被手术所证实,现报道如下。     

急性局灶渗出性肺炎60例64排CT表现特点分析

目的总结急性局灶渗出性肺炎64排CT表现特点,以提高诊断准确性。方法分析经临床证实的60例急性局灶渗出性肺炎64排CT表现征像。结果病灶呈斑片状影37例,类圆形影11例,三角形影7例,磨玻璃状影5例;密度不均41例,支气管气像4例;病变边缘模糊49例,周边少量索条状影12例。做出肯定诊断51例,提示性诊断4例,误诊结核5例。结论 MDCT是诊断急性局灶渗出性肺炎的主要方法,定性困难时应抗生素治疗短期内复查。     

64排螺旋CT尿路成像的临床应用价值探讨

目的：探讨64排螺旋CT尿路成像的临床应用价值。方法：对临床怀疑泌尿系统病变的52例患者行64排螺旋CT容积扫描及尿路三维重建。结果：52例中输尿管瘘1例，输尿管结石12例，输尿管癌5例，双肾盂2例，肾盂癌5例，膀胱癌2例，其他3例，正常22例。CT图像不仅能清晰地显示输尿管走行、腔内改变、梗阻部位及原因，还可以同时显示管壁及腔外情况。结论：64排螺旋CT可多方位动态观察肾盂、输尿管及膀胱的正常解剖形态及各种病理改变，并从三维立体图像上获得更丰富的诊断信息，是全面立体动态诊断泌尿系统病变较好的影像检查方法。     

环肺静脉电隔离术对心房颤动患者左心房、左心耳、左心房顶部结构的影响

目的应用64排螺旋CT观察环肺静脉电隔离（CPVA）术对心房颤动患者左心房（LA）、左心耳（LAA）、LA顶部结构的影响。方法心房颤动患者共28例,行CPVA术3~14.8（6.5±3.9）个月后进行随访,根据术后有无复发分为成功组（22例）和复发组（6例）。应用64排螺旋CT测量CPVA术前、后LA[包括LA横径（LA1）、上下径（LA2）和前后径（LA3）、LA容积]、LAA（包括LAA口长径、短径和面积、LAA长度、LAA容积）、LA顶部（包括LA顶长度、距离和深度）的相关径线。结果成功组CPVA术后的LA1、LA2、LA3、LA容积、LAA口长径、LAA口面积、LAA容积、LAA长度、LA顶长度、LA顶距离术后比术前减小,术前术后分别为LA1（6.97±0.87）cm vs（6.32±0.94）cm,LA2（6.02±0.84）cm vs（5.63±0.63）cm,LA3（3.71±0.64）cm vs（3.46±0.59）cm,LA容积（83.61±25.98）cm3vs（66.11±22.84）cm3,LAA口长径（3.01±0.54）cm vs（2.64±0.62）cm,LAA口面积（4.99±1.79）cm2vs（4.11±1.94）cm2,LAA容积（11.11±4.34）cm3vs（9.59±4.82）cm3,LAA长度（3.99±0.84）cm vs（3.74±0.82）cm,LA顶长度（4.02±0.89）cm vs（3.55±0.76）cm,LA顶距离（3.90±0.88）cm vs（3.43±0.73）cm（均P〈0.05）;LAA口短径和LA顶深度无明显变化（P〉0.05）。复发组CPVA术前、后比较,除了LA2较术前减小（6.43±1.04）cm vs（5.92±1.27）cm（P〈0.05）,余LA、LAA、LA顶部结构无明显变化（P〉0.05）。结论成功组CPVA术后的LA、LAA、LA顶部较术前减小,即结构重构可以逆转;而复发组CPVA术前、后比较LA、LAA、LA顶部无明显变化,未出现逆重构。     

64排螺旋CT对16例冠状动脉瘘诊断分析

目的：探讨64排螺旋CT对冠状动脉瘘（CAF）的诊断价值。资料与方法：回顾性分析16例CAF患者的CT资料,所有图像均行容积再现（VR）、多平面重组（MPR）和曲面重组（CPR）进行图像重组,观察瘘的起源、走行及引流位置。结果：全组病例CAF的起源、走行、引流位置均清晰显示。单纯起源于右冠状动脉6例（37.5%）,左冠状动脉4例（25%）,起源于左、右冠状动脉者6例（37.5%）。引流至左心系统者6例（37.5%）,引流至右心系统者3例（18.75%）,引流至肺动脉者7例（43.75%）,瘘管呈管状的6例,蚯蚓状的4例,丛状的6例。164排冠状动脉成像可以准确、直观的显示CAF的情况和严重程度,为临床治疗提供更为详尽的信息。     

经球囊超声消融肺静脉口治疗阵发性心房颤动的临床研究

目的对经球囊超声消融肺静脉口治疗阵发性心房颤动的疗效和安全性进行临床评价。方法阵发性心房颤动患者5例，症状明显且应用抗心律失常药物治疗无效。经球囊超声消融肺静脉的开口，消融终点为肺静脉电学隔离。结果总计消融了19支肺静脉，单纯超声消融肺静脉实现电学隔离15支(73、7％)。早期有1例心房颤动复发，1例频发房性期前收缩，1例偶发房性期前收缩，均经胺碘酮治疗后消失。所有患者的随访时间超过6个月，均可以无需药物而维持窦性心律。并发症包括消融中1例出现心房穿孔，1例出现严重迷走反应，无肺静脉狭窄。结论肺静脉口超声消融是治疗阵发性心房颤动的一种有效手段。     

阵发性心房颤动患者射频消融术后心房颤动晚期复发的相关因素

目的探讨阵发性心房颤动患者射频消融术后心房颤动晚期复发的相关因素。方法收集接受三维电解剖标测系统指导下射频消融手术治疗的阵发性心房颤动患者80例,对其年龄、左房内径、术后48h内心房颤动复发及术中电复律等情况进行多因素分析,寻找心房颤动晚期复发的相关因素。结果80例患者接受82次心房颤动射频消融手术;在术后12个月的随访期内,共有25例患者心房颤动晚期复发。组间比较显示年龄、左房内径及术后48h内心房颤动复发两组之间差异有统计学意义;多元Logistic回归分析提示术后48h内心房颤动复发是阵发性心房颤动射频消融术后心房颤动晚期复发的临床预测指标（OR=3．861,95％CI=1．142～13．056,P=0．03）。结论术后48h内心房颤动复发是阵发性心房颤动射频消融术后心房颤动晚期复发的临床预测指标,术后48h内心房颤动复发患者晚期复发率增高。     

实时三维超声心动图评价阵发性心房颤动患者射频消融术后右心房大小和机械功能变化

目的 应用实时三维超声心动图评价阵发性心房颤动患者射频消融术后右房大小和机械功能的变化,并探讨右房与左房大小和机械功能变化之间的相关性.方法 35例阵发性心房颤动患者接受射频消融手术.应用实时三维超声心动图、经胸超声心动图及组织多普勒超声心动图分别于术前、术后1月及术后3月测量右房收缩末期容积及面积、右房射血分数、三尖瓣舒张晚期A峰速度、组织多普勒三尖瓣环舒张晚期A'峰速度、三维右房收缩末期容积、三维右房射血分数、左房收缩末期容积及面积、左房射血分数、二尖瓣舒张晚期A峰速度、组织多普勒二尖瓣环舒张晚期A'峰速度、三维左房收缩末期容积、三维左房射血分数.结果 35例患者均成功获得满意的三维超声心动图及组织多普勒图像.左房收缩末期面积与三维左房收缩末期容积从术后1月开始即出现了明显的缩小[分别为(18.8±6.3)cm2对(21.5±6.2)cm2,(38.8±17.0)ml对(46.1±20.0)ml,均P＜0.05].心房机械功能方面,三维左房射血分数在术后1月较术前明显下降,到术后3月逐步上升接近术前水平[(41.1±13.7)%对(51.7±15.9)%,(41.1±13.7)%对(45.6±18.3)%,P＜0.05].右房的大小与机械功能的所有参数术后与术前相比差异无统计学意义.术后1月与3月时,右房容积及机械功能的变化与左房容积和机械功能的变化无明显相关性(r值分别为0.23,0.26,0.32,0.03,P＞0.05).结论 实时三维超声心动图能精确定量心房的容积和机械功能.阵发性心房颤动患者射频消融术后左房明显缩小,而右房大小及机械功能均无明显改变.

Abstract：

Objective To assess the changes of right atrial size and mechanical function after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation using real-time threedimensional echocardiography(RT-3DE), and to study the correlation between the changes of left atrial(LA)and right atrial(RA) volume and function. Methods Thirty-five patients with paroxysmal atrial fibrillation were undergone radiofrequency catheter ablation (RFCA) successfully. Transthoracic echocardiography (TTE),tissue Doppler imaging(TDI) and RT-3DE were performed before, 1 month and 3 months after procedure respectively. Late systolic volume and area of RA and LA,ejection fraction(EF) of RA and LA,late diastolic peak velocity of mitral valve inflow, tricuspid valve inflow and late diastolic peak velocity of mitral annulus and tricuspid annulus were recorded. Results The 3DE images of all patients were satisfied.LA max area and 3DE LA max volume were significantly reduced at 1 months and 3 months after procedure compared with basic stage [ ( 18.8 ± 6.3) cm2 vs (21.5 ± 6.2) cm2 , (38.8 ± 17.0) ml vs (46.1 ± 20.0) ml,P ＜ 0.05]. 3DE LA EF also declined markedly at 1 month after RFCA, and restored at 3 months later compared with baseline [(41.1 ± 13.7) % vs (51.7 ± 15.9) %, (41.1 ± 13.7) % vs (45.6 ± 18.3) %, P ＜0.05]. The size and mechanical function of the right atrial after procedure were no obvious changes. There were no evidently correlation between the changes of LA and RA volume and function. Conclusions RT3DE can provide a precise method to quantify the value of atrial volume and function. The LA size and volume are significantly reduced after RFCA in patients with paroxysmal atrial fibrillation, however, the RA size and function are no obvious changes.     

Symptoms versus objective rhythm monitoring in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation

BACKGROUND: Pulmonary vein (PV) ablation is a treatment option for patients with atrial fibrillation (AF). The efficacy of treatment is often assessed by the evaluation of symptoms. However, a high proportion of AF episodes occur in the absence of symptoms as observed in pharmacological treated patients. The purpose of this study was to assess the association of symptoms and AF in patients who underwent PV ablation for the treatment of paroxysmal AF. METHODS: All consecutive patients scheduled for PV ablation received an event recorder 1 month prior to the ablation for the period of 4 months. Event strips were sent by telephone on a daily basis, and in case the patient suffered palpitations or other symptoms believed to be related to the arrhythmia. RESULTS: Forty-one patients (7 females; mean age 52 years (range 24 to 71 years)) sent a total of 3,046 event strips (735 before ablation; 2,311 after ablation). Before ablation, a total amount of 244 event strips were obtained of which were 85 (35%) were asymptomatic. After ablation, a total amount of 254 AF event strips were obtained of which 164 were asymptomatic (65%). Correlation between symptoms and rhythm was often absent during AF. CONCLUSION: Our data demonstrate that for the evaluation of effectiveness of PV ablation, the lack of symptoms during follow-up is not a valid indication. Objective rhythm monitoring in order to detect asymptomatic AF should be performed.     

心房颤动患者导管消融治疗后左心房结构和功能变化分析

目的 应用组织多普勒技术分析导管消融术后阵发性心房颤动(房颤)患者左心房结构和功能的变化.方法 32例阵发性房颤患者(房颤组)在Ensite NvaX三维标测系统下,完全肺静脉电解剖隔离,应用超声心动图于手术前和术后24 h、1周、1个月测量左心房内径及容积、二尖瓣跨瓣压差,多切面测定二尖辩环舒张早期和晚期运动峰值速度,取平均值并计算其比值;以同年龄组非心房颤动志愿者32例为对照(对照组).结果 房颤组均达到完全肺静脉隔离,随访1个月无复发;房颤组患者术前左心房内径及容积均大于对照组(P均<0.01),术后24 h左心房容积较术前扩大(P<0.05),术后1周缩小(P<0.05),术后1个月与时照组比较,差异无统计学意义(P>0.05);二尖瓣环晚期运动峰值速度房颤组术前较对照组减低(P<0.01),术后24 h较术前减低(P<0.05),1周后增加(P<0.05或P<0.01),1个月后与对照组比较差异无统计学意义(P>0.05).结论 导管消融术是治疗阵发性房颤的有效方法 ,术后24 h左心房有所扩张、收缩功能减低,但1周好转,1个月时接近术前,可能与消融对左心房损伤后修复过程有关,提示术后应重视血栓的风险和手术的损伤.     

组织多普勒评价阵发性心房颤动患者环肺静脉左心房线性消融术后左心房功能变化

目的 利用组织多普勒超声评价阵发性心房颤动(房颤)患者环肺静脉左房线性消融术后左房功能的动态变化.方法 阵发性房颤患者108例,CARTO系统下行环肺静脉左房线性消融术,术前48 h及术后48 h、1个月、3个月、6个月分别行组织多普勒及常规超声心动图检查.结果 106例阵发性房颤患者成功施行环肺静脉左房线性消融术.与术前相比,左房前后径和左房容积减小,但术后48 h、1个月差异无统计学意义(P＞0.05),术后3个月和6个月差异有统计学意义(P＜0.05);左室舒张末内径、左室收缩末内径、左室射血分数差异无统计学意义(P＞0.05);二尖瓣舒张早期峰速差异无统计学意义(P＞0.05),二尖瓣舒张晚期峰速术后48 h较术前降低(P＜0.05),术后1个月、3个月、6个月逐渐增高,3个月时恢复到术前水平.与术前相比,二尖瓣环左室侧壁收缩期峰速、舒张早期峰速差异无统计学意义(P＞0.05),舒张晚期峰速术后48 h较术前降低(P＜0.05),术后1个月、3个月、6个月逐渐增高,1个月时恢复到术前水平.结论 环肺静脉左房线性消融术后左房内径和容积减小;环肺静脉左房线性消融术后可出现左房主动收缩功能降低(左房顿抑),经过一段时间可自行恢复.     

Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach

Background  Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug refractory atrial fibrillation. However, catheter ablation of atrial fibrillation is still a challenge. This is partially due to the high degree of variability with regard to the individual anatomy. Nevertheless, 3D imaging systems (CT, MRI) provide detailed information about the individual left atrial and pulmonary vein morphology. A 3D CT or MRI reconstruction of the left atrium can be displayed in the Navx-/Ensite-system in a synchronised way during the ablation procedure, thereby facilitating the intervention. This study summarizes our preliminary experience with different strategies of AF ablation using the Navx-/Ensite-system and a CT-/MRI-guided approach. Methods  In a total of 41 patients, cardiac MRI (n = 7) or multi-detector spiral computed tomography (n = 34) was performed prior to an ablation procedure. Catheter ablation was performed for paroxysmal atrial fibrillation in 31 patients and for persistent atrial fibrillation in 10 patients. A 3D MRI or high resolution spiral CT data acquisition was performed and a surface rendered model of the LA was created. This model was displayed in the Navx-/Ensite-system throughout the ablation procedure. Results  Catheter ablation was performed using the Navx-system (n = 38) or the Ensite-system (n = 3). Three strategies were used depending on the type of atrial fibrillation: segmental isolation of the pulmonary veins (facilitated by a 3D real-time visualization of the ablation catheter and a circumferential mapping catheter; group A: 20 patients), linear lesions (group C: 3 patients) and a combined approach (group B; 18 patients). The CT-/MRI-models provided an excellent overview over the pulmonary veins and the left atrial appendage. They revealed a high degree of variability with regard to the individual anatomy (e.g. dimensions of the left atrial appendage, pulmonary vein ostia). The CT scans provided a more detailed reconstruction of the left atrial anatomy than the MRI scans (especially in patients who were in atrial fibrillation at the time of the data acquisition). In some patients, the CT-/MRI-models revealed a very small diameter of some pulmonary veins or side branches close to the ostium (e.g. right inferior pulmonary vein). Therefore, no attempt was made to achieve complete pulmonary vein isolation in some patients. In group A, 16/20 (80%) patients had no arrhythmia recurrence [mean follow-up 359 days (SD ± 317 days)]. Twelve out of eighteen (67%) patients in group B [mean follow-up 452 days (SD ± 311 days)] and 2/3 (67%) patients in group C did not experience an arrhythmia recurrence [mean follow-up 1,000 days (SD ± 34 days)]. There were no major complications. Conclusions  The information derived from 3D CT- or MRI-reconstructions facilitates AF ablations performed with the Navx-/Ensite-mapping system and enhances the safety of these procedures. Furthermore, the availability of an additional impedance-based 3D real-time visualization of the ablation catheter and the circular mapping catheter placed in the pulmonary veins represents a major advantage of the Navx system.     

Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management

Introduction: Atrial fibrillation (AF) is the most common human arrhythmia. AF is a progressive disease, initially being nonsustained and induced by trigger activity, and progressing towards persistent AF through alteration of the atrial myocardial substrate. Treatment of AF aims to decrease the risk of stroke and improve the quality of life, by preventing recurrences (rhythm control) or controlling the heart rate during AF (rate control). In the last 20 years, catheter-based and, less frequently, surgical and hybrid ablation techniques have proven more successful compared with drug therapy in achieving rhythm control in patients with AF. However, the efficiency of ablation techniques varies greatly, being highest in paroxysmal and lowest in long-term persistent AF.

Areas covered: In this review, we discuss the fundamental differences between paroxysmal and persistent AF and the potential impact of those differences on patient management, emphasizing the available therapeutic strategies to achieve rhythm control.

Expert commentary: Treatment to prevent AF recurrences is suboptimal, particularly in patients with persistent AF. Emerging technologies, such as documentation of atrial fibrosis using magnetic resonance imaging and documentation of electrical substrate using advanced electrocardiographic imaging techniques are likely to provide valuable insights about patient-specific tailoring of treatments.     

应变率成像评价孤立性阵发性房颤患者左心房主动泵血功能

目的 应用应变率成像技术定量评价孤立性阵发性房颤(paroxysmal atrial fibrillation,PAF)患者左心房(leftatrial,LA)的主动泵血功能及经导管射频消融治疗的影响.方法 选取成功接受首次经导管射频消融术并维持窦性心律半年以上的孤立性PAF患者20例作为PAF组,平均年龄(59±11...