生理性起搏对病态窦房结综合征预防心房颤动的疗效观察

病态窦房结综合征是临床上常见的心律失常,尤其是慢-快综合征常合并有心悸、头晕、黑朦,起搏治疗心动过缓和药物治疗心动过速相结合,可避免药物治疗引起的缓慢性心律失常,同时可抑制快速心律失常的发生和发展。本文旨在观察病态窦房结综合征伴或不伴阵发性心房颤动患者在植入不同起搏器后心房颤动的发生率,以选择合适的起搏方法。     

心房颤动与慢快综合征

慢 -快综合征 (Bradycardia -tachycardiasyn drome)为病态窦房结综合征的常见类型之一。慢 -快综合征在 1975年由BlomerH命名。 1978年BowerPJ报道在病态窦房结综合征中慢 -快综合征约占三分之二。慢 -快综合征以老年患者发病率较高。且常为病态窦房结综合征病情进展的表现形式。它的缓慢心律以显著的窦性心动过缓为最多见 ,其次为心室率缓慢的房颤 ;快速心律则以快心室率的阵发性房颤为最常见 ,其次为心房扑动 ,阵发性房性心动过速或交界性心动过速并不多见 ,而室性心动过速罕见 (发生率约 8%～ 10 % )。其发生的电生理基础是由于窦房…     

心房颤动与快慢综合征

早在上个世纪六、七十年代FerrerMI和Ka planBM等在描述“病态窦房结综合征 (sicksinussyndrome)”时 ,就命名了两个亚型 ,一种是“慢快综合征 (bradycardia -tachycardiasyndrome)” ,另一种为“快慢综合征 (tachycardia -bradycardiasyn drome)”。而国内的教科书和心电图学在病态窦房结病的章节中只描述了“慢快综合征”这一亚型。可能因为两者只在心电图表现上存在差别 (前者是在慢的窦性节律后出现快的异位心房律 ,后者则是在快的心房率后出现窦性停搏 ) ,同一个患者两种心电图现象往往同时存在 ,其病理基础都在窦房结本身 ,两者的…     

快速性房性心律失常并发快慢综合征患者的临床特点

目的通过对快速性房性心律失常并发快慢综合征患者的临床资料、心电图、电生理资料的分析，探讨快慢综合征患者的临床特点，为阐明其发生机制和选择合理的治疗方案提供临床依据。方法8例快速性房性心律失常患者均因反复头昏、晕厥入院，经电生理检查证实窦房结功能正常，经其他检查排除器质性心脏病，均行射频导管消融治疗。结果所有手术成功患者术后心动过速未再发，症状消失。结论经各种检查确诊的快慢综合征患者应首选射频导管消融治疗。     

无器质性心脏病快慢综合征者的临床特点

病态窦房结综合征（SSS）是一组由多种病因引起的窦房结本身及周围组织病变的综合征。临床常以缓慢与快速心律失常交替出现,曾也称之为快慢综合征。近年来快慢综合征重新引起关注,这种现象可出现在一部分无器质性心脏病和无窦房结功能障碍者。其发生机制,表现方式和治疗选择均与SSS不同。本文收集近几年来的7例,对其临床特点作分析,报告如下。     

快慢综合征的临床诊治与机制研究

正1973年Kaplan等[1]首次提出了快-慢综合征这一概念,并认为是病态窦房结综合征的一种类型,表现为平时不伴有症状性窦性心动过缓和窦性停搏的患者,在快速房性心律失常(主要是心房颤动)突然终止后,在恢复窦性心律之前有一段长间歇,即窦性停搏。患者可出现头昏、胸闷、黑朦甚至晕厥。快慢综合征的主要特点为:(1)无房性快速心律失常时,窦性心律正常,或有间歇性无症状性窦缓。(2)平时有各种阵发性房性快速心律失常,均在正常窦     

慢-快综合征动态心电图特征及其临床意义

目的 探讨慢-快综合征动态心电图(DCG)特征及其临床意义.方法 对35例的DCG资料及临床资料进行回顾性分析评价.结果 慢-快综合征者24h总体心率不慢,缓慢心律失常70%～80%多发生在夜间.约80%以上快速心律失常发生在白天,部分患者在此心律失常基础上可合并高级别室性期前收缩(PVS).结论 慢-快综合征的发生除了与基础病变有关外,可能还与迷走神经与交感神经活动有关,选择起搏治疗可起到良好的治疗作用.     

射频消融房性心动过速治疗房性心动过速伴快慢综合征一例

患者男性,19岁,于2003年开始出现发作性心悸、胸闷症状。动态心电图检查发现有频发的房性早搏、短阵房性心动过速(简称房速)以及交界性逸搏现象,诊断为"慢快综合征",医生建议其植入永久起搏器。患者于2008年5月就诊于本院后首选了导管射频消融术治疗房速,术后进行窦房结恢复时间及校正窦房结恢复时间测定分别为990 ms及445 ms,均在正常范围之内。最后诊断为房速伴快慢综合征。     

病态窦房结综合征合并阵发性心房颤动的射频消融治疗

目的探讨病态窦房结综合征患者合并阵发性房颤的射频消融治疗效果。方法 7例病态窦房结综合征合并阵发性房颤患者,术前动态心电图诊断为病态窦房结综合征,24小时内有数次停搏及多次阵发房颤发作,其中有5例患者停搏均发生在房颤终止时,2例停搏与房颤发作无明显关联。接受环肺静脉前庭电隔离术。术后动态心电图随访。结果该7例患者,有2例房颤复发,1例再次接受手术并成功,1例拒绝再次手术。动态心电图提示有4例(考虑为快慢综合征)心动过缓明显好转,2例(考虑为慢快综合征)房颤发作明显减少但是心动过缓无改善,接受心脏永久起搏器置入治疗。此7例患者术前与术后1个月最大心率、最小心率、平均心率比较,最小心率、平均心率术后较术前增加,最大心率术后较术前无明显变化。结论快慢型病态窦房结综合征合并阵发性房颤患者对房颤射频消融治疗效果较好,大部分患者术后心动过缓明显改善,而不需要置入心脏永久起搏器。     

特殊类型“慢——快”型室上性心律失常的临床特点及射频消融治疗后的随访

目的探讨特殊类型"慢--快"型室上性心律失常的临床特点与治疗方法.方法以射频导管消融为主的方法控制快速性心律失常治疗4例特殊类型"慢--快"型室上性心律失常患者.结果4例特殊类型"慢--快"型室上性心律失常,2例为房室折返性心动过速(AvRT),1例房室结折返性心动过速(AVNRT),于长时间心动过速发作终止时均有心脏停搏伴有晕厥或黑朦,经射频导管消融根除室上性心动过速后,由其引起的症状不复存在,随访窦房结功能正常;另1例左侧显性旁道、AVRT,心房扑动伴晕厥,在临时心脏起搏保护下,同步直流电复律终止心房扑动,口服乙胺碘酮有效控制心动过速发作,未再发生缓慢性心律失常和晕厥.结论以射频导管消融为主的方法控制快速性折返性心律失常对特殊类型"慢--快"型室上性心律失常患者具有十分重要的临床意义.     

Takotsubo syndrome: the broken-heart syndrome

Takotsubo syndrome – also known as broken-heart syndrome, Takotsubo cardiomyopathy, and stress-induced cardiomyopathy – is a recently discovered acute cardiac disease first described in Japan in 1991. This review aims to update understanding on the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of Takotsubo syndrome, highlighting aspects of interest to cardiologists and general practitioners.Key words: broken-heart syndrome, stress cardiomyopathy, Takotsubo cardiomyopathy, Takotsubo syndrome     

Myelodysplastic syndrome accompanied by Evans syndrome

Various cases of myelodysplastic syndrome (MDS) with diverse immunological disorders have been reported by many investigators. In this case report, we present a 70-year-old woman who had been diagnosed as having MDS and liver cirrhosis (LC) type C for 20 months, and who finally developed autoimmune phenomena against autologous blood cells. She was admitted to our hospital in order to evaluate her advanced anemia, thrombocytopenia and fatigue. The laboratory data at admission were as follows: hemoglobin 5.3 g/dl, red blood cell count 109 x 10(4)/microliter, white blood cell count 1,760/microliter, platelet count 4.3 x 10(4)/microliter and reticulocyte count 1.3%. The direct Coombs test was positive. In addition, anti-platelet antibody was positive, using the MPHA method. With these results, Evans syndrome secondary to MDS or LC was diagnosed. The mechanisms for the development of immunological disorders in patients with MDS or LC have not been fully elucidated. To our knowledge, this patient is one of the rare cases with MDS and Evans syndrome reported in the literature. During the generation process of autoantibodies, the role of HCV antigen in the pathogenesis of Evans syndrome was of interest in this patient.     

Broken-heart syndrome (Takotsubo syndrome)

We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.     

Sweet's syndrome associated with myelodysplastic syndrome

A 49-year-old man was hospitalized because of cutaneous plaques and pancytopenia. Hematological findings, and the skin eruption suggested Sweet's syndrome associated with myelodysplastic syndrome (refractory anemia with excess of blasts; RAEB). Treatment for pancytopenia was attempted without effect. Also we tried treatment with antibiotics. The skin lesions healed and the body temperature returned to normal. This case was unusual in the association of myelodysplastic syndrome with Sweet's syndrome.     

Cronkhite-Canada syndrome associated with myelodysplastic syndrome

We report a case of Cronkhite-Canada syndrome (CCS) associated with myelodysplastic syndrome (MDS). A 54-year-old woman, diagnosed as MDS the prior year after evaluation of anemia, visited our hospital with the chief complaint of epigastric discomfort. She also had dysgeusia, alopecia, atrophic nail change, and pigmentation of the palm, all of which began several months ago. Blood tests revealed severe hypoalbuminemia. Colonoscopy (CS) showed numerous, dense, red polyps throughout the colon and rectum. Biopsy specimens showed stromal edema, infiltration of lymphocytes, and cystic dilatation of the crypt. Her clinical manifestations and histology were consistent with CCS. We prescribed corticosteroids, which dramatically improved her physical findings, laboratory data, and endoscopic findings. This is the first report of CCS in a patient with MDS.