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目的 采用多层螺旋CT定量测量心房颤动(AF)患者左心房、左心耳功能,探讨不同类型AF患者之间左心房及左心耳功能的差异。方法 收集71例AF患者,包括阵发性房颤(PAF)40例(PAF组),持续性房颤(PeAF)31例(PeAF组)。应用心功能后处理软件测量AF患者左心耳最大容积(LAAVmax)、左心耳最小容积(LAAVmin)、左心房最大容积(LAVmax)和左心房最小容积(LAVmin),并计算左心耳射血分数(LAAEF)、左心耳射血量(LAAEV)、左心房射血分数(LAEF)、左心房射血量(LAEV)。结果 PeAF组LAAEF、LAEF、LAEV均小于PAF组(P均<0.01),LAAVmax、LAAVmin、LAVmax、LAVmin均大于PAF组(P均<0.05)。2组间LAAEV差异无统计学意义(P=0.23)。AF患者LAAEF与LAEF呈正相关(rs=0.57,P<0.01),与AF持续时间呈负相关(rs=-0.26,P=0.03)。结论 应用多层螺旋CT可以客观评价左心房和左心耳功能,对认识不同分型AF患者左心耳和左心房功能改变有重要临床意义。 相似文献
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Kubala M Hermida JS Nadji G Quenum S Traulle S Jarry G 《Pacing and clinical electrophysiology : PACE》2011,34(7):837-843
Background: Pulmonary vein cryoablation (PVC) is a new approach in the treatment of recurrent atrial fibrillation (AF). Computed tomography (CT) can be used to evaluate the left atrium anatomy and PVs dimensions to facilitate the procedure. In radiofrequency procedures, some anatomic variants such as common left (CLPV) or right (CRPV) PV were reported as factors associated with technical procedure difficulties and potential long‐term complications. We hypothesized that the absence of CLPV as determined by CT would predict better AF‐free survival after PVC. Methods and results: We included 118 consecutive patients (mean age 56 ± 10 years; 77% males) with drug refractory paroxysmal (72%)/persistent (28%) AF, with more than 6 months follow‐up, who underwent PVC. On CT scanning images performed within 1 month prior to ablation, we evaluated PV anatomic patterns: presence of CLPV or CRPV. Each patient was evaluated by 24‐hour Holter monitoring within 1 and 3 months and all patients were periodically evaluated at 1, 3, and 6 months, and every 6 months thereafter. Patients were asked to record their 12‐lead electrocardiogram whenever they experienced symptoms suggestive of AF. Recurrence was defined as AF that lasted at least 30 seconds. CLPV was present in 30 (25%) patients and no patients with CRPV were identified. At the end of the 13 months follow‐up, patients with normal PVs had significantly better AF‐free survival compared to patients with CLPV (67% vs 50%, P = 0.02). The difference was present in patients with paroxysmal AF (P = 0.008) but not in patients with persistent AF (P = 0.92). Conclusion: In patients undergoing cryoballoon PV isolation for AF, the presence of normal PVs pattern is associated with better AF‐free survival as compared to atypical PV anatomy with CLPV, particularly in patients with paroxysmal AF. (PACE 2011; 34:837–843) 相似文献
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Masuda M Inoue K Iwakura K Okamura A Koyama Y Kimura R Toyoshima Y Ito N Komuro I Fujii K 《Pacing and clinical electrophysiology : PACE》2012,35(3):327-334
Background: The effect of atrial fibrillation (AF) ablation on left atrial (LA) function has not been sufficiently determined. Methods: We enrolled 115 consecutive patients with paroxysmal or persistent AF that underwent AF ablation. Multidetector computed tomography was performed in sinus rhythm before and 3 months after ablation to evaluate LA volume (LAV) and function. Estimates of maximum and minimum LAV were used to calculate LA emptying fraction (LAEF) ([maximum–minimum LAV]/maximum LAV × 100). Results: AF ablation significantly decreased maximum LAV (59.0 ± 20.4 to 53.3 ± 16.7 cm3, P = 0.001), and maintained LAEF (44.5 ± 13.1% to 43.7 ± 10.9%, P = 0.49). The larger the baseline maximum LAV, the greater the decrease in LAV after ablation, and a smaller baseline LAEF was associated with a larger recovery of LAEF after ablation (regression coefficient =−0.45 and −0.56, respectively, P < 0.0001). Multivariable analyses revealed that an impaired baseline LAEF was an independent predictor of an improvement in LA function (an increase in LAEF of >10%; odds ratio [OR] = 0.88, P < 0.0001), while an older age and preserved baseline LAEF were independently associated with a deterioration of LA function (a decrease in LAEF of >10%; OR = 1.06, P = 0.03; and OR = 1.10, P = 0.0001). Conclusions: AF ablation appears to have a beneficial effect on LA function in patients with impaired LA function at baseline. However, it may reduce LA function in patients with an older age and preserved baseline LAEF. (PACE 2011;1–8) 相似文献
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Cardiac CT assessment of tissue thickness at the ostium of the left atrial appendage predicts acute success of radiofrequency ablation 下载免费PDF全文
John Whitaker BM BCh MRCP Sandeep Panikker MBBS MRCP Thomas Fastl MSc Cesare Corrado PhD Renu Virmani MD Robert Kutys MS PA Eric Lim MBBS MRCP Mark O'Neill DPHIL FRCP FHRS Ed Nicol MD MBA FRCP Steven Niederer PhD Tom Wong MD FRCP 《Pacing and clinical electrophysiology : PACE》2017,40(11):1218-1226
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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。 相似文献
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目的 观察左心房容积(LAV)与肺静脉容积(PVV)比(LAV/PVV)预测导管消融术后心房颤动(AF)复发的价值。方法 纳入95例接受导管消融术治疗的AF患者,根据术后随访1年内有无AF复发将其分别归入复发组(n=23)与未复发组(n=72)。采用2种方法(方法1,对各支肺静脉均渲染至距肺静脉开口部后2 cm;方法2,对各支肺静脉均渲染至肺静脉分叉后1 cm)基于心脏CT血管成像(CTA)测量左肺上静脉容积(LSPVV)、左肺下静脉容积(LIPVV)、右肺上静脉容积(RSPVV)及右肺下静脉容积(RIPVV),计算LAV及PVV;比较2种方法测值,评估LAV/PVV预测导管消融术后AF复发的价值。结果 方法1、2所测LIPVV差异有统计学意义(P<0.05)。根据单因素分析结果,性别、年龄、体质量指数(BMI)、心力衰竭、LAV及LAV/PVV均为导管消融术后AF复发的危险因素;多因素分析结果显示,仅LAV/PVV为AF复发的危险因素。以8.27为方法1所获LAV/PVV的最佳截断值,其预测导管消融术后AF复发的曲线下面积(AUC)、敏感度及特异度分别为0.774、78.26%... 相似文献
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Knackstedt C Visser L Plisiene J Zarse M Waldmann M Mischke K Koch KC Hoffmann R Franke A Hanrath P Schauerte P 《Pacing and clinical electrophysiology : PACE》2003,26(6):1371-1378
Ectopic beats originating from sleeves of atrial tissue within the pulmonary veins (PVs) can induce and sustain paroxysmal atrial fibrillation (AF). Left atrial stretch and dilatation favors the development of atrial ectopy and AF. Similarly, PV dilatation, if present, might trigger PV ectopy in patients with AF. This study was designed to evaluate whether PV dilatation is present in patients with nonfocal AF and whether the PV diameter correlates to the left atrial diameter (LAD). The diameters of the right superior (RSPV) and left superior PV (LSPV) were measured at the ostium and at a depth of 1 cm in 170 patients (AF, n = 75; sinus rhythm [SR], n = 95) using transesophageal echocardiography. The LAD was determined by transthoracic echocardiography. The diameters of the PVs were significantly larger in patients with AF than in patients with SR (LSPV(ostium): AF 13.6 +/- 3.5 mm vs SR 10.6 +/- 2.7 mm, P < 0.001; LSVP(1cm): AF 12.5 +/- 2.9 mm vs SR 10.2 +/- 2.5 mm, P < 0.001; RSPV(ostium): AF 13.9 +/- 3.5 mm vs SR 11.7 +/- 2.9 mm, P < 0.001; RSVP(1cm): AF 12.8 +/- 2.8 mm vs SR 10.6 +/- 2.6 mm, P < 0.05). Similarly, LAD was larger in patients with AF (44.7 +/- 7.7 mm) as compared to patients with SR (38.8 +/- 6.8 mm, P < 0.001). Neither for the SR nor the AF group did the PV size correlate to the LAD. AF is associated with a significant enlargement of the RSPV, LSPV, and LAD. There is no correlation between LAD and PV diameters. This raises the question whether PV dilatation in patients with AF is a cause or a consequence of AF and whether it may contribute to the development and perpetuation of AF. 相似文献
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目的 探讨超声心动图评估完全型肺静脉异位连接(TAPVC)中肺静脉病变的价值。方法 收集55例TAPVC患儿的超声心动图资料,并与CTA及术中所见进行对比。结果 应用超声心动图根据肺静脉引流部位对55例TAPVC患儿进行分类,分为心上型24例、心内型20例、心下型7例及混合型4例。15例垂直肺静脉梗阻中,心上型的梗阻多出现在垂直静脉与无名静脉或上腔静脉之间,心下型的梗阻均出现在垂直静脉与肝静脉或门静脉之间。肺静脉狭窄4例,其中3例局限性狭窄均为心内型,出现在分支肺静脉与共同肺静脉腔或右心房之间,1例弥漫性狭窄为心下型。分支肺静脉异常9例,其中超声心动图仅检出1例,而CTA检出8例。结论 超声心动图能对TAPVC中的肺静脉的引流、梗阻和分支肺静脉近端的狭窄做出更为全面的评价。CTA评估分支肺静脉的汇入和数目异常及远端肺静脉的成像方面优于超声心动图。 相似文献
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目的 探讨超声心动图(ECG)联合增强CT对肺静脉异位引流(APVC)的诊断价值。方法 回顾性分析经手术证实的34例APVC患者,术前均接受ECG检查,其中18例联合增强CT检查,统计诊断准确率、漏诊率、误诊率。结果 34例APVC患者中,ECG正确诊断28例(28/34,82.35%),漏诊3例(3/34,8.82%),误诊3例(3/34,8.82%)。经ECG联合CT诊断的18例患者中,单独经ECG正确诊断15例(15/18,83.33%),无漏诊,误诊3例(3/18,16.67%);ECG联合CT正确诊断17例(17/18,94.44%),无漏诊0例,误诊1例(1/18,5.55%)。结论 ECG联合增强CT可准确诊断APVC。 相似文献
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Herweg B Ilercil A Whitaker DM Hamilton L Khan NG Barold SS 《Pacing and clinical electrophysiology : PACE》2004,27(8):1153-1157
This report describes two patients with sustained regular left atrial tachycardias originating from multiple pulmonary veins in the absence of clinical evidence of atrial fibrillation. The tachycardias were eliminated by activation map-guided pulmonary vein isolation. Stable sustained regular pulmonary vein tachycardias unassociated with atrial fibrillation are uncommon, and they belong to the spectrum of pulmonary vein arrhythmias that include the more common paroxysmal and unstable tachycardias engendering atrial fibrillation. 相似文献
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目的评价超声心动图结合Flash CT对肺静脉畸形引流(APVC)的诊断价值。 方法2011年9月至2015年5月郑州大学第一附属医院收治行心脏畸形矫治的各种不同类型的APVC患者71例。所有患者均经手术确诊。包括完全性肺静脉畸形引流(TAPVC)患者44例,部分性肺静脉畸形引流(PAPVC)患者27例。所有患者术前均行超声心动图与Flash CT检查。记录所有病例的CT剂量指数和剂量长度乘积(DLP),计算有效辐射剂量(ED)。采用Fisher确切概率法比较超声心动图与Flash CT对TAPVC/PAPVC分型、TAPVC/PAPVC合并畸形的诊断准确率差异。 结果超声心动图与Flash CT对TAPVC分型的诊断准确率分别为86.4%(38/44)和97.7%(43/44),差异无统计学意义(P>0.05)。超声心动图与Flash CT对TAPVC合并畸形的诊断准确率分别为100%(62/62)和95.2%(59/62),差异无统计学意义(P>0.05)。Flash CT对PAPVC分型的诊断准确率为96.3%(26/27),高于超声心动图对PAPVC分型的诊断准确率74.1%(20/27),且差异有统计学意义(P<0.05)。超声心动图对PAPVC合并畸形的诊断准确率为97.7%(43/44),高于Flash CT对PAPVC合并畸形的诊断准确率72.3%(34/44),且差异有统计学意义(P<0.01)。71例APVC患者的辐射剂量:平均DLP为(13.5±3.9) mGy ? cm,平均ED值为(0.324±0.065)mSv。 结论超声心动图是诊断APVC传统的可靠方法,尤其对瓣膜病变、肺动脉压力及心功能可以做出全面评价。Flash CT大螺距扫描技术对心脏周围血管畸形的诊断具有独特的优势,在不影响诊断准确率的前提下,大大减少了射线的辐射剂量,尤其对于PAPVC患者,Flash CT诊断准确率要高于超声心动图,对超声心动图起到了很好的补充诊断作用。 相似文献
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目的:分析脑静脉窦/脑静脉血栓形成(CVST/CVT)CT平扫的影像学表现特征,以便提高CT平扫对CVST/CVT的早期认识,优化诊断方法,减少误诊。材料与方法:搜集拟诊为CVST/CVT病例25例的平扫及部分增强病例,经与MR与DSA等对照。重点回顾会诊前后血栓本身的CT平扫的直接征象及间接征象并进行对照,比较两者的结果。结果:CT平扫初诊血栓的直接征象的阳性率为13/25,阴性率为12/25,其中假阳性3例,假阴性8例。会诊后血栓阳性征象为21/25,阴性率为4/25,经统计学分析两者差别有显著性。而脑实质改变,会诊前检查的阳性率为20/25,阴性为5/20,而会诊后影像学阳性率为21/25,阴性为4/25,经统计学分析两者的差别无显著性。同时分析了CT平扫误诊原因及正确进行影像学检查的策略。结论:CVST/CVT CT初次平扫,大多都有血栓的直接征象及间接征象,正确认识这些征象,可以提示CVST/CVT的存在,并推荐立即行CTV检查来证实CT平扫的初步意见。 相似文献
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目的 比较双源CT(dual-source computed tomography,DSCT)超低管电压结合迭代重建技术与经胸超声心动图(trans-thoracic echocardiography,TTE)检查对婴幼儿复杂先天性心脏病肺静脉异位引流(anomalous pulmonary venous connec... 相似文献
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Hugo‐Enrique Coutio Erwin Strker Ken Takarada Giacomo Mugnai Juan‐Pablo Abugattas Juan Sieira Francesca Salghetti Muryo Terasawa Varnavas Varnavas Riccardo Maj Thiago Guimares Osrio Diego Neach Pedro Brugada Carlo de Asmundis Gian‐Battista Chierchia 《Pacing and clinical electrophysiology : PACE》2019,42(11):1456-1462