静脉地尔硫Zhuo治疗老年人快速心室率房颤,房扑和室上速的？…

目的：观察静脉地尔硫Ｚｈｕｏ对老年人快速心室率的房颤、房扑及室上速的疗效与安全性、方法１５例患者（７例房颤、３例房扑，５例室上速）静脉注射地尔硫Ｚｈｕｏ１０－１５ｍｇ，有反应者继以１０－１５ｍｇ／ｈ浓度持续静点６－１２ｈ。结果用药后心室率比用药前基础心率减少〉２０％，转复为窦性心律或心室率〈１００次／ｍｉｎ为治疗有反应，本组１５例患者１２例（８０％）有反应；用药后心室率下降最大效应时间１１ｍｉｎ，     

医院外使用地尔硫治疗快速心房颤动

目的 评价医院外静脉注射地尔硫(艹卓)治疗快速心房颤动(房颤)或心房扑动(房扑)的疗效。 方法 采用回顾性对照研究。地尔硫(艹卓)治疗组43例来自1999年全美辅助医疗机构的快速房颤或房扑患者,平均心室率≥150次/分,接受9个月地尔硫(艹卓)治疗,平均剂量19.8mg。对照组27例,从1998年起未用地尔硫(艹卓)治疗。剔除气管插管或电击复律史者。以转为窦性心率、心室率≤100次/分或     

静脉应用地尔硫在房颤及房扑治疗中的安全性及疗效

观察静脉应用各种剂量地尔硫(艹卓)控制房颤、房扑的心室率之效果及其副反应。 方法 62例房颤患者和22例房扑患者在静脉用药前心室率>120次/分,首先在2分钟内静推20mg地尔硫(艹卓)。如在15分钟内没有获得预期疗效(转为窦律,心室率<100次/分,或心室率比发作时降低20％以上)或临床上需进一步降低心率,可以静推25mg如仍无效,该病例退出,另选治疗方案,对上述方法     

静脉地尔硫(卓)治疗老年人快速心室率房颤、房扑和室上速的临床观察

目的　观察静脉地尔硫艹卓 对老年人快速心室率的房颤、房扑及室上速的疗效与安全性。方法　 1 5例患者 (7例房颤、3例房扑、5例室上速 )静脉注射地尔硫艹卓 1 0～ 1 5mg,有反应者继以 1 0～ 1 5mg/ h浓度持续静点 6～ 1 2 h。结果　用药后心室率比用药前基础心率减少 >2 0 % ;转复为窦性心律或心室率 <1 0 0次 / min为治疗有反应 ,本组 1 5例患者 1 2例 (80 % )有反应 ;用药后心室率下降最大效应时间 1 1 min,心室率下降幅度 42± 1 6次 / min。结论　地尔硫艹卓 能安全地应用于快速心室率的房颤或房扑及室上速的老年人 ,并在大多数病人能迅速有效地达到心率的控制和中止室上速的发作 ,而且不会引起或加重心功能障碍。     

静脉注射地尔硫Zhuo与毛花甙C控制快速房性心律失常心室？…

目的 观察和比较静脉注射地尔硫Ｚｈｕｏ、毛花甙Ｃ控制快速心房颤动（房颤）和心房扑动（房扑）心室率的即时疗效及安全性。方法５４例快速房颤或房扑患,采用随机方式分且,分别静脉注射地尔硫Ｚｈｕｏ、毛花甙Ｃ。结果 地尔硫Ｚｈｕｏ、毛花甙Ｃ组控制房颤或房扑的快速心室总有效率分别为：９４％、７０％,心室率平均下降幅度分别为：３４％、２３％,平均起铲时间分别为：（７．１±４．２）分钟、（３２．８±２２．８）分     

地尔硫(艹卓)在急诊控制心房颤动快速心室率中的应用

目的观察比较静脉注射地尔硫(艹卓)、毛花甙C控制急诊心房颤动快速心室率即时疗效比较及安全性.方法71例急诊心房颤动伴快速心室率患者随机分成2组,分别静脉注射地尔硫(艹卓)或毛花甙C.结果地尔硫(艹卓)、毛花甙C二组控制心房颤动快速心室率总有效率为93.5%,72.9%;心室率平均下降幅度分别为36%、28%;平均起效时间为6.5±3.4min、24±16.5min.地尔硫(艹卓)组有2例出现一过性低血压,可自行恢复.结论静脉注射地尔硫(艹卓)10mg,10～15mg/h维持静脉滴注对心房颤动快速心室率的控制安全、迅速、有效.     

控制快速房性心律失常心室率即时疗效临床用药体会

目的　观察并比较静脉注射毛花甙C、艾司洛尔及地尔硫艹卓控制快速房性心律失常心室率的有效性。方法　将2001-03~2003-08中国医学科学院阜外心血管病医院94例快速房性心律失常(房颤、房扑、房速)患者随机分为3组,分别静脉用毛花甙C(29例)、艾司洛尔(30例)和地尔硫(35例)。结果　毛花甙C、艾司洛尔和地尔硫均能有效控制快速房性心律失常的心室率,心室率下降幅度分别为30 .4%、29.3%和27. 6%,总有效率分别为86%、83%和85%,平均用药有效时间分别为( 34. 3±21 .0 )min、( 10. 0±3. 9 )min和( 10 .0±3. 9 )min。结论　艾司洛尔、毛花甙C及地尔硫艹卓均能有效、迅速、安全控制快速房性心律失常的心室率。     

地尔硫缓释剂对高血压合并冠心病患者动态血压及心电图的影响

目的观察地尔硫缓释剂对高血压合并冠心病患者疗效。方法２９例高血压合并冠心病患者口服地尔硫缓释剂９０ｍｇ，２／ｄ，用药４周，应用２４ｈ动态血压和动态心电图观察用药前后血压和缺血性ＳＴ段的变化。结果用药后２４ｈ收缩压（ＳＢＰ）从１４５±９降至１２７±１２ｍｍＨｇ，舒张压（ＤＢＰ）从１０６±１１降至８２±１５ｍｍＨｇ（Ｐ＜０．０５）；ＳＢＰ负荷由６４±９％降至３８±９％（Ｐ＜０．０１），ＤＢＰ负荷由５４±１４％降至２９±１０％（Ｐ＜０．０１）。心肌缺血发作频率从４．３±２．０降至２．３±１．０／２４ｈ，缺血总时间（ｍｉｎ／２４ｈ）从１６．９±３．９降至９．４±２．９，最大ＳＴ段下移由１．４±０．５ｍｍ降为０．８±０．３ｍｍ（Ｐ＜０．０１）。结论地尔硫缓释剂能显著改善高血压合并冠心病患者的心肌缺血和降低患者血压。     

静脉注射地尔硫治疗不稳定性心绞痛临床疗效观察

目的观察静脉地尔硫对不稳定性心绞痛（ＵＡＰ）患者的疗效与安全性。方法选择１５例严重且硝酸甘油疗效不好的ＵＡＰ患者，静注地尔硫１０～２０ｍｇ（０．２５ｍｇ／Ｋｇ体重）后，继以５～１０ｍｇ／ｈ维持４８小时。观察心绞痛症状，心电图及血流动力学变化，其中８例行漂浮导管检查。结果（１）１５例中１１例（７３．３％）ＵＡＰ患者静注地尔硫后约８．５±８．１分钟时，心绞痛症状缓解。与用药前４８小时内相比，开始用药４８小时后的心绞痛次数减少，每次最长持续时间明显缩短。（２）静脉地尔硫使１０／１５例的异常ＳＴ段恢复，３／１５明显改善。（３）静脉使用地尔硫后血压、心率降低，１０１５分钟起效，维持持续静滴的４８小时，尤其血压×心率值降低更为明显。（４）８例漂浮导管监测显示，静脉使用地尔硫中心静脉压（ＣＶＰ）短暂升高。（５）出现４例窦性心动过缓，１例一过性低血压，经处理后恢复。结论静脉地尔硫治疗对某些较顽固的ＵＡＰ有效，且相对安全。     

静脉注射地尔硫与毛花甙-C控制快速房性心律失常心室率即时疗效和安全性的对比观察

目的　观察和比较静脉注射地尔硫、毛花甙C控制快速心房颤动 (房颤 )和心房扑动(房扑 )心室率的即时疗效及安全性。方法　 5 4例快速房颤或房扑患者 ,采用随机方式分两组 ,分别静脉注射地尔硫、毛花甙C。结果　地尔硫、毛花甙C组控制房颤或房扑的快速心室率总有效率分别为 :94 %、70 % ,心室率平均下降幅度分别为 :3 4%、2 3 % ,平均起效时间分别为 :( 7 1± 4 2 )分钟、( 3 2 8± 2 2 8)分钟。地尔硫组出现可耐受性低血压 2例 ,发生窦性停搏 1例 ,均自行缓解 ,无心力衰竭加重表现。结论　静脉注射地尔硫能迅速、安全、有效地控制房颤、房扑的快速心室率。     

左房异常与心房颤动的关系

目的探讨左房异常与心房颤动发生的关系。方法应用心电图和动态心电图进行,持续性房颤患者为A组,阵发性房颤、房扑患者为B组,仅有心电图P波增宽的患者为C组,A、B、C三组各40例。所有入选患者均经超声心动图检测左房大小,观察患者窦性心律时心电图P波时限、切迹和P波离散度,并分析与房颤发生的关系。结果房颤男性多于女性,年龄大于60岁者94例(占78.3%),三组中86.7%的患者存在器质性心脏病(104例)。心电图P波切迹明显、P波离散度大者快速房颤发生率高;超声心动图检测左房直径大者房颤发生率高,持续性房颤比阵发性房颤患者左房直径大(p<0.05)。结论左房扩大、房内阻滞及P波离散度增大的患者易发生房颤。     

Dual independent atrial tachycardias after ablation of chronic atrial fibrillation

We report the case of a 71-year-old man with two atrial tachycardias evolving simultaneously and independently in two dissociated regions after extensive ablation for chronic atrial fibrillation. One tachycardia was a focal tachycardia originating from the right inferior pulmonary vein and activating the posterior left atrium with a 2:1 conduction block, while the other tachycardia was an atrial flutter circulating around the tricuspid annulus, activating the right atrium and the anterior wall of the left atrium. These two atrial tachycardias were successfully ablated prior to restoration of sinus rhythm.     

Electrocardiographic differentiation of atrial flutter from atrial fibrillation by physicians

The purpose of this study was to determine the ability of physicians to differentiate atrial flutter from atrial fibrillation on a surface electrocardiogram (ECG). A questionnaire containing three 12-lead ECGs was mailed to 689 physicians, with multiple-choice questions asking whether the rhythm on each ECG was atrial flutter or atrial fibrillation. ECG 1 showed atrial fibrillation with prominent atrial activity (>0.2 mV) in lead V1; ECG 2 displayed atrial fibrillation with prominent atrial activity (>0.2 mV) in leads III and V1; and ECG 3 displayed atrial flutter. Overall, ECG1 was correctly identified as atrial fibrillation by 79% of physicians, ECG 2 was correctly identified as atrial fibrillation by 31%, and ECG 3 was correctly identified as atrial flutter by 90%. Cardiology fellows and cardiologists correctly identified ECG 1 more often than house officers and internists (95% vs 63%; P < or = .01). ECG 2 was correctly identified by 26% of cardiology fellows and cardiologists and by 37% of house officers and internists (P = .10). ECG 3 was correctly identified by 91% of cardiology fellows and cardiologists and by 82% of house officers and internists (P = .06). In conclusion, atrial fibrillation is frequently misdiagnosed as atrial flutter. Misdiagnosis of atrial fibrillation occurs more often when atrial activity is prominent on an ECG in more than one lead.     

Simultaneous occurrence of atrial fibrillation and atrial flutter

INTRODUCTION: Early reports suggested that some patients with "atrial fibrillation/flutter" might have atrial fibrillation in one atrium and atrial flutter in the other. However, more recent conceptions of atrial fibrillation/flutter postulate that the pattern is due to a relatively organized (type I) form of atrial fibrillation. We report the occurrence and ECG manifestations of simultaneous atrial fibrillation and flutter in patients undergoing attempted catheter ablation of atrial flutter. METHODS AND RESULTS: In patients undergoing radiofrequency ablation for atrial flutter, an attempt was made to entrain atrial flutter by pacing in the right atrium. The arrhythmias observed occurred following attempts at entrainment, or spontaneously in one case. Twelve transient episodes of simultaneous atrial fibrillation and flutter were observed in five patients. The atrial fibrillation was localized to all or a portion of one atrium, during which the other atrium maintained atrial flutter. In each case, the surface 12-lead ECG reflected the right atrial activation pattern. No patients had interatrial or intra-atrial conduction block during sinus rhythm, suggesting functional intra-atrial block as a mechanism for simultaneous atrial fibrillation/flutter. CONCLUSION: In certain patients, the occurrence of transient, simultaneous atrial fibrillation and flutter is possible. In contrast to prior studies in which it was suggested that left atrial or septal activation determines P wave morphology, the results of the present study show that P wave morphology is determined by right atrial activation. Functional interatrial block appears to be a likely mechanism for this phenomenon.     

Importance of right and left atrial dilation and linear ablation for perpetuation of sustained atrial fibrillation

INTRODUCTION: Atrial dilation associated with increasing atrial pressure plays an apparent role in the development of atrial fibrillation (AF). We characterized a new model of separate and biatrial dilation in the Langendorff-perfused rabbit heart. The aim of this study was to examine if sustained AF in this model (1) would be inducible by separate right atrial (RA) and left atrial (LA) dilation; (2) would be reproducibly inducible at the same pressure level; and (3) could be suppressed by RA, LA, or biatrial ablation. METHODS AND RESULTS: Intra-atrial pressure was increased stepwise in the RA (n = 13), LA (n = 12), or both atria (n = 25) until sustained AF could be induced or a pressure of 20 cm H2O was reached. The stimulation protocol was repeated once in RA and LA dilation (n = 9) and three times in biatrial dilation (n = 7). Then, RA orifices (superior and inferior caval veins, tricuspid valve annulus, and foramen ovale) or LA orifices (pulmonary veins, mitral valve annulus, and foramen ovale) were connected by radiofrequency (RF) lesions. Sustained AF was rendered inducible in 100% of hearts with biatrial dilation, but in only 92% of hearts with RA dilation and 67% with LA dilation. Inducibility of sustained AF was reproducible. Under biatrial dilation, not RA ablation (0/10 hearts; P = NS) but LA ablation (4/11 hearts; P < 0.05) and biatrial ablation (16/21; P < 0.01) reduced the inducibility of sustained AF. CONCLUSION: The inducibility of sustained AF due to increased intra-atrial pressure differs between the RA and LA. LA and biatrial lesions, not RA RF lesions, reduce the ability to perpetuate sustained AF.     

Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function

BACKGROUND: The effects of left atrial (LA) circumferential ablation on LA function in patients with atrial fibrillation (AF) have not been well described. OBJECTIVES: The purpose of this study was to determine the effect of LA circumferential ablation on LA function. METHODS: Gated, multiphase, dynamic contrast-enhanced computed tomographic (CT) scans of the chest with three-dimensional reconstructions of the heart were used to calculate the LA ejection fraction (EF) in 36 patients with paroxysmal (n = 27) or chronic (n = 9) AF (mean age 55 +/- 11 years) and in 10 control subjects with no history of AF. Because CT scans had to be acquired during sinus rhythm, a CT scan was available both before and after (mean 5 +/- 1 months) LA circumferential ablation (LACA) in only 10 patients. A single CT scan was acquired in 8 patients before and in 18 patients after LACA ablation. Radiofrequency catheter ablation was performed using an 8-mm-tip catheter to encircle the pulmonary veins, with additional lines along the mitral isthmus and the roof. RESULTS: In patients with paroxysmal AF, LA EF was lower after than before LACA (21% +/- 8% vs 32 +/- 13%, P = .003). LA EF after LA catheter ablation was similar among patients with paroxysmal AF and those with chronic AF (21% +/- 8% vs 23 +/- 13%, P = .7). However, LA EF after LA catheter ablation was lower in all patients with AF than in control subjects (21% +/- 10% vs 47% +/- 5%, P < .001). CONCLUSION: During medium-term follow-up, restoration of sinus rhythm by LACA results in partial return of LA function in patients with chronic AF. However, in patients with paroxysmal AF, LA catheter ablation results in decreased LA function. Whether the impairment in LA function is severe enough to predispose to LA thrombi despite elimination of AF remains to be determined.     

Effect of gender on atrial electrophysiologic changes induced by rapid atrial pacing and elevation of atrial pressure

INTRODUCTION: The incidence of atrial fibrillation is greater in men than in women, but the reasons for this gender difference are unclear. The purpose of this study was to evaluate the effects of gender on the atrial electrophysiologic effects of rapid atrial pacing and an increase in atrial pressure. METHODS AND RESULTS: Right atrial pressure and effective refractory period (ERP) were measured during sinus rhythm and during atrial and simultaneous AV pacing at a cycle length of 300 msec in 10 premenopausal women, 11 postmenopausal women, and 24 men. The postmenopausal women were significantly older than the premenopausal women (61 +/- 8 years vs 34 +/- 10 years; P < 0.01). During sinus rhythm, mean atrial ERP in premenopausal women was shorter (211 +/- 19 msec) than in postmenopausal women and age-matched men (242 +/- 18 msec and 246 +/- 34 msec, respectively; P < 0.05). Atrial ERPs in all patients shortened significantly during atrial and simultaneous AV pacing. However, the degree of shortening during atrial pacing (43 +/- 8 msec vs 70 +/- 20 msec and 74 +/- 21 msec; P < 0.05) and during simultaneous AV pacing (48 +/- 16 msec vs 91 +/- 27 msec and 84 +/- 26 msec; P < 0.05) was significantly less in premenopausal women than in postmenopausal women or age-matched men. CONCLUSION: The results of this study demonstrate a significant gender difference in atrial electrophysiologic changes in response to rapid atrial pacing and an increase in atrial pressure. The effect of menopause on the observed changes suggests that the gender differences may be mediated by the effects of estrogen on atrial electrophysiologic properties.     

Acute effects of left atrial radiofrequency ablation on atrial fibrillation

INTRODUCTION: Acutely, when left atrial ablation is performed during atrial fibrillation (AF), the AF may persist and require cardioversion, or it may convert to sinus rhythm or to atrial tachycardia/flutter. The prevalence of these acute outcomes has not been described. METHODS AND RESULTS: Left atrial ablation, usually including encirclement of the pulmonary veins, was performed during AF in 144 patients with drug-refractory AF. Conversion to sinus rhythm occurred in 19 patients (13%), to left atrial tachycardia in 6 (4%), and to atrial flutter in 6 (4%). In the 6 patients with a focal atrial tachycardia, the mean cycle length was 294 +/- 45 ms. The tachycardia arose in the left atrial roof in 3 patients, the left atrial appendage in 2, and the anterior left atrium in 1. In 3 of 6 patients, the focal atrial tachycardia originated in an area that displayed a relatively short cycle length during AF. In 6 patients, AF converted to macroreentrant atrial flutter with a mean cycle length of 253 +/- 47 ms, involving the mitral isthmus in 5 patients and the septum in 1 patient. All atrial tachycardias and flutters were successfully ablated with 1 to 15 applications of radiofrequency energy. CONCLUSION: When left atrial ablation is performed during AF, the AF may convert to atrial tachycardia or flutter in approximately 10% of patients. Focal atrial tachycardias that occur during ablation of AF may be attributable to driving mechanisms that persist after AF has been eliminated, whereas atrial flutter results from incomplete ablation lines.     

动态心房超速起搏预防阵发性房颤

目的观察动态心房超速起搏预防阵发性房颤的临床疗效和安全性。方法选择病态窦房结综合症伴阵发性房颤,并需植入永久起搏器的患者8例,分别植入具有动态心房起搏功能的起搏器,PacessetterTrilogy23643例,VitatronSelectionTM900E5例;随访6个月,前3个月不打开动态心房起搏功能,后3个月打开动态心房起搏功能,根据起搏器记录到的模式转换次数和持续时间来判断其预防房颤发作的疗效。结果打开动态心房起搏功能前后,患者房颤发作的次数分别为2437±956次/月和472±135次/月(P<0.05);模式转换持续时间分别为173±105小时/月和48±25小时/月(P<0.05);房颤负荷分别为33±8%和10±7%(P<0.05)。结论动态心房超速起搏,是阵发性房颤预防治疗的有效和安全的方法之一。