高频起搏犬房颤模型心房重塑及窦房结和房室结功能的变化

 目的:持续高频起搏犬左心房,观察房颤(AF)发生率、心房重塑以及窦房结、房室结传导功能。方法: 健康比格犬15只随机分为起搏组(P组,n=9)和对照组(N组,n=6)。2组均在左心房心外膜缝合固定一起搏电极,P组以400 min-1的频率起搏,N组不起搏。采用程序起搏技术测定电生理参数。结果: (1) 4周后P组阵发性AF和持续性AF的诱发率与N组比较差异均有统计学意义（分别P<0.05,P<0.01）,P组第2周2只犬自发AF,第4周AF诱发率达100%,且持续性AF的发生率高。 (2) P组4周后心房有效不应期(AERP)在不同基本起搏周期(250 ms、300 ms和350 ms)时均较N组缩短 (P<0.05);房室结文氏点(AVN-Wen) 较N组有意义延长［(294.44±26.03)min-1 vs (328.33±24.01)min-1, P<0.05］;房室结有效不应期(AVERP)在不同起搏周期均明显延长 (P<0.01)。(3) 与N组比较,P组4周后窦房结恢复时间（SNRT）和校正恢复时间（cSNRT）均延长（P<0.01）;P波时限2组比较差异没有统计学意义(P>0.05)。(4) P组2周后心脏超声与N组比较显示左心房前后、上下、左右径都有明显增大(P<0.01),右心房上下增大(P<0.05)。结论: 持续４周心房高频起搏后房颤发生率高,心房肌、窦房结和房室结电生理发生特征性的相应改变,左、右心房不同程度扩大,提示电重塑、结构重塑与房颤的发生关系密切。     

经食管心脏调搏终止持续性室性心动过速临床研究

目的：观察和总结食管心脏调搏终止持续性室性心动过速（简称室速）的表现特征及临床应用价值。方法：8例患者均经食管心脏调搏终止室速。根据体表12导心电图、食管导联心电图以及分别经食管心房和心室调搏终止室速等资料进行观察分析、总结特点。结果：8例患者经食管调搏，室性心动过速被终止了。结论：经食管心脏调搏终止室速简便易行，安全有效。     

右心房梗死伴左心房高频起搏诱发慢性房颤的电生理特性研究

目的： 建立右心房梗死伴左心房高频起搏新型慢性心房颤动(AF)模型并探讨其电生理特性。方法： 24只健康新西兰大白兔随机分为3组：对照组(C)、起搏组(P)、心房梗死+起搏组(I)。C组：在左心房外膜缝合固定一起搏电极,但不起搏;P组：在左心房外膜缝合固定一起搏电极并以1 000 beats/min的频率高频起搏;I组：结扎右冠状动脉心房分支,并在左心房外膜缝合固定一起搏电极,以1 000 beats/min的频率高频起搏。采用心外膜程序起搏技术测定心房肌的电生理特性。结果： (1) I组:起搏3周后AF诱发成功率高达100%。(2) I组、P组在起搏1 h、1周、3周后心房有效不应期（ERPA）均缩短;I组、P组、C组：起搏3周后在基本起搏周期（PCL）200 ms时的ERPA分别为(87.5±12.8) ms、(81.3±12.5) ms、(115.0±7.6) ms,I组、P组与C组比较,显著差异（P<0.01）。(3)在频率适应性方面,I组、P组均表现为频率适应不良,在术后3周时表现明显,与C组比较差异显著(分别P<0.01,P<0.05)。 (4) I组在起搏3周后P波时限延长与P组、C组比较差异显著(P<0.05,P<0.01)。（5）I组：快速起搏后1 h至3周,均表现为ERPA缩短、心房相对不应期(RRPA)延长与C组比较显著差异（P<0.01）、房间传导时间（IACD）延长与P组、C组比较显著差异（均P<0.01）。结论：右心房梗死+左心房高频起搏建立兔慢性AF与传统的单纯心房起搏相比,AF诱发成功率高并且稳定,其电生理参数有特征性意义,表现为ERPA缩短,频率适应不良,RRPA延长,IACD延长。     

替米沙坦对高血压合并阵发性房颤患者P波离散度的影响

目的观察经过服用替米沙坦对高血压并阵发性房颤患者P波离散度（Pd）的变化,评价替米沙坦对P波离散度的影响。方法把60例高血压并阵发性房颤的患者随机分为替米沙坦治疗组和对照组,每组30例,治疗5个月。在治疗前后分别采用同步12导联心电图机测定P波最大时限（Pmax）和最窄P波时限（Pmin）,根据公式Pd（ms）=Pmax—Pmin计算并比较其差异性,并观察治疗后房颤复发的次数。结果治疗组高血压并阵发性房颤患者治疗后Pmax、Pd分别为（109．33±7．89）ms、（36．98±8．06）ms,较对照组治疗后（125．43±7．20）ms、（45．87±8．19）ms。显著减少,P〈0．05;治疗组房颤复发总次数及平均每例复发次数（57次、1．90次）,较对照组（178次、5．90次）显著减少,P〈0．05。结论替米沙坦能缩短高血压伴阵发性房颤患者的Pmax及Pd,可减少房颤的复发。     

桂枝甘草汤联合稳心颗粒对房颤患者心功能及左心房电生理指标的影响

目的 探讨桂枝甘草汤联合稳心颗粒对房颤患者心功能及左心房电生理指标的影响。方法选择2021年3月至2022年5月大连市金州区中医医院心内科接收的90例房颤患者,采用随机列表法分为对照组和观察组,各45例。对照组采取常规治疗及口服胺碘酮,观察组在对照组基础上服用桂枝甘草汤联合稳心颗粒。治疗4周后评价总有效率,比较两组症状积分、左室射血分数（LVEF）、心搏量（SV）、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左心房有效不应期（LAERP）,同时记录两组每周房颤持续时间及发作次数。结果 观察组总有效率高于对照组（91.1%比75.6%,P<0.05）。治疗后,两组症状积分均降低,且观察组低于对照组（P均<0.05）;心功能均改善,观察组LVEF和SV大于对照组,LVEDD和LVESD小于对照组（P均<0.05）;观察组LAERP大于对照组,房颤持续时间及发作次数均小于对照组（P均<0.05）。结论 桂枝甘草汤联合稳心颗粒的疗效更为理想,能够促进症状减轻,改善心功能及左心房电生理指标,减少房颤发作次数。     

心房纤颤患者心房肌细胞超微结构和细胞凋亡的变化

目的探讨风湿性心脏病（风心病）心房纤颤（房颤）患者的心房结构和细胞凋亡的变化与房颤发病机制之间的关系。方法选择接受外科换瓣手术的风心病患者共43例，分为3组，其中窦性心律15例（A组），阵发性房颤8例（B组），慢性房颤20例（C组）。在手术中取左心房组织，应用TUNEL法检测各组患者左心房肌细胞凋亡的情况，计算其凋亡指数（AI）：应用电镜观察左心房肌细胞的超微结构的变化。结果C组的AI为24．6％±9．1％，与A组和B组的比较明显升高（P〈0．01）。且AI分别与左心房内径、房颤持续时间呈明显正相关（P〈0．05-P〈0．006）。在B组和C组中，在电镜下见肌节长短不一，结构模糊；线粒体肿胀，大小不一，闰盘扭曲，肌浆网肿胀、破裂，以C组更为明显。结论慢性房颤时左心房肌细胞凋亡增加和其超微结构的变化在房颤的发生和持续存在中起重要的作用。     

厄贝沙坦联合胺碘酮治疗原发性高血压合并心房颤动患者的临床疗效

目的评价厄贝沙坦与小剂量胺碘酮联合治疗原发性高血压合并阵发性心房颤动（房颤）患者维持窦性心律的长期疗效。方法70例合并阵发性房颤的原发性高血压患者,在常规口服胺碘酮基础上随机分为两组：厄贝沙坦组35例,氨氯地平组35例,随访12个月,一级终点为房颤复发。观察两组降压疗效、人组后房颤复发情况及治疗前后左心房内径（LADd）、左心室舒张末期室间隔厚度（WST）、左心室后壁厚度（LVPWT）。结果两组均能显著降低血压,厄贝沙坦组窦性心律维持率为71．4％,氨氯地平组为48．6％,两组间比较有统计学意义（P〈0．05）。厄贝沙坦组治疗12个月后患者LADd、IVST、LVPVT较治疗前均有下降,治疗前后比较差异有统计学意义（P〈0．05）,氨氯地平组治疗前后比较差异无统计学意义（P〉0．05）。结论长期服用厄贝沙坦在有效降低血压、逆转左室肥厚的同时,可延缓左房扩大,改善心房的电重构,从而减少原发性高血压合并房颤的复发。     

阈下条件刺激对心房不应期的影响及对心房起搏节律的抑制作用

给１４例病人作心内电生理检查时，观察阈下条件单个刺激（Ｓｓ）和串刺激（Ｓｔ）对心房不应期和心房起搏节律的作用。初步结果表明：在Ｓ１－Ｓ２间期中加发Ｓｔ，可使心房相对不应期和有效不应期延长；且随Ｓｔ强度的增加，不应期延长量增加。在Ｓ１－Ｓ２间期中加发Ｓｓ，只有３／９例，心房相对不应期延长。另外，Ｓｔ和Ｓｓ可抑制心房起搏节律。     

甲状腺素对犬心房电生理特征和连接蛋白Cx43的影响

目的 研究甲状腺素对犬心房电生理特征和连接蛋白Cx43表达及分布的影响，探讨甲状腺功能亢进性心脏病（甲亢性心脏病）发生房颤的机制。方法 健康成年杂种犬16只，随机分为对照组（n=6）和实验组（n=10）。给实验组犬腹腔注射左旋甲状腺素（L-Thy）80μg/(kg·d)，持续8个月，以建立犬甲亢动物模型，分别于0、2、4、6和8个月测定心房有效不应期（AERP），Western blot检测心房连接蛋白Cx43表达，激光共聚焦显微镜观察Cx43表达及分布的改变。 结果 和对照组相比，L-Thy组犬第4、6、8个月AERP明显缩短（P<0.05），左右心房Cx43表达显著下降(P<0.01)，两组左房Cx43的表达量的差值显著高于两组右房Cx43表达量的差值(P<0.05)，左右心房分布于细胞两端的Cx43显著减少（P<0.01）。结论 甲状腺激素导致的心房电重构和连接蛋白的重构是甲状腺激素所致心房重构过程的一部分，参与促成了甲亢性心脏病房颤的发生、发展及维持。     

替米沙坦联用胺碘酮治疗阵发性房颤临床疗效观察

目的观察胺碘酮与替米沙坦联合应用治疗阵发性房颤的临床疗效。方法选取55例阵发性房颤患者,随机分为胺碘酮对照组（25例）和胺碘酮＋替米沙坦组（30例）。比较两组治疗后3,6,9,12个月的窦性心律维持率和治疗前、治疗后的左房前后径。结果治疗后3个月,对照组与治疗组窦性心律维持率比较无统计学差异（P〉0.05）。治疗后6个月对照组与治疗组窦性心律维持率比较有统计学差异（P〈0.05）。治疗9个月后,对照组左心房前后径明显大于治疗组（P〈0.05）。结论胺碘酮与替米沙坦联合治疗阵发性房颤患者疗效确切,可有效控制左心房扩大,值得推广和应用。     

经食管心房调搏治疗阵发性室上性心动过速

本文报告了78例阵发性室上性心动过速(PSVT)经食管心房调搏(TEAP)治疗的资料,其中除2例逆传型房室折返性心动过速需要伍用心律平外,均以短阵快速起搏法和超短阵猝发刺激法终止发作,总有效率100％,且操作简单、付作用小,几乎无并发症和禁忌症,对病态窦房结综合征合并PSVT发作者,转复过程一旦出现心脏停搏还可以立即经食管心房起搏,确保生命安全,因此建议在基层医院推广使用。     

食管心房调搏终止阵发性折返性室上性心动过速的体会

用食管心房调节(TEAP)技术,对21例阵发性折返性室上性心动过速(PSVRT)患者,行超短阵猝发刺激(TP),结果显示:10例房室结折返性心动过速(AVNRT)及8例房室折返性心动过速(AVRT)一次终止成功,而3例冠心病(CHD)中1例房内折返性心动过速(IART)易终止,另两例调搏中出现房颤,则不易终止。结论认为:TEAP终止PSVRT安全,简便,作用准确迅速,具有很高的临床实用性。     

Physiologic atrial cardiac pacing for the prevention of chronic atrial fibrillation associated with sick sinus syndrome

Long-term results of physiologic atrial pacing have been analyzed for the possibility of avoiding the recurrence of paroxysmal atrial fibrillation and the progression to chronic permanent atrial fibrillation in patients with paroxysmal atrial fibrillation related to sick sinus syndrome. Seventy four patients were evaluated and divided into two groups; 39 patients underwent atrial pacing (AAI, 53%) and 35 had ventricular pacing by single-lead pacing (VVI, 47%). All patients had been evaluated periodically on an out-patient basis by 24 hour Holter monitoring. Basic rhythms in all AAI patients were based on atrial pacing, resulting from the suppression of paroxysmal atrial fibrillation. Basic rhythms in the VVI paced patients were variable, consisting of regular sinus rhythm, transient atrial fibrillation, and ventricular pacing in 30 of 35 patients in the VVI group. The remaining five patients progressed to chronic permanent atrial fibrillation (0% in AAI vs. 14% in VVI, p < 0.05). Thromboembolic complications were not observed in the AAI pacing group. Three patients demonstrated thromboembolic complications (0% in AAI vs. 8.6% in VVI, p < 0.05). The effect of preventing paroxysmal atrial fibrillation and the progression to chronic atrial fibrillation was evident in the AAI paced group, but VVI pacing cannot prevent paroxysmal atrial fibrillation and chronic atrial fibrillation. In addition, potential risks of thromboembolic complications caused by atrial fibrillation were not decreased in VVI paced patients.     

Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

The present case report describes a patient with an artificial mitral valve and dual chamber pacemaker implanted due to perioperative complete atrio-ventricular block. One year later an upgrade to cardiac resynchronization therapy (CRT) combined with ICD function was performed due to significant progression of heart failure symptoms. Beneficial effects of CRT are demonstrated, but unfavourable haemodynamic consequences of right atrial appendage pacing are also underlined. Important interatrial conduction delay during atrial paced rhythm resulted in a significant time difference between optimal sensed and paced atrio-ventricular delay (AVD). This report provides a practical outline how to determine the interatrial delay and the sensed-paced AVD offset under echocardiography in patients treated with CRT.     

MPO、MMP-2和MMP-9在兔房颤模型心房肌中的表达变化

目的:观察兔房颤模型心房肌组织髓过氧化物酶(MPO)、基质金属蛋白酶(MMP)-2和MMP-9的表达,并探讨三者与房颤时心房结构重构的关系。方法:20只新西兰大白兔,开胸后于左心房植入起搏电极,随机分为2组:快速心房起搏组(RAP组)以600 min-1的频率快速起搏心房3周;假手术组(sham组)不予起搏。起搏前、后行超声心动图检查评价心房和心室的结构和功能,行心房burst刺激检测房颤诱发率;起搏后采用Masson染色评价心房的间质纤维化程度,采用RT-q PCR和Western blot检测心房MPO、MMP-2和MMP-9 mRNA和蛋白的表达水平。结果:起搏3周后,与sham组相比,RAP组兔左心房明显扩张伴收缩功能障碍,左心室的结构和功能变化不明显;RAP组房颤诱发率和间质纤维化百分比均明显增加,且心房MPO、MMP-2、MMP-9 mRNA和蛋白的表达明显增加。结论:持续快速心房起搏兔房颤模型会出现明显心房结构重构,心房MPO、MMP-2和MMP-9表达上调可能是其潜在的分子机制。     

The relationship between the left atrial volume and the maximum P-wave and P-wave dispersion in patients with congestive heart failure

PURPOSE: A maximum P-wave duration (Pmax) of > or = 110 msec and a P-wave dispersion (PWD) > or = 40 msec are accepted indicators of a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse, respectively. The left atrial (LA) volume has been reported to be strongly associated with a systolic and diastolic dysfunction and is considered to be an index of atrial remodeling. We aimed to investigate the relationship between LA volume and Pmax or PWD in patients with congestive heart failure (CHF). PATIENTS AND METHODS: Sixty-one patients with CHF were enrolled in this study. The study population was classified into four groups: two groups were divided according to the Pmax (> or = 110 msec or < 110 ms), and the other two groups were formed based on the PWD (> or = 40 msec or < 40 msec). The left atrial volume index (LAVi) was measured by three-dimensional (3-D) transthoracic echocardiography. The Pmax and PWD were measured from a 12-lead electrocardiogram. RESULTS: There were significant differences in the ejection fraction (EF), diastolic function, and LAVi between patients with a Pmax > or = 110 ms or a PWD > or = 40 ms and those with a Pmax < 110 ms or a PWD < 40 ms. The LAVi was independently associated with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse. The LAVi can be used to identify patients with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse with reasonably good accuracy. CONCLUSION: We concluded that a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse in patients with CHF is associated with an increase in the LA volume and a deleterious systolic and diastolic dysfunction.     

Amiodarone in atrial fibrillation

Twenty-seven patients with atrial fibrillation without any concomitant conduction abnormality have been treated with oral amiodarone in a daily maintenance dose of 200 mg. The drug has been used for three purposes: 1) to block atrioventricular conduction, thereby decreasing the ventricular rate during atrial fibrillation (9 patients), 2) as prophylaxis against paroxysmal atrial fibrillation (8 patients), 3) as prophylaxis against recurrence of atrial fibrillation after DC conversion to sinus rhythm (13 patients). All patients were considered refractory to other antiarrhythmic drugs in these respects. In the second group, 4 of the 8 patients reported complete cessation of attacks and the others a marked reduction of the attack rate. In the third group, 10 of the 13 patients have maintained sinus rhythm for a longer period on treatment with amiodarone than with other drugs, resulting more than a triple prolongation of the time in sinus rhythm. In 3 patients the drug has been discontinued because of side-effects. In conclusion, amiodarone affords protection from episodes of paroxysmal atrial fibrillation, as well as from recurrence of atrial fibrillation after DC conversion to sinus rhythm. If the drug is ineffective in either of these respects, it may still be useful as a means of moderating the ventricular response in atrial fibrillation.     

高血压合并阵发性房颤患者心脏超声临床特点

目的:观察分析高血压合并阵发性房颤患者的心脏超声特点,为临床准确诊断提供依据。方法:选取2019年08月至2020年08月我院收治的51例高血压合并阵发性房颤患者作为研究组,同时选取51例单纯高血压患者作为常规组,所有患者均接受心脏超声诊断确定有无二尖瓣返流;同时观察心脏收缩期右房上下径、左房前后径、室间隔厚度、舒张期左心室末期内径、左室射血分数、早期二尖瓣血流速度/心房收缩时二尖瓣充盈峰速(Early mitral valve velocity/Mitral valve filling peak velocity during atrial contraction,E/A)。结果:研究组与常规组血压、腰围、BMI指数、血脂、血糖以及血尿素氮无差异(p>0.05);研究组二尖瓣返流病例数多于常规组(P<0.05);研究组E/A、室间隔厚度、收缩期左房前后径均高于常规组(P<0.05),而收缩期右房上下径、舒张期左心室末期内径、左室射血分数无差异(P>0.05)。通过Logistic分析发现,二尖瓣反流、室间隔厚度、收缩期左房前后径与阵发性房颤相关(P<0.05)。结论:高血压合并阵发性房颤的心脏超声特点包括:室间隔厚度增加、左心房扩大、二尖瓣返流等,与单纯高血压差异显著。