应用非接触球囊导管标测系统指导心动过速的心内膜标测与消融

目的观察非接触球囊导管标测系统指导难治性室性心动过速的标测与射频消融的有效性和优越性。方法5例患者均为男性，平均年龄33.2岁。经股静脉或股动脉置入64极球囊电极和射频消融导管至同一心室，计算机标测系统首先构建心腔的几何构型，然后建立心动过速的腔内等电势图，分析心动过速的最早起源点及折返激动的关键峡部，最终利用计算机导航系统指导消融导管至拟定靶点处进行环状或线形消融。结果5例患者共诱发出6种心动过速，心动过速平均周期为（336.6±42.7）ms。2例特发性左室室性心动过速及1例隐匿性束室纤维患者均消融成功。1例扩张型心肌病患者共有两种心动过速，一种起源于右室流出道，另一种起源于左室间隔部，前者消融成功，后者因导管操作致心动过速持续发作伴血流动力学不稳定而终止手术。1例致心律失常性右室心肌病患者于最早激动点处做环状消融，未获成功。5例患者术中和术后均无并发症发生。随访4个月，所有消融成功患者均未再有心动过速发作。结论非接触性球囊导管标测系统指导心律失常的心内膜标测与消融是安全、有效的，与常规的标测和消融方法比较，该系统有一定的优越性，尤其适用于复杂病例、血流动力学不稳定和非持续性室性心律失常的标测及指导射频消融。     

Carto三维标测系统指导房性心动过速射频导管消融的临床分析

目的 探讨Carto三维标测系统指导房性心动过速射频导管消融的方法及疗效.方法 对10例房性心动过速患者应用Carto三维标测系统标测右和/或左心房,实时构建三维电解剖图.判断房性心动过速起源部位及类型.局灶性或大折返性房性心动过速,并于心房最早激动点或折返环的关键峡部消融.结果 10例患者均为局灶性房性心动过速,右心房性8例,其中6例起源于右心房底部(冠状静脉窦口附近2例、间隔部1例、侧壁3例),2例起源于右心房上部(间隔部1例、后壁1例);左心房性2例均起源于左心房右上肺静脉口.所有病例在Carto三维标测系统指导下射频导管消融均获得成功,无并发症,随访5～24个月均无复发.结论 应用Carto三维标测系统标测房性心动过速,对判断房性心动过速起源及类型准确快速,能安全、有效指导射频导管消融,减少X线曝光时间,进一步提高成功率.     

环肺静脉左心房线性消融术后复发的房性心律失常

目的研究心房颤动(房颤)患者环肺静脉左心房线性消融术后复发房性心律失常的机制。方法28例房颤患者接受环肺静脉左心房线性消融术,平均年龄(54±11)岁,其中阵发性房颤10例,持续性房颤18例。采用Carto电解剖标测系统及双Lasso标测导管技术,分别进行环左、右侧肺静脉线性消融;消融终点为肺静脉电位消失,左心房-肺静脉双向阻滞。复发患者再次消融术采用双Lasso导管指导在原环形消融线上标测“漏点”并消融封闭之,对不能终止心动过速者再行拖带标测、激动标测或结合Carto系统标测;对典型心房扑动(房扑)行右心房峡部线性消融。结果初次消融术后平均随访(245±65)d,18例无复发;8例复发房性心律失常包括5例典型房扑、2例其他房性心动过速、1例阵发性房颤;2例左上肺静脉电位未完全隔离者仍持续房颤。除外1例持续性房颤,另外9例接受了再次消融术,证实所有复发患者均有左心房-肺静脉传导恢复;8例射频消融成功并随访(192±92)d无复发。结论左心房-肺静脉传导恢复是环肺静脉左心房线性消融术后复发房性心律失常的重要因素;初次手术附加右心房峡部线性消融可能减少复发率。     

三维标测指导心房颤动环肺静脉线性消融130例分析

目的:探讨三维标测系统指导下行心房颤动(房颤)环肺静脉线性消融的临床效果。方法:2006年6月至2009年8月对新疆维吾尔自治区人民医院收治的130例房颤患者进行三维标测系统(CARTO系统)指导下的环肺静脉线性消融,消融的主要终点为肺静脉电学隔离。随访3个月症状性快速性房性心律失常消失视为成功。结果:129例(99.2%)实现肺静脉电隔离,阵发性房颤消融成功率为84.5%,持续性、永久性单次房颤消融成功率71.1%。严重并发症包括心脏压塞1例,心包穿刺引流后痊愈;肺栓塞1例,治疗后康复;无死亡病例。结论:三维标测指导下心房颤动环肺静脉线性消融是安全、有效的。     

三维标测系统指导心房颤动导管消融的临床研究

目的 探讨三维标测系统指导下导管射频消融治疗心房颤动的有效性与安全性.方法 回顾性分析39例在三维标测系统指导下行环肺静脉线性消融术的心房颤动患者(其中阵发性心房颤动33例和持续性心房颤动6例)的临床资料,着重分析术前准备、标测及消融方法 、手术结果 、术后治疗和随访.结果 消融终点为Lagso标测的所有肺静脉均达到完全电学隔离,若消融结束后心房颤动仍未终止,即行同步直流电复律恢复窦性心律.39例患者共完成78条环形消融线,肺静脉完全电学隔离率为93.6%(73/78).手术操作时间为(245±56)min、X线曝光时间为(46±15)min.术后随访6个月～12个月,33例临床症状得到改善,无心房颤动复发,6例需服用抗心律失常药维持窦性心律,其中3例心房颤动复发患者接受再次导管消融后无发作.射频消融术后总成功率为84.6%(33/39).结论 三维标测系统指导下导管射频消融治疗心房颤动是安全和有效的治疗方法.     

起源上腔静脉快速房性心律失常的电生理特征和射频导管消融治疗

目的:分析上腔静脉起源的异位冲动诱发阵发性心房颤动(房颤)和房性心动过速(房速)的特点,总结射频导管消融电隔离上腔静脉治疗快速房性心律失常的经验。方法:连续收治快速房性心律失常患者108例,对经电生理检查证实房性心律失常起源于上腔静脉的11例患者行上腔静脉造影,明确上腔静脉开口位置后应用标测导管于上腔静脉进行激动标测,标测上腔静脉最早激动点及肌袖电位分布位置进行消融,直至房性心律失常终止及上腔静脉电位消失。结果:11例患者中,房速5例,房颤6例。5例房速患者上腔静脉房速发作周长为260～390ms;P波形态除1例判定不清外,其余4例均为Ⅰ、Ⅱ、Ⅲ、aVF、aVL导联直立,aVR导联倒置。6例房颤患者中,4例在环肺静脉隔离后仍可诱发或自发短阵房速或频发房性期前收缩,经标测起源于上腔静脉;2例术中自发房颤标测过程中发现上腔静脉电位频率较肺静脉电位频率更快。上腔静脉电隔离后,术中均成功终止心动过速。随访6～20个月,1例患者阵发性房颤复发,1例患者因窦性停搏行永久起搏器治疗。结论:上腔静脉是房速和房颤的起源部位之一,射频导管消融治疗有很高的成功率。     

非接触心内膜激动标测系统引导下的左房消融治疗阵发性心房颤动的初步研究

为探讨非肺静脉起源的阵发性心房颤动 (简称房颤 )用非接触心内膜激动标测系统 (EnSite30 0 0 )标测房颤的起始激动部位、折返途径与传导以及射频消融术治疗的方法、效果及其安全性。对 6例左房起源的房颤 ,用改良Ross法穿刺房间隔后置入EnSite30 0 0标测球囊导管于左房 ,将大头导管分别送至左上、下肺静脉 ,右上、下肺静脉 ,二尖瓣口及在左房前后、左右各壁移动 ,描记左房三维几何图形。记录诱发房颤的房性早搏 (简称房早 )起源点、房颤起始的传导方向、折返部位。设计消融点与消融线 ,用 5 0～ 5 5℃温控消融导管放电 ,每点 6 0s。参考消融终点 :①房早等房性心律失常消失 ,必要时静脉滴注异丙肾上腺素重复检查 ;②设计的线状消融部位传导中断 ;③先前的电生理方法不能诱发房颤和其他房性心律失常。结果 :经EnSite30 0 0标测 ,6例房早均起源于左房后壁 ,其中单点起源 2例、多点起源 4例 ;折返限于左房壁 2例、与左上肺静脉有关 3例、与右上肺静脉有关 2例、合并典型心房扑动 1例。EnSite30 0 0引导下的左房消融术 3例成功、3例有效 ,无并发症发生。随访 1个月 ,2 4h动态心电图检查术后房早明显减少 (5 6 .8±7.5 8个vs 15 2 6 2 .4± 8914 .5个 ,P <0 .0 0 1)。结论 :用EnSite30 0 0能准确标测左房非?     

三维标测系统指导下射频消融局灶性房性心动过速47例临床评价

目的:探讨CARTO指导下导管射频消融治疗局灶性房性心动过速的临床疗效。方法:47例症状明显、发作频繁、经抗心律失常药物治疗无效的局灶性房性心动过速患者,其中23例曾因阵发性房颤行环肺静脉前庭电隔离(CPVA)术。在CARTO系统指导下对这47例患者行导管射频消融术,消融终点为终止房性心动过速,并且药物和程序电生理刺激均不再诱发能持续存在的房性心律失常。结果:47例患者中45例手术即刻成功(95.7%)。按消融成功的部位判断房性心动过速的起源:66.0%(31/47)起源于肺静脉及其周围的前庭组织,17.0%(8/47)起源于二尖瓣环周围组织,4.3%(2/47)左心耳及附近、2.1%(1/47)左心房顶部、2.1%(1/47)希氏旁、4.3%(2/47)高右房后侧壁、2.1%(1/47)低右房侧壁、2.1%(1/47)冠状窦口。平均手术操作时间(100.3±24.4)min,X线曝光时间为(20.4±12.7)min。随访(12.8±6.3)个月,累计无房性快速心律失常率为93.6%。结论:在三维标测系统指导下,心房局灶性房速的标测和消融安全有效,成功率高。     

三维标测系统指导下射频消融局灶性房性心动过速47例临床评价

目的:探讨CARTO指导下导管射频消融治疗局灶性房性.42动过速的临床疗效. 方法:47例症状明显、发作频繁、经抗心律失常药物治疗无效的局灶性房性心动过速患者,其中23例曾因阵发性房颤行环肺静脉前庭电隔离(CPVA)术.在CARTO系统指导下对这47例患者行导管射频消融术,消融终点为终止房性心动过速,并且药物和程序电生理刺激均不再诱发能持续存在的房性心律失常. 结果:47例患者中45例手术即刻成功(95.7%).按消融成功的部位判断房性心动过速的起源:66.0%(31/47)起源于肺静脉及其周围的前庭组织,17.0%(8/47)起源于二尖瓣环周围组织,4.3%(2/47)左心耳及附近、2.1%(1/47)左心房顶部、2.1%(1/47)希氏旁、4.3%(2/47)高右房后侧壁、2.1%(1/47)低右房侧壁、2.1%(1/47)冠状窦口.平均手术操作时间(100.3±24.4)min,X线曝光时间为(20.4±12.7)min.随访(12.8±6.3)个月,累计无房性快速心律失常率为93.6%. 结论:在三维标测系统指导下,心房局灶性房速的标测和消融安全有效,成功率高.     

三维标测系统指导下导管射频消融治疗难治性心律失常6例

目的 评价三维标测(Carto)系统指导下导管射频消融治疗的难治性心律失常安全性和有效性.方法 术中运用Carto重建肺静脉和心房的模拟三维结构图像, 心房颤动在左右肺静脉口周围0.5 cm～1.0 cm处作环形电隔离,由三维标测系统监测消融路径是否连续.心房扑动病人在心动过速折返环的关键峡部行线性消融,并以冷肝素盐水灌注导管,术后随访观察.结果 6例消融病人, 2例随访5个月无复发,1例于术后第3天出现1次阵发性心房颤动,另3例病人术后均无任何不适,体表心电图显示为窦性心律目前仍在随访中.结论 应用Carto系统指导导管射频消融难治性心律失常治疗安全有效.     

Open-window mapping of accessory pathways utilizing high-density mapping

Journal of Interventional Cardiac Electrophysiology - Accessory pathway (AP) mapping is currently based on point-by-point mapping and identifying if a local electrogram’s origin is atrial,...     

Phylogenetic fate mapping

Cell fate maps describe how the sequence of cell division, migration, and apoptosis transform a zygote into an adult. Yet, it is only in Caenorhabditis elegans where microscopic observation of each cell division has allowed for construction of a complete fate map. More complex, and opaque, animals prove less yielding. DNA replication, however, generates somatic mutations. Consequently, multicellular organisms comprise mosaics where most cells acquire unique genomes that are potentially capable of delineating their ancestry. Here we take a phylogenetic approach to passively retrace embryonic relationships by deducing the order in which mutations have arisen during development. We show that polyguanine repeat DNA sequences are particularly useful genetic markers, because they frequently change length during mitosis. To demonstrate feasibility, we phylogenetically reconstruct the lineage of cultured mouse NIH 3T3 cells based on mutations affecting the length of polyguanine markers. We then employ whole genome amplification to genotype polyguanine markers in single cells taken from a mouse and use phylogenetics to infer the developmental relationships of the sampled tissues. The result is consistent with the present understanding of embryogenesis and demonstrates the large scale potential of this method for producing a complete mammalian cell fate at the resolution of a single cell.     

Epicardial isopotential mapping from body surface isopotential mapping in myocardial infarction

It is useful to construct the epicardial isopotential mapping (the Ep Map) from the body surface isopotential mapping (the Body Map) for clinical diagnosis of cardiac disease, even though there are many unsolved problems in using the inverse solution. Yamashita et al. carried out this solution by using the finite element technique. In the present study, the clinical value of that method has been investigated in cases of myocardial infarction. The Ep Maps at 20, 25 and 30 msec. from the beginning of the QRS complex were obtained from the Body Map at the same time by using that method; the infarcted areas on the Ep Map were determined by using Toyama's method which was reported in a previous study. The infarcted area at 30 msec. on the Ep Map was located at the anterior wall along the ventricular septum in anterior infarction and at the posterior wall of the left ventricle in inferoposterior infarction. Patients were independently examined with the scintigram with thallium-201 and the infarcted area was coincident to the location of the abnormal findings of the scintigram. Moreover, the size of the infarcted area on the Ep Map and the size of the abnormal findings of the scintigram were parallel in most cases except one.     

Body surface isopotential mapping system by colored spatial mapping electrocardiography]

We developed a new body surface isopotential mapping system using a colored spatial mapping electrocardiographic technique based on Frank's vectorcardiography to be used with CERX CQ-3011 and NEC PC-100 computers. We assessed its usefulness in comparison with the conventional body surface mapping technique in 12 patients with old myocardial infarction (6 with anterior and 6 with inferior infarction), and in 10 healthy subjects. All distributions of positive and negative zones presented on body surface isopotential maps were obtained with this new technique, which corresponded well with the distribution of zones on conventional body surface isopotential maps. Although the maximum and minimum positions of the 2 maps did not coincide with one another, this new map aided in diagnosing anterior and inferior infarction from the minimum position determined 20 msec after the onset of QRS. This new mapping system allows a clear spatial representation of vectorcardiograms and requires less complicated procedure compared with the conventional body surface mapping technique. Thus, this body surface isopotential mapping system should be clinically useful.     

Endocardial mapping of right ventricular outflow tract tachycardia using noncontact activation mapping

INTRODUCTION: Activation mapping and pace mapping identify successful ablation sites for catheter ablation of right ventricular outflow tract (RVOT) tachycardia. These methods are limited in patients with nonsustained tachycardia or isolated ventricular ectopic beats. We investigated the feasibility of using noncontact mapping to guide the ablation of RVOT arrhythmias. METHODS AND RESULTS: Nine patients with RVOT tachycardia and three patients with ectopic beats were studied using noncontact mapping. A multielectrode array catheter was introduced into the RVOT and tachycardia was analyzed using a virtual geometry. The earliest endocardial activation estimated by virtual electrograms was displayed on an isopotential color map and measured 33 +/- 13 msec before onset of QRS. Virtual unipolar electrograms at this site demonstrated QS morphology. Guided by a locator signal, ablation was performed with a mean of 6.9 +/- 2.2 radiofrequency deliveries. Acute success was achieved in all patients. During follow-up, one patient had a recurrence of RVOT tachycardia. Compared with patients (n = 21) who underwent catheter ablation using a conventional approach, a higher success rate was achieved by noncontact mapping. Procedure time was significantly longer in the noncontact mapping group. Fluoroscopy time was not significantly different in the two groups. CONCLUSION: Noncontact mapping can be used as a reliable tool to identify the site of earliest endocardial activation and to guide the ablation procedure in patients with RVOT tachycardia and in patients with ectopic beats originating from the RVOT.     

Functional connectivity density mapping

Brain networks with energy-efficient hubs might support the high cognitive performance of humans and a better understanding of their organization is likely of relevance for studying not only brain development and plasticity but also neuropsychiatric disorders. However, the distribution of hubs in the human brain is largely unknown due to the high computational demands of comprehensive analytical methods. Here we propose a 10³ times faster method to map the distribution of the local functional connectivity density (lFCD) in the human brain. The robustness of this method was tested in 979 subjects from a large repository of MRI time series collected in resting conditions. Consistently across research sites, a region located in the posterior cingulate/ventral precuneus (BA 23/31) was the area with the highest lFCD, which suggest that this is the most prominent functional hub in the brain. In addition, regions located in the inferior parietal cortex (BA 18) and cuneus (BA 18) had high lFCD. The variability of this pattern across subjects was <36% and within subjects was 12%. The power scaling of the lFCD was consistent across research centers, suggesting that that brain networks have a “scale-free” organization.     

Body surface potential mapping for mapping and treatment of persistent atrial fibrillation

Techniques facilitating individual mapping and ablation of arrhythmogenic substrates are desired to enhance our understanding of persistent atrial fibrillation (persAF) mechanisms as a prerequisite to increasing the success rates of single procedure persAF catheter ablation. The technique of body surface potential mapping (BSM) involves the use of multiple electrodes to collect the potentials over a large body surface area and, with the use of a computed tomography scan, it facilitates their correlation to a 3D model of the atrial structures. During AF,the visualization and localization of AF driver activity, both reentrant and focal wavefronts, is possible with this technique. The ECVUE system from CardioInsight was examined for this indication in clinical studies and showed a termination rate of persAF of 63?% in a large multicenter trial (AFACART) with a promising low recurrence rate during follow-up. From our initial experience, the system appears to be effective in persAF patients who have continuous AF for less than ?1 year. However, the utility of the system for highly challenging cases like long-standing persistent AF and patients with very short AF cycle length remains to be explored. Further studies are needed to confirm these data and answer the multitude of open questions in this field.     

Information-based functional brain mapping

The development of high-resolution neuroimaging and multielectrode electrophysiological recording provides neuroscientists with huge amounts of multivariate data. The complexity of the data creates a need for statistical summary, but the local averaging standardly applied to this end may obscure the effects of greatest neuroscientific interest. In neuroimaging, for example, brain mapping analysis has focused on the discovery of activation, i.e., of extended brain regions whose average activity changes across experimental conditions. Here we propose to ask a more general question of the data: Where in the brain does the activity pattern contain information about the experimental condition? To address this question, we propose scanning the imaged volume with a "searchlight," whose contents are analyzed multivariately at each location in the brain.