房颤时诊断心房扩大的心电图研究

目的探讨房颤时诊断心房扩大的理论依据。方法对54例房颤患者的心电图与彩色多普勒结果进行回顾性分析。结果通过V1，V2导联R波电压幅度及比值关系可以得出以下结论：当V1电压很低，V2电压偏高，V2／V1〉5时，100％心房扩大；5〉V2／V1〉3时，85％心房扩大；V1，V2电压很低，几乎为0时，100％心房扩大。结论心电图对诊断心房扩大有一定价值。     

Management of atrial fibrillation

Atrial fibrillation (AF) is a condition of genuine clinical concern. This arrhythmia increases patient morbidity and mortality, most notably due to stroke, thromboembolism and heart failure. Consequentially, there is a strong impetus to acquire a greater understanding of its natural history and course in order to provide crucial evidence-based treatment and resource allocation in the future. The objective of this review article is to present a concise overview of the management of AF, with reference to the recent evidence-based National Institute of Clinical Excellence (NICE) National Clinical Guidelines for the management of AF.     

History of atrial fibrillation

The authors review the history of atrial fibrillation, the most frequent clinically observed cardiac arrhythmia. A French "clinicopathologist", Jean Baptist de Sénac (1693-1770), was the first who assumed a correlation between "rebellious palpitation" and a stenosis of the mitral valve. From an analysis of simultaneously recorded arterial and venous pressure curves, the Scottish Sir James Mackenzie (1853-1925) demonstrated that a praesystolic a wave can not be seen on the jugular phlebogram during "pulsus irregularis perpetuus". The first human ECG depicting atrial fibrillation was published by Willem Einthoven (1860-1927) in 1906. The proof of a direct connection between absolute arrhythmia and auricular fibrillation was established by two Viennese physicians, Rothberger and Winterberg. The major discoveries relating to the pathomechanism and the clinical features of atrial fibrillation in the 20th century stemmed from the scientific activities of Karel Frederik Wenckebach, Sir Thomas Lewis, Gordon Moe and Maurits Allessie.     

Mapping of atrial fibrillation

Cardiac mapping has been defined as: "a method by which cardiac signals are recorded from multiple sites of the heart and spatially depicted as a function of time in an integrated manner". It requires determination of the local activation time at each electrode and the creation of activation maps which provide a spatial model of the activation sequence. With respect to atrial fibrillation, mapping is useful to gain insight into the underlying mechanism of atrial fibrillation. In this review, we will discuss the mapping studies of experimental and clinical atrial fibrillation.     

动态心电图对房性早搏引起阵发性心房颤动的应用研究

目的 探讨动态心电图在房性早搏引起阵发性心房颤动诊断中的应用价值.方法 对61例常规12导联心电图检查发现有房性早搏的患者进行24 h动态心电图监测,观察房性早搏引起阵发性心房颤动的房性早搏前周期、房性早搏联律间期的时间及特点.结果 61例房性早搏患者动态心电图监测出现阵发性心房颤动25例(41%),25例阵发性心房颤动患者中,24 h平均房性早搏(3270±256)次,阵发性心房颤动(251±38)次.引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期分别为(352±39)ms和(835±98)ms,未引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期分别为(447±41)ms和(725±105)ms,引起阵发性心房颤动与未引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期比较差异均有统计学意义(P<0.05).结论 通过动态心电图监测发现房性早搏患者心房颤动发生率较高,P-on-T房性早搏是引起阵发性心房颤动的主要原因.加强对房性早搏的认识可以有效地降低心房颤动的发生率.     

动态心电图对房性早搏引起阵发性心房颤动的应用研究

目的 探讨动态心电图在房性早搏引起阵发性心房颤动诊断中的应用价值.方法 对61例常规12导联心电图检查发现有房性早搏的患者进行24 h动态心电图监测,观察房性早搏引起阵发性心房颤动的房性早搏前周期、房性早搏联律间期的时间及特点.结果 61例房性早搏患者动态心电图监测出现阵发性心房颤动25例(41%),25例阵发性心房颤动患者中,24 h平均房性早搏(3270±256)次,阵发性心房颤动(251±38)次.引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期分别为(352±39)ms和(835±98)ms,未引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期分别为(447±41)ms和(725±105)ms,引起阵发性心房颤动与未引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期比较差异均有统计学意义(P<0.05).结论 通过动态心电图监测发现房性早搏患者心房颤动发生率较高,P-on-T房性早搏是引起阵发性心房颤动的主要原因.加强对房性早搏的认识可以有效地降低心房颤动的发生率.     

动态心电图对房性早搏引起阵发性心房颤动的应用研究

目的 探讨动态心电图在房性早搏引起阵发性心房颤动诊断中的应用价值.方法 对61例常规12导联心电图检查发现有房性早搏的患者进行24 h动态心电图监测,观察房性早搏引起阵发性心房颤动的房性早搏前周期、房性早搏联律间期的时间及特点.结果 61例房性早搏患者动态心电图监测出现阵发性心房颤动25例(41%),25例阵发性心房颤动患者中,24 h平均房性早搏(3270±256)次,阵发性心房颤动(251±38)次.引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期分别为(352±39)ms和(835±98)ms,未引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期分别为(447±41)ms和(725±105)ms,引起阵发性心房颤动与未引起阵发性心房颤动的房性早搏联律间期及房性早搏前周期比较差异均有统计学意义(P<0.05).结论 通过动态心电图监测发现房性早搏患者心房颤动发生率较高,P-on-T房性早搏是引起阵发性心房颤动的主要原因.加强对房性早搏的认识可以有效地降低心房颤动的发生率.     

心房颤动诊治的新认识心房颤动心电图诊断中的有关问题

心房颤动(房颤)是临床最常见的持续性快速心律失常.房颤的临床危害不仅在于其发作时的临床症状(心悸、加重心功能不全)给患者生活质量带来影响;更严重的危害是增加血栓栓塞的危险,房颤患者脑卒中的发生率增加5倍,显著增加致残、致死率.心电图是临床房颤诊断最简单、实用的方法.     

36例心脏黏液瘤的外科治疗

目的总结36例心脏黏液瘤外科治疗的经验。方法回顾性分析36例心脏黏液瘤病例手术资料,左房黏液瘤25例,右房黏液瘤11例,均在体外循环下行黏液瘤摘除。结果所有患者手术顺利,无手术死亡。随访1～3年心功能恢复良好,无复发。结论术中应注意麻醉诱导与插管方法,选择恰当的手术径路,防止瘤体破碎、脱落造成栓塞,切除黏液瘤要彻底。     

Thoracoscopic treatment of atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in humans. The majority of patients with AF can function reasonably well on a daily basis with anti-arrhythmic drugs. A small proportion of patients with AF remain symptomatic despite anti-arrhythmic drugs. They might have an indication for invasive treatment for AF, such as endovascular catheter ablation (effective particularly in paroxysmal AF) or the Cox-Maze procedure (open heart surgery), in which the conductivity between the pulmonary veins and the left atrium is blocked. Hybrid thoracoscopic pulmonary vein isolation (VATS-PVI) is a new minimally invasive treatment for AF where the cardiothoracic surgeon and cardiologist work closely together. During this procedure the cardiologist performs electrophysiological measurements to verify whether the blockade of conductivity is successful. This approach has a success rate of 86% at a follow-up of 12 months.     

Drug therapy of atrial fibrillation

The authors summarize the up-to-date knowledge relating to the pharmacological treatment of atrial fibrillation. They emphasize that drug treatment continues to be in the forefront of the therapy of the arrhythmia, which can now be considered to constitute a cardiovascular epidemic. In the era following the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AF-FIRM) trial, the strategy of pharmacological treatment will certainly change: in place of "rhythm control", which in recent decades has been overforced in patients identical with the elderly, cardiac patients with an impaired left ventricular function who were enrolled into AFFIRM, there will be a more frequent use of ventricular "rate control". Naturally, this does not mean that, in certain patient groups, an effort should not be made to restore and maintain the sinus rhythm. In cases involving congestive heart failure and structural heart disease complicated by a depressed left ventricular systolic function, atrial fibrillation is currently treated with antiarrhythmic drugs possessing low proarrhythmic activity that prolong refractory period (Class 3), and with the even safer mortality-reducing beta-receptor blockers. The classical antiarrhythmic drugs (quinidine, procainamide, disopyramide) are being increasingly forced into the background, and the areas of indication of the novel Na(+)-channel blocker antiarrhythmics (propafenone, flecainide) have also narrowed: they are administered only in the event of atrial fibrillation in patients with a structurally intact heart or left ventricular hypertrophy. After a brief survey of the more important aspects of ventricular rate control, and of the drugs available, the research trends aimed at the progression of the pharmacological treatment of atrial fibrillation are outlined. The clinical introduction of procedures based on myocardial gene therapy is now a realistic therapeutic approach as concerns atrial fibrillation too.     

Non-pharmacologic treatment of atrial fibrillation

The authors provide an update on non-pharmacological treatment of atrial fibrillation (AF). They emphasize that although antiarrhythmic drugs continue to be first-line therapy for the arrhythmia considered to be a cardiovascular epidemic, clinical research to develop non-pharmacological means of treatment has been unprecedentally intensified during the last decade. Electrical cardioversion is the most successful non-pharmacological method to restore sinus rhythm, also the efficacy and safety of AV node ablation for palliative ventricular rate-controll is established. "Hybrid" therapeutic procedures, involving combinations of pharmacological and non-pharmacological interventions have gained widespread use. Curative transcatheter ablation for arrhythmia prevention is to be considered in case of clinical suggestions that AF is initiated by a primary regular arrhythmia that is amenable to routine catheter ablation (secondary AF). Despite encouraging results, at this point in time, curative catheter ablation for primary AF may offer significant improvement or even cure only for a small subset of patients, mostly young individuals with normal heart, and paroxysmal AF with frequent, symptomatic episodes refractory to multiple antiarrhythmic drugs. These interventions are to be performed in the settings of a clinical research project in some institutions. Regarding pacemaker therapy in case of bradycardia indication, physiologic pacing (AAI or DDD) is associated with significantly lower incidence of atrial fibrillation than ventricular pacing. Large-scale randomized controlled trials are needed to assess the clinical value of specially designed implantable devices to prevent atrial fibrillation in patients with no conventional bradycardia indication. Also, technical optimization and proper clinical evaluation is needed for implantable atrioverters and implantable cardioverter defibrillators capable of atrial cardioversion therapy.