心房颤动的命名和分类

心房颤动 (房颤 )是临床上最常见的持续性心律失常 ,也是当前心律失常治疗中最薄弱的环节。尽管最近几年 ,对房颤机制有了更深入了解 ,但在临床治疗策略上 ,除了华法林抗凝治疗以外 ,却没有大的突破。这就需要研究一些新的治疗方法并设计相应的多中心临床试验以验证其有效性 ,而多中心临床试验以及房颤的其他研究都需要有相对统一的房颤分类和命名标准。尽管房颤的分类很多 ,但一直没有普遍满意的命名和分类方法。以往常用的心房颤动分类方法按病因分类　　房颤大多数发生在有器质性心脏病的患者中 ,以往研究表明风湿性心脏病、冠状动脉粥样…     

心房颤动——命名、分类和非药物治疗

~~心房颤动——命名、分类和非药物治疗@陈新!100037北京$中国医学卫生院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心 @陈柯萍!100037北京$中国医学卫生院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心 @张澍!100037北京$中国医学卫生院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心~~     

慢性肝炎的命名和分类

慢性肝炎的命名和分类王宝恩编者按：教授１９２６年出生，１９４８年毕业于北京大学医学院，在北大医院任住院医师，１９５２年至今任首都医科大学北京友谊医院主治医师、内科副主任、主任、院长、所长、名誉院长、内科教授、主任医师。１９７８年起任硕士研究生导师、１...     

心房颤动的发生机制和分类

心房颤动 ( atrial fibrillation,AF)是常见的心律失常 ,在一般群体内它有 2 %的发病趋势 ,随年龄的增长发生率上升 ,65岁以上者发生率可达 5%。有器质性心脏病者 AF发生率上升。AF也见于正常心脏 ,5%～ 1 5%的 AF无器质性心脏病基础。AF虽常见 ,但在过去几十年内没有与其他心律失常一样受到同等的重视 ,因此对 AF治疗落后于其他心律失常 ,仅在近年内有急起直追之势。　　 1 .心房颤动与心房扑动的区别　 AF与心房扑动 ( atrial flutter,AFL)关系密切 ,但 AFL极少见 ,通常一个心脏专科医师 1年内能见到 AFL的病例也许不足 1 0例 ,…     

心房颤动的“三P”分类和治疗对策

心房颤动 (房颤 )是最常见的临床快速心律失常 ,随年龄增长而增多。房颤常见于风湿性心脏病、甲亢、冠心病、高血压病、缩窄性心包炎、肺心病等疾病。但发生于心脏正常而原因不明的房颤并不少见 ,称为孤立性房颤。房颤的治疗主要包括 :1寻找并纠正病因或诱因 ;2减慢心室率 ,保持血流动力学稳定 ;3恢复或维持窦性心律 ;4预防血栓 -栓塞并发症。老年人房颤的病因诊断 ,应注意 :1对初诊原因不明的房颤 ,应注意除外甲亢 ;2对无明确心绞痛或心肌梗死的老年人房颤不应盲目归因于冠心病。高血压、心脏退行性改变都可能是老年人房颤的原因 ,孤立性房…     

皮肤癣菌病的命名和分类方法研讨摘要

<正> 一、依据: 1.1956年发表《1500例头癣:临床和病原菌的观察和研究》发现我国头癣病原菌与国外基本不同。 2.1957年发表《解放后上海市八个医院皮肤性病科二十万初诊病例的统计报告》。1977年秦万章等发表《上海市十一万职工皮肤病调查报告》,皮肤癣菌病在初诊病人中占17.44％,在职工普查中占49.89％。某些地区发病率可能更高。由此推算,全国患皮肤癣菌病者数以亿计,值得重视。     

关于周围血管疾病的分类与命名

现代医学根据血管解剖学及病理特征,把周围血管分为动脉、静脉、毛细血管和淋巴管疾病,在此基础上对各个疾病命名。而中医学立足于病因病机分析,着重于辨证论治,对疾病的命名多以“证”而论。因此,取中、西医对血管病分类的优点,对周围血管疾病进行分类与命名,有利于中西医结合治疗周围血管疾病。     

原发性心肌病的命名与分类

心肌病 (CM)是指以心肌病变为主的非血管性、非瓣膜性心肌疾病。根据 CM是否有明确的病因 ,可将其分为原发性心肌病 (亦称为特发性心肌病 )及继发性心肌病 (亦称特异性心肌病 )。前者病因不明 ;后者病因明确 ,包括遗传代谢病糖原累积病 型 (Pompe型 )所致的心肌病变、神经肌肉疾病伴发的心肌病及维生素 B1 缺乏所致的心肌病等。原发性心肌病的命名与分类比较混乱 ,有较多争议 ,近30年常用以下分类方法1　 Goodwin分类法 (1972年 )此法将原发性心肌病分为三型 :1充血型心肌病(CCM) :以心腔广大、心脏收缩功能降低、充血性心力衰竭为主要…     

浅谈对心房颤动的认识

心房颤动（房颤）是临床常见的心律失常之一，非瓣膜病房颤患者脑卒中发生率为3％～5％，房颤合并脑卒中致死致残率高，预后不良。因此，我们应该提高对房颤发病机制及其治疗的认识。     

加强心房颤动的研究

心房颤动（简称房颤）是常见的心律失常，每年因房颤住院的病人超过心动过缓性心律失常或严重室性过速性心律失常的两倍。随年龄增长房颤的发生率明显增加：＜60岁人群为0．4％、＞60岁为2％～4％、＞75岁为11％～17％。房颤常见于器质性心脏病患者，但无器质性心脏病者亦占3％～11％。房颤本身可引起心脏结构和心功能的变化，使血液动力学状态恶化，影响生活质量和危及患者生命。房颤患者的脑栓塞发生率是窦性心律的4～7倍。合并心脏病者的死亡率较未合并心脏病者增加两倍。近15年来，射频消融、植入式心棒转复除颤器（ICD）与生理性起搏…     

Catheter ablation of persistent atrial fibrillation: The importance of substrate modification

Accumulating data have shown that elimination of atrial fibrillation (AF) sources should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions and complex fractionated atrial electrograms (CFAEs) ablation have shown limited efficacy in patients with persistent AF. A combined approach using voltage, CFAEs and dominant frequency (DF) mapping may be helpful for the identification of AF sources and subsequent focal substrate modification. The fibrillatory activity is maintained by intramural reentry centered on fibrotic patches. Voltage mapping may assist in the identification of fibrotic areas. Stable rotors display the higher DF and possibly drive AF. Furthermore, the single rotor is usually consistent with organized AF electrograms without fractionation. It is therefore quite possible that rotors are located at relatively “healthy islands” within the patchy fibrosis. This is supported by the fact that high DF sites have been negatively correlated to the amount of fibrosis. CFAEs are located in areas adjacent to high DF. In conclusion, patchy fibrotic areas displaying the maximum DF along with high organization index and the lower fractionation index are potential targets of ablation. Prospective studies are required to validate the efficacy of substrate modification in left atrial ablation outcomes.     

Cardiac resynchronization therapy in patients with heart failure and atrial fibrillation: importance of new-onset atrial fibrillation and total atrial conduction time

Aims: Cardiac resynchronization therapy (CRT) is an established therapyfor patients with heart failure and sinus rhythm (SR), but itsvalue in atrial fibrillation (AF) remains unclear. Furthermore,response to CRT may be difficult to predict in these patients.The aim of our study was to investigate whether predictors forCRT success differ between patients with AF and SR and to studythe influence of present or developing AF on response to CRT. Methods and results: We examined consecutive patients in whom CRT was implanted disregardingthe atrial rhythm. Atrial fibrillation was defined as eithercurrent or earlier AF, response to CRT was defined as a decreasein the left ventricular end-systolic volume of 10% after 6 months.Total atrial conduction time (TACT), a measure to predict therisk of developing AF, was determined by echocardiography. Weincluded 114 patients, of whom 56 (49%) were known with AF (23current AF and 33 earlier AF). The other 58 patients had nohistory of AF. After 6 months, response in current and earlierAF and that in SR patients was comparable (56, 58 and 55%, respectively).In AF patients, multivariate analysis revealed a shorter TACTat baseline [odds ratio (OR) 16.7 (1.5–185.3), P = 0.02]and an interventricular mechanical delay (IVMD) >40 ms [OR10.4 (1.0–110.9), P = 0.05] as predictors for response.Non-responders more frequently suffered from new-onset AF (P= 0.02). Conclusion: Failure to CRT is associated with new-onset AF. Total atrialactivation time may be a parameter to predict response in AFpatients.     

Recurrence of atrial fibrillation after internal cardioversion of persistent atrial fibrillation: prognostic importance of electrophysiologic parameters.

BACKGROUND: The purpose of this study was to determine whether the extent of atrial electrical remodeling affects the recurrence of atrial fibrillation (AF) after cardioversion of persistent AF (PAF). METHODS AND RESULTS: Internal atrial cardioversion was performed in 47 patients with PAF. The right atrial monophasic action potential duration (RA-MAPD) at pacing cycle lengths (PCLs) of 800-300 ms and P wave signal-averaged electrocardiogram were recorded after cardioversion. Bepridil (150-200 mg/day) and carvedilol (10 mg/day) were administered to all patients after cardioversion. Of the 47 patients, 20 had recurrent AF within 3 months. No relation was observed between age, left atrial dimension, left ventricular ejection fraction, and AF recurrence. The AF duration was significantly longer (p<0.05) and RA-MAPD at PCLs of 800 to 300 ms were significantly shorter (p<0.05) in patients with AF recurrence than in those without recurrence. The mean slope of the RA-MAPD for PCLs between 600 and 300 ms did not differ between the patients with and without AF recurrence. The filtered P-wave duration (FPD) was significantly longer in the patients with AF recurrence than in those without (p<0.05). Multivariate analysis also showed that the RA-MAPD at a PCL of 300 ms and FPD were predictors of AF recurrence (RAMAPD: p=0.038; FPD: p=0.052). CONCLUSION: These results suggest that electrical remodeling related to the repolarization and depolarization may be the main contributors to early AF recurrence after cardioversion under the administration of bepridil and carvedilol.     

心房颤动与心房重构的最新进展

心房颤动（房颤,AF）是引起心血管发病和死亡的重要原因.房颤是常见的由一系列心脏疾病引起心房重构的终点事件,其本身也能引起心房重构从而促进心律失常的发展[1].随着人们对心房重构的机制及其在房颤进展中作用的逐渐认识,对离子通道调控机制和作用靶点的研究也有了较深入的发展.本文将重点综述这方面的进展.