影像标志与动脉搏动指导穿刺股动脉方法的对比研究

为探讨和评价一种新的影像标志指导穿刺股动脉的方法，对３２８例采用动脉搏动指导法穿刺股动脉、１５８例采用影像标志指导法穿刺股动脉进行对比研究。两种方法的总成功率、并发症发生率无显著性差异（９７．７％ｖｓ１００％，３．９％ｖｓ４．４％，Ｐ均＞０．０５）；但对脉弱或无脉的患者影像标志指导法成功率明显高于动脉搏动指导法〔１００％（７／７）ｖｓ３６．４％（４／１１），Ｐ＜０．００１〕。影像标志指导法却在一次穿刺成功率及穿刺次数、穿刺时间方面劣于动脉搏动指导法（７８．５％ｖｓ９６．０％；３．６±３．８次ｖｓ１．１±０．５次；１．２±５．７ｍｉｎｖｓ０．８±０．４ｍｉｎ，Ｐ均＜０．０５）。结果提示影像标志指导法为动脉搏动指导法穿刺股动脉的有益补充；尤其适用于因各种疾病或肥胖、新近血肿、疤痕等造成股动脉搏动减弱或消失者     

腹主动脉结扎大鼠心房纤维化的实验研究

高血压患者有较高心律失常的发生率，房性心律失常可能与左房扩大或心房纤维化有关。为观察压力负荷增高大鼠中心房纤维化的发生情况，将Ｗｉｓｔａｒ大鼠随机分成假手术组和手术组，手术组大鼠行肾上腹主动脉部分结扎。术后４，８，１２周分别测定大鼠颈动脉压及心房胶原容积分数（ＣＶＦ），结果发现：①手术组左室舒张压明显高于假手术组（４，８，１２周分别为１８．５±２．５ｋＰａｖｓ１５．７±１．９ｋＰａ，１８．６±２．７ｋＰａｖｓ１５．３±１．３ｋＰａ，１９．６±３．１ｋＰａｖｓ１５．２±１．９ｋＰａ，Ｐ＜０．０５或０．０１）。②手术组心房ＣＶＦ明显高于假手术组（４，８，１２周左、右房分别比较：４．２３±０．７６％ｖｓ２．９３±０．８７％，４．６５±１．４５％ｖｓ３．１１±１．０７％，５．６２±１．６２％ｖｓ３．２３±１．２８％；３．８８±１．１５％ｖｓ２．５１±０．８４％，４．２４±１．６５％ｖｓ２．５１±０．８４％，５．３４±１．３２％ｖｓ２．３３±１．１４％；Ｐ＜０．０５或０．０１），手术组心房ＣＶＦ有逐渐上升趋势。③左房ＣＶＦ与左室舒张压之间无直线相关关系（ｒ＝０．１６９１，Ｐ＞０．０５）。提示在高血压大鼠模型中存在心房?     

经皮球囊二尖瓣成形术对心率变异的影响

为了解经皮球囊二尖瓣成形术（ＰＢＭＶ）对风湿性心脏病二尖瓣狭窄病人心率变异（ＨＲＶ）的影响，自同期行ＰＢＭＶ的７１例病人中选择窦性心律者作为观察对象。于术前二日和术后第三日记录５ｍｉｎ的心搏数，经短时ＨＲＶ软件分析。结果表明术后ＲＲ间期均值标准差（３３．１８±１０．４２ｍｓｖｓ４２．８０±１５．８４ｍｓ，Ｐ＜０．０５）、相邻ＲＲ间期差值的均方根（２９．６１±１３．３８ｍｓｖｓ３７．５２±２６．０８ｍｓ，Ｐ＜０．０５）、相邻ＲＲ间期差值大于５０ｍｓ的百分比（６．７６±７．４９％ｖｓ９．０３±１０．２３％，Ｐ＜０．０１）、高频能谱（６１５．５８±４８５．６２ｂｐｍ２ｖｓ７０１．９７±６４９．９６ｂｐｍ２，Ｐ＜０．０５）均明显增大或升高。而平均心率（７４．３２±１１．３７ｂｐｍｖｓ６５．８８±７．７３ｂｐｍ，Ｐ＜０．０１）、最大心率（９５．６８±２８．６８ｂｐｍｖｓ７６．１４±８．５３ｂｐｍ，Ｐ＜０．０１）、低频能谱（４３８．２２±４０９．３１ｂｐｍ２ｖｓ２４０．１８±１９８．６８ｂｐｍ２，Ｐ＜０．０１）、极低频能谱（９７１．７４±５２９．５３ｂｐｍ２ｖｓ７２１．４３±５６４．０９ｂｐｍ２，Ｐ＜０．０１）均明显降?     

不同起搏方式对病窦综合征患者远期效果的影响

为了解不同起搏方式对病窦综合征特别是慢－快综合征患者心功能及房性心律失常的影响，利用超声心动图、体表心电图及Ｈｏｌｔｅｒ检查，对２１１例病窦综合征患者采用自身对照方法进行回顾性分析。结果发现：生理性起搏（ＡＡＩ／ＤＤＤ）组术后左室射血分数（ＬＶＥＦ）、心输出量（ＣＯ）明显增加（ＡＡＩ：５３．５±６．１％ｖｓ４７．２±７．８％，４．９５±０．５７Ｌ／ｍｉｎｖｓ４．２０±０．６２Ｌ／ｍｉｎ；ＤＤＤ：５２．５±６．８％ｖｓ４４．３±０．１％，５．１２±０．７１Ｌ／ｍｉｎｖｓ４．４１±０．３８Ｌ／ｍｉｎ；Ｐ均＜０．０１），左房内径（ＬＡＤ）无明显变化；ＤＤＤ组Ｅ／Ａ比值明显增加（０．９８±０．０９ｖｓ０．８７±０．１５，Ｐ＜０．０１），ＡＡＩ组Ｅ／Ａ比值呈增加趋势（Ｐ＝０．０５７）。房性心律失常发生率明显减少（１５．９％ｖｓ５０％，Ｐ＜０．０１）。非生理性起搏（ＶＶＩ）组术后ＬＶＥＦ、ＣＯ明显下降（４４．１±４．７％ｖｓ４８．３±４．３％，３．７７±０．４２Ｌ／ｍｉｎｖｓ４．１７±０．８５Ｌ／ｍｉｎ，Ｐ均＜０．０１），ＬＡＤ明显增大（３９．２６±２．３７ｍｍｖｓ３６．８１±２．３５ｍｍ，Ｐ＜０．０１），Ｅ／Ａ比值呈?     

心房起搏法在射频消融房室结折返性心动过速中的应用

将射频消融治疗的９４例房室结折返性心动过速（ＡＶＮＲＴ）病人按心房起搏法和常规法进行分组（分别为３９及５５例），回顾性比较两组病人的消融治疗结果，以评价这两种方法在射频消融治疗ＡＶＮＲＴ中的安全性、成功率和复发率。随访１０．８±４．５个月，总成功率为９６．８％、复发率为２．１％。与常规组相比，起搏组有效放电时间明显延长（１４５±３８ｓｖｓ８２±２６ｓ，Ｐ＜０．０１）、慢径阻断成功率高（６１．５％ｖｓ４０．０％，Ｐ＜０．０１）、一过性房室阻滞发生率低（２．６％ｖｓ１２．７％，Ｐ＜０．０５），但各种类型的永久性房室阻滞发生率和复发率无显著性差异（Ｐ＞０．０５）。表明ＡＶＮ－ＲＴ消融术中采用心房起搏法较常规法更为安全有效。     

心肌缺血和冠状动脉病变对QTc离散度的影响

为探讨ＱＴｃ离散度（ＱＴｃｄ）与心肌缺血和冠状动脉（简称冠脉）病变程度的关系，分析２８例冠脉正常和５７例冠心病患者１２导联心电图的ＱＴｃｄ。结果示：冠心病组ＱＴｃｄ较冠脉正常组显著增大（４６．７±１２．６ｍｓｖｓ２６．３±１０．９ｍｓ，Ｐ＜０．０１）；不稳定型心绞痛ＱＴｃｄ明显大于稳定型心绞痛者（５４．６±１３．７ｍｓｖｓ４２．３±１４．１ｍｓ，Ｐ＜０．０５）；双支病变与单支病变以及三支病变与双支病变相比，ＱＴｃｄ均有显著增大（４８．７±１３．２ｍｓｖｓ３５．７±１１．９ｍｓ及５９．６±１５．１ｍｓｖｓ４８．７±１３．２ｍｓ，Ｐ均＜０．０５）。提示心肌缺血是引起冠心病患者ＱＴｃｄ增大的主要原因之一，ＱＴｃｄ的变化对于判断心肌缺血和冠脉病变程度有一定价值。     

心肌缺血大鼠的心率功率谱变化及其与心脏性猝死关系的研究

采用心率变异（ＨＲＶ）频域指标定量评价心肌缺血大鼠的心脏自主神经功能变化及其与心脏性猝死（ＳＣＤ）的关系。Ｈｏｌｔｅｒ监测仪记录假手术组（２０只）及心肌缺血后存活组（５４只）与ＳＣＤ组（３６只）大鼠的心电信号。结果显示存活组或ＳＣＤ组大鼠于心肌缺血初始１５ｍｉｎ内的低频（ＬＦ）及低频／高频比值（ＬＦ／ＨＦ）较假手术组明显升高〔ＬＦ（ｍｓ２／Ｈｚ）：１９８．８±４１．３或２２６．７±５６．４ｖｓ６５．４±１９．６，Ｐ均＜０．０１；ＬＦ／ＨＦ：４．０８±１．１或５．１２±１．４ｖｓ１．８７±０．７，Ｐ均＜０．０１〕，而且ＳＣＤ组大鼠的ＬＦ与ＬＦ／ＨＦ较存活组增高〔ＬＦ（ｍｓ２／Ｈｚ）：２２６．７±５６．４ｖｓ１９８．８±４１．３，Ｐ均＜０．０５；ＬＦ／ＨＦ：５．１２±１．４ｖｓ４．０８±１．１，Ｐ＜０．０５〕，各组间ＨＦ无明显变化；ＳＣＤ组大鼠于ＳＣＤ发生前１５ｍｉｎ内，心率功率谱动态变化表现为ＬＦ及ＬＦ／ＨＦ随死亡时间的濒临而呈进行性升高（Ｐ＜０．０１及０．０５）。表明大鼠心肌缺血后其交感神经活性明显亢进，ＨＲＶ降低与ＳＣＤ的发生密切相关。     

心室频率适应式起搏对老年患者的应用价值

为探讨心室频率适应式起搏（ＶＶＩＲ）对老年人的应用价值，对１８例安置ＶＶＩＲ的老年患者按单盲交叉法随机程控为ＶＶＩＲ及ＶＶＩ两种起搏方式各四周，起搏期间作有关症状的定量评分、生活质量量表评价，并对患者进行自行选择起搏方式的调查。１６例完成上述研究者显示ＶＶＩＲ方式起搏时乏力与气急症状评分值较ＶＶＩ方式起搏时增加（３．８±１．３ｖｓ３．５±１．４，４．５±０．８ｖｓ４．３±１．０，Ｐ均＜０．０５），即症状好转；而心悸、头晕、胸闷、胸痛症状评分及每日硝酸甘油用量比较，差异无显著性（Ｐ均＞０．０５）。ＶＶＩＲ方式起搏时总体生活质量、精神状态及认知能力、社会参与性评分值较ＶＶＩ方式起搏时明显提高（１３２．６±１２．１ｖｓ１２５．０±１７．２，４０．４±４．４ｖｓ３８．４±５．７，１７．１±２．７ｖｓ１５．８±２．１，Ｐ均＜０．０５）。选择ＶＶＩＲ方式起搏者多于选择ＶＶＩ者（６２，Ｐ＜０．０５）。结果提示：ＶＶＩＲ起搏较ＶＶＩ起搏更能改善老年患者的自觉症状、提高其生活质量     

经皮冠状动脉腔内成形术对不稳定型心绞痛患者心率变异的影响

应用长程心电图分析系统对１６例不稳定型心绞痛患者（ＵＡＰ组）入院后第２日、经皮冠状动脉腔内成形术（ＲＴＣＡ）后第１，３，３０日以及１４８例健康中、老年人（对照组）２４ｈ心电图进行心率变异（ＨＲＶ）分析。结果：ＵＡＰ组２４ｈ连续正常ＲＲ间期的标准差（ＳＤＮＮ）、２４ｈ内连续５ｍｉｎ节段平均正常ＲＲ间期的标准差（ＳＤＡＮＮｉ）、相邻ＲＲ间期差的均方根（ｒＭＳＳＤ），相邻两个正常心动周期差值大于５０ｍｓ个数占总搏数的百分比（ＰＮＮ５０）、低频功率（ＬＦ）及高频功率（ＨＦ）均明显低于对照组（分别为９２．７±１４．３ｍｓｖｓ１２８．９±１７．８ｍｓ、７８．８±１０．６ｍｓｖｓ１１８．６±１９．１ｍｓ、１９．３±７．７ｍｓｖｓ２９．８±１２．７ｍｓ、３．６±１．７％ｖｓ６．５±５．５％、３１７．２±１４８．３ｍｓ２ｖｓ４７６．５±２８７．３ｍｓ２，Ｐ均＜０．０５），而ＬＦ／ＨＦ高于对照组（３．５±１．３ｖｓ２．４±１．１，Ｐ＜０．０５）。ＰＴＣＡ术后３０天ＵＡＰ患者ＨＲＶ逐渐恢复正常。结果提示ＵＡＰ患者交感神经和迷走神经张力下降，而以后者更明显；ＰＴＣＡ后ＨＲＶ逐渐恢复，说明ＰＴＣＡ能改善ＵＡＰ患者的ＨＲＶ。     

β-受体阻断剂和血管紧张素转换酶抑制剂对心肌梗死患者心率变异影响的比较

为了解β－受体阻断剂和血管紧张素转换酶抑制剂（ＡＣＥＩ）对心肌梗死患者心率变异（ＨＲＶ）的影响，采用惠普系列双通道动态心电图机对５３例急性心肌梗死（ＡＭＩ）和３２例陈旧性心肌梗死（ＯＭＩ）患者进行了ＨＲＶ分析。β－受体阻断剂治疗的ＡＭＩ患者（Ｂ组）与对照组（常规治疗的ＡＭＩ患者即Ｃ组）相比，２４ｈＲＲ间期总体标准差（ＳＤＮＮ）、相邻ＲＲ间期大于５０ｍｓ的百分比（ｐＮＮ５０）均增加（７．２６±３．４４ｍｓｖｓ４．２７±２．０１ｍｓ，１２６．３４±３０．０５ｖｓ９１．４８±２９．２１，Ｐ均＜０．０５），高频带（ＨＦ）增大（８．５３±１．９７ｍｓ２／Ｈｚｖｓ６．７２±２．０８ｍｓ２／Ｈｚ，Ｐ＜０．０５），低频带（ＬＦ）降低（１２．６４±３．０５ｍｓ２／Ｈｚｖｓ１５．３１±４．２１ｍｓ２／Ｈｚ，Ｐ＜０．０１）。ＡＣＥＩ治疗的ＡＭＩ患者（Ａ组）与对照组（ｃ组）相比，ｐＮＮ５０增加（１２３．５９±２７．６３ｖｓ９１．４８±２９．２１，Ｐ＜０．０５），低频与高频的比值降低（２．１３±１．０５ｖｓ２．３５±０．８７，Ｐ＜０．０５），其中伴有心力衰竭者与不伴心力衰竭者相比ＨＲＶ改善较显著。ＡＣＥＩ和β－受体阻断剂对ＯＭＩ患者?     

超声引导下右颈内静脉穿刺置管在血液透析中的应用

目的总结右颈内静脉穿刺置管的经验,探讨超声引导下右颈内静脉穿刺置管在血液透析中的应用价值。方法回顾性分析535例使用传统盲穿、超声定位及超声引导三种方法行右颈内静脉穿刺置管术成功率、穿刺时间、病人满意度和发生并发症的种类和例数。结果传统盲穿218例中,一次成功103例（47.25%）,穿刺时间（65±11）s,总成功率83.01%（181例）,发生局部气肿、血肿17例（7.80%）,误伤颈动脉9例（4.29%）,神经损伤3例（1.38%）,血气胸1例（0.46%）,病人满意度54.13%;超声定位210例中,一次成功121例（57.62%）,穿刺时间（45±8）s,总成功率91.43%（192例）,发生局部气肿、血肿12例（5.71%）,误伤颈动脉4例（1.90%）,神经损伤1例（0.48%）,无血胸、气胸病例,病人满意度77.62%;超声引导107例,一次成功92例（85.98%）,穿刺时间（30±7）s,总成功率100%,除1例发生局部皮下血肿外,未发生其他并发症,病人满意度达82.22%。与传统盲穿比较,超声定位,尤其超声引导穿刺有很大的优越性。结论血液透析患者行右颈内静脉穿刺置管,是一种风险较大的有创性操作,在超声引导下穿刺能缩短操作时间,提高成功率,减少并发症,提高病人满意度。     

经颈内静脉床旁盲插普通电生理导管紧急临时心脏起搏

为探讨经颈内静脉床旁盲插普通电生理导管行紧急临时心脏起搏的疗效和安全性。选择 5 1例缓慢性心律失常伴血流动力学障碍的患者经右颈内静脉在床旁无X线透视条件下插入普通 4极电生理导管 ,如有室性早搏或短阵室性心动过速为插管成功 ,观察起搏操作时间 ,可靠性和并发症情况。结果 :4 9例患者起搏成功 ,成功率 96 .1%。2例起搏失败的患者需要在X线透视下起搏成功。从穿刺开始到成功起搏的时间平均为 4± 1.7(3～ 5 )min ,起搏阈值为 1.5± 0 .7(0 .5～ 3)mA ,床旁X线片证实右室心尖部起搏 2 5例 ,右室流入道起搏 13例 ,右室流出道起搏 11例。起搏时间为 5± 3.7(3～ 9)天 ,在此起搏期间有 3例患者出现导管脱位不能有效起搏 ,经调整导管后重新起搏。所有患者无并发症发生。结论 :经颈内静脉床旁盲插导管行临时心脏起搏是一种快速有效的起搏方法。     

锁骨下静脉穿刺与头静脉切开途径安置心脏起搏器的随机对照研究

为比较锁骨下静脉穿刺与头静脉切开途径安置心脏起搏器的价值 ,将 1 0 0例需安置心脏起搏器的病人随机分为锁骨下静脉穿刺组和头静脉切开组 (均包括单腔亚组和双腔亚组 ) ,每组各 5 0例。观察两种手术径路安置起搏器的手术时间、X线曝光时间、手术并发症及病人对手术切口及囊袋的满意度。结果 :无论是手术时间 ,还是X线曝光时间 ,锁骨下静脉组中单腔亚组及双腔亚组均比头静脉组中的对应亚组为短 ( 64.1± 1 4.2minvs 73.8± 1 1 .6min ,86.4± 1 3.2minvs 1 0 6.5± 1 9.4min和 3.45± 0 .83minvs 4.5 1± 2 .2 7min ,5 .5 9± 0 .78minvs 8.2 7± 4.91min ,P均 <0 .0 5 )。锁骨下静脉穿刺组心室电极导线放置成功率为 1 0 0 % ,而头静脉切开组则为 5 6% ,二者亦有显著性差异 (P <0 .0 5 )。而两组并发症发生率无差异。病人对切口及囊袋满意程度的积分 ,锁骨下静脉组明显高于头静脉组 ( 2 .2 4± 0 .5 6vs 1 .92± 0 .5 7,P <0 .0 1 )。结论 :只要锁骨下静脉穿刺技术熟练 ,安置心脏起搏器可首选锁骨下静脉穿刺     

Fluoroscopy vs. Traditional guided femoral arterial access and the use of closure devices: A randomized controlled trial

Objective: To compare the effectiveness of accessing the common femoral artery (CFA) using fluoroscopic guidance (FG) versus traditional anatomic landmark guidance (TALG) during cardiac catheterization and to determine the effect of the two modalities on the appropriateness for use of vascular closure devices (VCDs). Background: Previous studies have shown a consistent relationship between the head of the femur and the CFA, yet there is no prospective data validating the superiority of fluoroscopy‐assisted CFA access. Methods: A total of 972 patients were randomized to either FG or TALG access. The primary endpoint of the study was the angiographic suitability of the puncture site for VCD use. Secondary endpoints included arteriotomy location, time and number of attempts needed to obtain access, and the incidence of vascular complications. Results: Of these, 474 patients were randomized into the FG arm and 498 patients into the TALG arm. A total of 79.5% of patients in the fluoroscopy arm and 80.7% in the traditional arm (P = 0.7) were deemed angiographically suitable for VCD based on the arteriotomy. The fluoroscopy group had significantly less arteriotomies below the inferior border of the head of the femur (P = 0.03). Total time for sheath insertion (105.7 ± 130.7 vs. 106.5 ± 152.6 sec) and number of arterial punctures (1.1 ± 0.4 vs. 1.1 ± 0.5) did not differ among the FG and TALG, respectively. The rates of vascular complications were not different. Conclusion: The angiographic suitability for VCD was not different between FG and TALG groups. Fluoroscopy decreased the number of low arteriotomies. The time to sheath insertion, number of arterial punctures needed to obtain access, and the incidence of complications were also similar. © 2009 Wiley‐Liss, Inc.     

Intracardiac Echocardiography Improves Procedural Efficiency During Cryoballoon Ablation for Atrial Fibrillation: A Pilot Study

Intracardiac Echocardiography Guided Cryoballoon Ablation. Background: Cryoballoon ablation is increasingly used for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). This new technique aims to perform PVI safer and faster. However, procedure and fluoroscopy times were similar to conventional RF approaches. We compared ICE plus fluoroscopy versus fluoroscopy alone for anatomical guidance of PVI. Methods: Forty‐three consecutive patients with paroxysmal AF were randomly assigned to ICE plus fluoroscopy (n = 22) versus fluoroscopy alone (n = 21) for guidance of cryoballoon PVI. A “single big balloon” procedure using a 28 mm cryoballoon was performed. The optimal ICE‐guided position of the cryoballoon was assessed by full ostial occlusion and loss of Doppler coded reflow to the left atrium (LA). Any further freezes were ICE‐guided only without use of fluoroscopy or contrast media injection. Results: A total of 171 pulmonary veins could be visualized with ICE. 80% of ICE‐guided freezes were performed with excellent ICE quality. Acute procedural success and AF recurrence rate at 6 months were similar in both groups (AF recurrence: ICE‐guided = 27% vs Fluoroscopy = 33%; P = ns). Patients without ICE guidance had significantly longer procedure (143 ± 27 minutes vs 130 ± 19 minutes; P = 0.05) and fluoroscopy times (42 ± 13 minutes vs 26 ± 10, P = 0.01). The total amount of contrast used during the procedure was significantly lower in patients with ICE guidance (88 ± 31 mL vs 169 ± 38 mL, P < 0.001). Conclusion: Additional ICE guidance appears to be associated with lower fluoroscopy, contrast, and procedure times, with similar efficacy rates. Specifically, ICE allows for better identification of the PV LA junction and more precise anatomically guided cryoballoon ablations. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1202‐1207, November 2010)     

Randomized trial of intracardiac echocardiography during cavotricuspid isthmus ablation

Randomized Trial of ICE During CTI Ablation. Introduction: Despite a high success rate, radio‐frequency ablation (RFA) of the cavotricuspid isthmus (CTI) can be unusually challenging in some cases. We postulated that visualization of the CTI with intracardiac echocardiography (ICE) could maximize the succes rate, decrease the procedure and ablation time, and minimize the radiation exposure. Methods and Results: In our prospective, randomized study, we included 102 patients scheduled for CTI ablation. We randomized patients in 2 groups: guided only by fluoroscopy (n = 52) or ICE‐guided (n = 50) group. Procedure time, fluoroscopy time, and the time spent for RFA were significantly shorter, radiation exposure (dose‐area product‐DAP) and the sum of delivered radio frequency energy were significantly lower in the ICE‐group (68.06 ± 15.09 minutes vs 105.94 ± 36.51 minutes, P < 0.001, 5.54 ± 3.77 minutes vs 18.63 ± 10.60 minutes, P < 0.001, 482.80 ± 534.12 seconds vs 779.76 ± 620.82 seconds, P = 0.001 and 397.62 ± 380.81 cGycm² vs 1,312.92 ± 1,129.28 cGycm², P < 0.001, 10,866.84 ± 6,930.84 Ws vs 16,393.56 ± 13,995.78 Ws, P = 0.048, respectively). Seven patients (13%) from the fluoroscopy‐only group crossed over to ICE‐guidance because of prolonged unsuccessful RFA and were all treated successfully. Four vascular complications and 2 recurrences were equally distributed between the 2 groups. Conclusions: ICE‐guided ablation of the CTI significantly shortens the procedure and fluoroscopy time, markedly decreases radiation exposure, and time spent for ablation in comparison with fluoroscopy‐only procedures. At the same time, visualization with ICE allowed successful ablation in challenging cases. (J Cardiovasc Electrophysiol, Vol. 23, pp. 996‐1000, September 2012)     

Effect of Electroanatomically Guided Versus Conventional Catheter Ablation of Typical Atrial Flutter on the Fluoroscopy Time and Resource Use: A Prospective Randomized Multicenter Study

Aims: Radiofrequency catheter ablation of typical atrial flutter is one of the most frequent indications for catheter ablation in electrophysiology laboratories today. Clinical utility of electroanatomic mapping systems on treatment results and resource utilization compared with conventional ablation has not been systematically investigated in a prospective multicenter study. Methods and Results: In this prospective, randomized multicenter study, the results of catheter ablation to cure typical atrial flutter using conventional ablation strategy were compared with electroanatomically guided mapping and ablation (Carto®). Primary endpoints of the study were procedure duration and fluoroscopy exposure time, secondary endpoints were acute success rate, recurrence rate, and resource utilization. A total of 210 patients (169 men, 41 women, mean age 63 ± 10 years) with documented typical atrial flutter were included in the study. Acute ablation success, that is, demonstration of bidirectional isthmus block, was achieved in 99 of 105 patients (94%) in the electroanatomically guided ablation group and in 102 of 105 patients (97%) in the conventional ablation group (P > 0.05). Total procedure duration was comparable between both study groups (99 ± 57 minutes vs 88 ± 54 minutes, P > 0.05). Fluoroscopy exposure time was significantly shorter in the electroanatomically guided ablation group (7.7 ± 7.3 minutes vs 14.8 ± 11.9 minutes; P < 0.05). Total recurrence rate of typical atrial flutter at 6 months of follow‐up was comparable between the 2 groups (respectively for the CARTO and conventional group 6.6% vs 5.7%, P > 0.05). The material costs per procedure in the electroanatomically guided and conventional groups (NaviStar® DS vs Celsius® DS) was €3035 (USD 3,870) and €2133 (USD 2,720), respectively. Conclusions: This multicenter study documented that cavotricuspid isthmus ablation to cure typical atrial flutter was highly effective and safe, both in the conventional and the electroanatomically guided ablation group. The use of electroanatomical mapping system significantly reduced the fluoroscopy exposure time by almost 50%, however, at the expense of increased cost of the procedure.     

Endomyocardial biopsy in heterotopic heart transplant recipients via the femoral vein

The results of endomyocardial biopsy (EMB) via the femoral vein in heterotopic heart transplant recipients were retrospectively analyzed and compared with those obtained using the right internal jugular vein approach. A total of 139 EMB were performed in 8 patients using the femoral (35) or the jugular (104) approach. Twenty three (64.7%) of the procedures performed via the femoral vein were part of the yearly hemodynamic and coronary artery study, and 12 (35.3%) constituted a routine postoperative evaluation of the myocardium rejection state in patients with imperviousness of the right internal jugular vein. Comparing the results obtained with the femoral approach, we observed a higher overall success rate (94.3 vs 88.5%, NS) and obtained more samples that were useful for histologic evaluation (95.5 vs 85.9%, NS); with the jugular procedure, the fragments were significatively larger in diameter (1.28 ± 0.55 vs 1.61 ± 0.85 mm, mean ± SD) and in area (1.49 ± 1.16 vs 2.28 ± 2.24 mm², mean ± SD). No cardiac or local complications were noted when the femoral approach was used, while two attempts to perform biopsy via the jugular vein resulted in obstruction of this vessel. Our data suggest that the femoral venous approach for endomyocardial biopsy in heterotopic heart transplant recipients is a valid alternative to the more commonly used routes.     

严重左心室功能不全冠心病患者冠状动脉内支架术疗效研究

目的　研究左心室 (左室 )功能不全冠心病患者冠状动脉 (冠脉 )内支架术的疗效及预后。方法　包括 6 6例左室功能不全 (射血分数≤ 0 35 ) (左室功能不全组 )和同期 6 6例年龄、性别及一般情况匹配但左室功能正常的行冠脉内支架术冠心病患者 (对照组 )。比较两组冠脉病变程度 ,冠脉内支架术中及术后随访情况。结果　与对照组相比 ,左室功能不全组多支冠脉病变患者明显增多 ( 6 7%和 4 7% ,P <0 0 5 ) ,完全血运重建率降低 ( 6 5 %和 82 % ,P <0 0 5 ) ;两组术中并发症发生率及支架术成功率均相似 (分别为 3%和 0 % ;95 %和 96 % ,P >0 0 5 )。平均随访二年发现左室功能不全组支架术后左室射血分数明显提高 (术后 0 35± 0 11和术前 0 30± 0 0 4 ,P <0 0 5 ) ,无严重心脏不良事件 ,生存率和对照组相似 ( 80 %和 86 % ,P >0 0 5 )。结论　冠脉内支架术对左室功能不全冠心病患者安全有效 ,术后患者远期生存率与左室功能正常者相似