心房扑动致心律失常性心肌病一例

患者男性．56岁．因持续性心房扑动9个月，入院做射频消融术治疗。患者9个月前发生不明原因的心房扑动．心室率一直持续为140～150bpm，近2～3个月来活动后心悸、气短，体检未见异常。心电图心房率300bpm，心室率140～150bpm．Ⅱ、Ⅲ、、aVF导联F波负向，aVR导联F波正向，F波2～3：1下传心室(图1A)，心电图诊断为I型心房扑动。超声心动图示：左     

阵发性心房扑动和/或分支性室性心动过速致右心功能不全为主的心动过速性心肌病一例

患者男性 ,19岁。 5年前不明原因反复出现阵发性心悸、胸闷 ,持续数小时至数天不等。发作持续时间较长则出现恶心、呕吐 ,可自行缓解 ,未行特殊治疗。 3年前因发作后持续月余不能缓解 ,出现纳差、恶心、腹胀、下肢浮肿、口唇轻度发绀 ,但能平卧无明显呼吸困难。住院做心电图诊断阵发性室上性心动过速。超声心动图发现右心扩大 ,右房内径35ｍｍ ,右室内径 30ｍｍ。室壁运动减弱 ,各瓣膜图像正常 ,左房、室大小正常 ,心包图像正常。胸腹部Ｂ超检查发现肝脏淤血性肿大、腹水、双侧胸腔少量胸水。胸部Ｘ线拍片双肺未见淤血改变 ,心影扩大 ,上腔…     

左房迷走神经性房性心动过速致心肌病一例

1例男性,29岁的发作性心悸患者,休息时发作,紧张和运动时减少或消失。超声示心脏扩大,第1次行电生理检查时诱发出心房扑动,消融右房峡部成功。但仍有心动过速发作,结合病史及临床发作特点,考虑为迷走神经性心动过速,予安定和力月西诱导睡眠后成功诱发出左房房性心动过速,消融成功。术后3个月超声示心腔正常。提示该患者为左房迷走神经性房性心动过速致心肌病。     

慢性房性心动过速致心律失常性心肌病一例

患者男性,48岁。既往体健,本次因心慌、气短、夜间不能平卧二个半月,以“室上性心动过速(室上速)、心力衰竭(心衰)待查”收入院。入院时检查:一般状况差,血压80/60ｍｍＨｇ(1ｍｍＨｇ=0133ｋＰａ),脉搏150次/ｍｉｎ,颈静脉怒张。心尖搏动弱,心界向左扩大,心律规整,150次/ｍｉｎ,第一心音低,心尖部Ⅱ级吹风样收缩期杂音,双肺底密集小水泡音。双下肢可凹性水肿明显。辅助检查:心肌酶谱轻度升高,肝功能、肾功能、血糖、血脂及甲状腺功能等生化检查均正常。心电图为室上速。Ｘ线胸片示心影两侧明显扩大,肺瘀血明显,心胸比率065。心脏彩超示左房3…     

心房扑动致起搏器心动过速1例

患者男,63岁。因患病态窦房结综合征伴晕厥于1993年8月5日植入DDD起搏器(美CPI产品937型)。术中测试:心房起搏阈值1.1V,2.0mA,P波振幅6.3mV,心室起搏阈值0.7V,1.3mA,R波振幅10mV,程控A—Vdelay     

特发性室性心动过速合并心房扑动一例

患者男性，37岁。一个月前因隐匿性左侧旁路合并顺向性房室折返性心动过速在我院行射频导管消融术治疗，出院半个月后反复发作心悸、胸闷、头晕，持续时间数小时不等，可自行终止。此次因心悸、头晕、胸闷6h来我院急诊。体格检查：心率187次／min，心律齐，血压90／60mmHg(1 mm Hg=0.133kPa)。查心电图(图1)．     

特发性室性心动过速伴心房扑动一例

患者女性，58岁。因心悸、胸闷2d入院。体格检查：血压110／70mmHg（1mmHg=0．133kPa），双肺呼吸音清晰，心界无扩大，心率194次／min，心律整齐，各瓣膜听诊区未闻及病理性杂音。患者既往有类似发作史，在外院行冠状动脉造影检查，无异常，超声心动图和X线胸片未见异常。入院时记录的心电图未见窦性P波，QRS波时限为134ms，RR间期为380ms，为宽QRS波心动过速，QRS波呈完全性右束支阻滞伴心电轴显著左偏，V6导联R／S〉1，诊断为特发性左心室心动过速。在心电监护下静脉注射维拉帕米5mg，15min后再给10mg，心动过速未终止。6h后改为普罗帕酮70mg，分别间隔15min，共3次静脉推注，描记心电图，宽QRS波形状与图1相同，可见窦性P波，频率72次／min，有的下传夺获心室，QRS波时限变窄。心动过速的QRS波与图1基本相同，RR间期为500ms，可以肯定为左心室心动过速。     

心室预激伴心房颤动致心动过速性心肌病一例

临床资料　患者男性,48岁。2年前无明显诱因开始出现心室预激伴心房颤动(房颤),3个月后感心悸、气短、双下肢水肿,曾以“预激综合征伴房颤、心肌病?”反复来我院治疗。由于药物转复心律后不能维持窦性心律,且心室率常在140次/min以上(动态心电图多次监测),心力衰竭难以控制,于1997年10月行射频消融术治疗。查体:颈静脉怒张,双肺无异常体征,心浊音界向左扩大,肝脏肿大,双下肢水肿。心电图(图1A)为B型心室预激伴房颤,心室率160～180次/min。超声心动图示左心房扩大(5.5cm),右心房扩大(5.6cm),右心室扩大(4.0cm)。入院后在心力衰竭控制后用体…     

急性心动过速性心肌病一例

目的报导比较少见的急性心动过速性心肌病一例.患者男性,59岁,无高血压、心律失常病史,2003年12月18日突发心悸,心室率160～210次/分,30 h后就诊,在急诊室出现血流动力学改变、休克,电复律后(200J)恢复窦性心律;住院期间还有一次心悸发作,心室率160次/分,心电图示房颤伴预激?静推可达龙150 mg后缓解,入院查体:T37℃,BP130/80 mmHg.慢性病容,口唇轻度紫绀,颈静脉充盈,双肺底可闻及细湿罗音,心界向左下扩大,心率88次/min,偶闻及早搏,心音低钝,心尖部可闻及3/6级BS.     

巨大心房扑动波酷似室性心动过速一例

心房扑动 (房扑 )在心电图中并不少见 ,约占住院患者心电图检查的 0 4 %～ 1 0 % ,男∶女为 4 7∶1 0 [1 ] ,一般诊断不难。特别巨大的房扑波酷似室性心动过速 (室速 )、心室扑动(室扑 )者也有报告[2 4 ] 。现报告 1例如下。患者女性 ,5 3岁。因风湿性心脏病二尖瓣狭窄 ,于 2 0 0 0年 12月 1日来院检查。体检示 :神清 ,“二尖瓣面容”。心界向左扩大 ,心率 15 0次 min ,心尖区可闻及舒张期隆隆样杂音。临床诊断 :风湿性心脏病 ,二尖瓣狭窄。心电图 (图 1)示P波消失 ,代之以形态、极性、周长都固定的房扑波 ,频率30 0次 min。心电图显示…     

Atypical access to typical atrial flutter.

Typical atrial flutter with reentry around the tricuspid valve can easily be cured by ablating the cavotricuspid isthmus. In the reported case, transvenous access to the tricuspid valve was not possible because of a total cavopulmonal connection in congenital mitral atresia. Successful angioplasty of a small fenestration between the total cavopulmonal connection and the genuine right atrium (RA) allowed anterograde transvenous access to the RA. Electroanatomic RA mapping confirmed peritricuspid reentry, and successful ablation was performed.     

射频消融治疗心房扑动

目的总结典型心房扑动的射频消融治疗经验。方法56例因反复心悸的住院患者,男性38例,女性18例,平均年龄(54.2±6.2)岁。体表心电图及动态心电图记录阵发心房扑动34例,持续心房扑动22例,口服胺碘酮治疗效果差。全部病例常规取右股静脉途径插入20极环状Halo电极记录心房激动顺序,4极电极送至冠状窦供起搏标测使用。结果全部手术成功。其中36例心房扑动于射频发放过程中终止,20例于窦性心律下放电消融。所有病例于消融结束后分别起搏冠状窦近端和低位右心房,证实峡部双相传导阻滞作为消融终点,即刻成功率100%。平均随访(6±2.6)个月,3例于术后2个月复发,复发率5.4%,经再次射频消融治疗成功,随访6个月,未再复发。结论以温控射频导管不间断放电线性消融治疗典型心房扑动疗效肯定,成功率高。     

射频导管消融典型心房扑动和手术疤痕折返性房性心动过速共存一例

典型心房扑动(房扑)的成功消融部位是右心房的先天性峡部(三尖瓣环-下腔静脉峡部)，而对于手术疤痕折返性房性心动过速(疤痕折返性房速)，消融部位则是与手术疤痕相关的后天性峡部。本文报道1例共存有上述两种心动过速患者的成功消融过程。     

Results of catheter ablation of typical atrial flutter

The purpose of this study was to evaluate the safety and efficacy of radiofrequency (RF) ablation of typical atrial flutter by using an 8-mm electrode catheter and a 100-W RF power generator. A limitation of previous trials of catheter ablation of atrial flutter is that the data were not collected as part of a prospective multicenter clinical trial. The study results associated catheter ablation of typical atrial flutter in a cohort of 150 patients with an 88% acute efficacy rate. At 6-month follow-up, recurrent typical atrial flutter was observed in 13% of patients. Of the 12 patients with typical atrial flutter recurrence, 4 were symptomatic and 8 were asymptomatic. Procedure duration was a significant predictor of typical atrial flutter recurrence. The 12-month rate for development of atrial fibrillation was 30%. Catheter ablation of atrial flutter was associated with significant improvements in 5 of 8 domains of the Short Form 36 Survey (quality of life) and significant decreases in 13 of the 16 symptoms of the Symptom Checklist. The device- or procedure-related complication rate was 2.7%. Skin burns occurred at the dispersive pad site due to stronger RF power in 3 patients. Use of a dual dispersive pad system mitigated this problem. Thus, the results of this study associated catheter ablation of atrial flutter with high acute efficacy, a small risk of recurrent atrial flutter, and an important risk of atrial fibrillation during follow-up.     

A new electrocardiographic algorithm to differentiate upper loop re-entry from reverse typical atrial flutter

OBJECTIVES: This study was performed to differentiate upper loop re-entry (ULR) from reverse typical atrial flutter (AFL). BACKGROUND: Right atrial ULR and reverse typical AFL have different mechanisms and ablation strategies, but similar electrocardiographic characteristics. METHODS: This study included 26 patients with reverse typical AFL and 20 patients with ULR. The noncontact mapping system (EnSite-3000, Endocardial Solutions, St. Paul, Minnesota) was used to confirm diagnosis and guide successful radiofrequency ablation. Flutter wave polarity and amplitude in the 12-lead surface electrocardiogram were determined by two independent electrophysiologists. RESULTS: The flutter wave polarity in leads I and aVL was significantly different between the reverse typical AFL and ULR groups (p < or = 0.001). Voltage measurement revealed significant differences between reverse typical AFL and ULR in leads I, II, aVR, aVF, V1, and V2 (p < 0.001). A new diagnostic algorithm based on negative or isoelectric/flat flutter wave polarity and amplitude < or =0.07 mV in lead I was useful for diagnosis of ULR, with an accuracy of 90% to 97%, a sensitivity of 82% to 100%, and a specificity of 95%. CONCLUSIONS: Polarity and voltage measurement of flutter wave in lead I can differentiate reverse typical AFL from ULR.     

典型心房扑动峡部冷冻消融的短期疗效

目的观察冷冻消融治疗峡部依赖性心房扑动(简称房扑)的可行性和短期疗效。方法选择阵发性和持续性房扑患者5例,采用8mm冷冻消融导管,设定输出温度-85℃,每点消融4min,从三尖瓣环至下腔静脉行线性消融,以峡部双向阻滞并保持30min为消融成功。结果5例均峡部双向阻滞,达到有效消融的平均次数5.2±1.9次,出现冷冻有效的时间56.0±11.4s,1例双向阻滞4min后恢复,再消融3次后成功,每例平均消融次数6.0±2.9次。4例未完成完整的线性消融便已达到消融终点。手术总时间为102±26.8min,X线曝光时间为14.42±7.74min。患者均无疼痛等不适主诉。随访76±11.4天,未见房扑复发。结论经导管冷冻可以有效,快速的行典型房扑峡部消融,短期疗效好。