100IR远程心电检测仪在心律失常射频消融术后患者中的应用

目的:探讨远程心电检测仪在心律失常射频消融术后应用中的临床意义。方法:以心律失常射频消融术(RFCA)后的202例患者为研究对象,其中室性早搏患者85例,心房颤动和阵发性室上性心动过速患者各50例,预激综合征患者17例,应用100IR远程心电检测仪在其射频消融术后行心电图追踪监测。结果:本组202例患者共发送心电图4970行,其中干扰图384行(7.73%),记录良好的有效图4586行(92.27%)。85例室性早搏患者RFCA后,正常48例,频发室性早搏23例,偶发室早14例;50例心房颤动患者RFCA后,正常44例,阵发性心房颤动6例;50例心房颤动患者RFCA后无异常;17例预激综合征患者RFCA后无异常。结论:对心律失常RFCA术后患者应用100IR远程心电检测仪进行院外心电图监测,使用方便,获得的有效心电图率高,对心律失常RFCA术后的效果进行追踪评估具有重要的临床意义。     

便携式远程心电监测仪和心电监测仪的对照研究

在我国，由心血管疾病引起的死亡占到了总死亡构成比的40％左右，对人们的健康造成了极大的威胁。心血管疾病的具有突发性和危险性的特点，但Norris等研究也指出72％的患者在心脏骤停发生前有明显不适，其中70％的患者的症状持续超过15min。因此，对患者进行实时心电监测以及时发现心电异常变化对心血管疾病防治有重要意义。     

量化评估护理在心律失常行射频消融术患者中的应用

目的:探讨量化评估护理在心律失常行射频消融术患者中的应用效果。方法:将80例行射频消融术的心律失常患者按照随机数字表法分为对照组和观察组各40例,对照组实施传统护理模式,观察组实施量化评估护理;比较两组护理前后心功能改善情况、心理状态[采用汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)、抑郁自评量表(SDS)]及满意度。结果:护理后,观察组心功能改善情况优于对照组(P0.05);护理后,两组HAMA、SAS、SDS评分均低于护理前(P0.05),且观察组评分均低于对照组(P0.05);观察组满意度高于对照组(P0.05)。结论:将量化评估护理应用在行射频消融术的心律失常患者中,不仅能够改善患者的心功能,同时能改善其焦虑、抑郁情绪,从而提高护理满意度。     

远程心电监测在院外患者中的应用及护理干预

目的:总结院外患者远程心电监测的护理经验。方法:2013年4~12月对80例心内科门诊行远程心电监测的患者护理人员指导其正确把握采集时机,正确使用监测仪,进行实时监测,实时指导。结果:80例患者中阳性检出率为90%,其中室性心律失常24例,房性心律失常22例,窦性心律失常15例,房室传导阻滞7例,ST段改变为7例。结论:精心的护理干预能使患者掌握远程心电监测仪正确的使用方法,把握时机,进行实时监测,实时指导,有利于提高检出率,有利于提高心血管疾病患者的自我管理水平,减少心脏突发事件的发生。     

射频导管消融术后的拔管反应原因及处理方法

近年来 ,在心脏病的介入性诊断及治疗中 ,射频导管消融术 (ｒａｄｉｏｆｒｅｑｕｅｎｃｙｃａｔｈｅｔｅｒａｂｌａｔｉｏｎ ,ＲＦＣＡ)已成为心律失常介入性治疗的重要手段。此方法 1991年引入我国 ,是目前治疗房室旁路及房室交界区折返引起的心动过速的最好方法 ,其成功率为 96 6 % ,复发率 2 8% ,并发症发生率 0 9% [1] ,死亡率0 0 6 % [2 ] 。但随着我院开展射频消融病例数的增加 ,射频消融术后的拔管反应也越来越引起我们的关注。查阅有关资料 ,鲜有报道 ,现总结分析如下 :1临床资料1.1一般资料　 1995— 2 0 0 0年北京市七建医院…     

快速心律失常患者射频消融术后的护理

目的探讨快速心律失常患者射频消融术后的护理方法。方法回顾性分析2009年10月至2010年4月120例快速心律失常行射频消融术患者的临床资料与术后护理要点。结果本组患者均成功完成了射频消融术。术后发生并发症6例,其中一过性Ⅲ度房室传导阻滞1例、穿刺部位出血1例、迷走神经反射1例、胸痛3例,经积极的治疗与护理,均好转出院。结论术后加强观察和护理可有效减少各种并发症的发生,提高手术成功率,有利于患者的术后康复。     

远程心电监测系统在阵发性房颤监测中的应用价值

目的 探讨远程心电监测系统在阵发性房颤监测中的应用价值.方法 选取2019年1月至2020年9月该院收治的90例阵发性房颤患者为研究对象,采用随机数字表法分成研究组与对照组,各45例.研究组应用远程心电监测系统进行检查,对照组应用常规心电图进行检查.记录并比较两组心率、PR间期、QRS时限、QT间期、QRS振幅、Ⅰ导联T波振幅.比较有症状阵发性房颤患者与无症状阵发性房颤患者合并窦性心律的情况.比较两组阵发性房颤复发检出率、无症状阵发性房颤检出率.结果 研究组Ⅰ导联T波振幅较对照组小,差异有统计学意义(P<0.05).90例患者中共检出有症状阵发性房颤患者68例,无症状阵发性房颤患者22例,有症状阵发性房颤患者中窦性心律7例(10.3％),无症状阵发性房颤患者中窦性心律4例(18.2％),差异有统计学意义(P<0.05).研究组阵发性房颤复发检出率、无症状阵发性房颤检出率均高于对照组,差异有统计学意义(P<0.05).结论 与常规心电图检查相比,远程心电监测系统的实时监测功能可早期诊断无症状阵发性房颤,早期评估复发情况,从而使临床能及时采取有效的治疗措施,防治疾病的进一步发展.     

心律失常患者射频消融术后并发症的观察的护理

目的探讨心律失常患者射频消融术后并发症的护理方法.方法通过320例快速心律失常患者射频消融术后出现的16例并发症总结了心律失常患者射频消融术后并发症的观察护理经验.结果对患者射频消融术后Ⅲ度房室传导阻滞、迷走神经反射、穿刺部位出血、气胸和心前区疼痛等并发症的观察护理提出了切实可行的方法.结论密切观察,及时发现问题并采取相应的护理措施对提高手术成功率起着重要作用.     

射频消融术后房性心律失常的临床意义及护理

射频导管消融术(RFCA)作为根治快速心律失常的安全、有效方法已被公认,而且射频电流对心肌损伤作用轻微,不会形成新的心律失常[1].但部分RFCA术后的病人会出现不同程度的房性心律失常,个别发作频繁持续,使病人不能耐受.     

吹气球在双极射频消融术后患者中的应用

目的通过吹气球呼吸训练法对双极射频消融术后患者进行训练,探索一种简单、安全、有效的促进患者术后恢复的方法。方法选择双极射频消融术后患者60例,随机分为对照组和实验组各30例,对照组用咳嗽、排痰、叩背等常规方法,实验组在此基础上加用吹气球呼吸训练法进行术后呼吸训练,通过观察对照组与实验组患者的胸片、血象、胸腔引流管留置时间、患者自我感觉评分进行对比分析。结果实验组胸片、血象、胸腔引流管留置时间、患者自我感觉评分均优于对照组（P〈0．05）。结论吹气球呼吸训练法能较好地促进双极射频消融术后患者康复。     

Pacemaker Function During Radiofrequency Ablation

There are increasing numbers of radiofrequency current ablation procedures being reported. Selected patients have antitachycardia or antibradycardia pacemakers. The pacemaker behavior during and after ablation procedures differs widely. We report on the pacemaker reaction of 25 patients with 13 different devices, most with unipolar electrodes. Sensing failures were observed in 8 (32.0%) and pacing failures in 4 (16.0%) patients. Prolonged pauses and induction of tachyarrhythmias were observed. No pacemaker damage was seen although it is reported by other investigators. We recommend deactivation of implanted generators and an external bipolar pacing electrode. Manufacturers should focus their attention on this problem and protect the generators and their functions for 500 kHz radiofrequency current.     

A New Pacemaker for Paroxysmal Atrial Fibrillation Treated with Radiofrequency Ablation of the AV Junction

Atrial fibrillation is a relative contraindication to atrial synchronous pacing because of the risk of the tracking of rapid atrial rhythms by the pacemaker. In this study, we describe the clinical results of an AV synchronous rate responsive pacemaker with an original algorithm, which is able to sense pathological increments in atrial rate and automatically to switch into a non-AV synchronous mode of pacing. This pacemaker was implanted in 12 patients who had undergone radiofrequency ablation of the A V junction in order to cure severely symptomatic, drug refractory, paroxysmal atrial fibrillation. In an acute, intrapatient comparison between the standard AV synchronous mode and the automatic switching mode, ventricular tracking of atrial fibrillation occurred in 35% and 4% of total beats at rest and in 24% and 2% of total beats during exercise, respectively (P < 0.001). During 5 ± 4 months of follow-up, no further tachyarrhythmia related symptoms occurred. In conclusion, the standard DDDR mode is unable to eliminate ventricular tracking of atrial fibrillation, thus undermining the efficacy of AV junction ablation therapy. The automatic switching mode eliminates this adverse effect of dual chamber pacing.     

Local Repolarization Abnormalities Induced by Transcatheter Radiofrequency Ablation in Pigs

Radiofrequency (RF) ablation alters action potential repolarization of myocardial cells and, theoretically, tbis should induce ST-T segment changes in the ECG. Since these ECG abnormalities have been rarely reported in patients submitted to RF ablation we assess the ability of the procedure to caase ST-T segment changes in local electrograms. Epicardial ECG mapping was performed in 17 anesthetized open chest pigs submitted to endocardial (n = 9) or to epicardial (n = 8) unipolar radiofrequency ablation (500 kHz, 20 W for 5-10 s). To characterize the cellular electrophysiological alterations induced by RE ablation transmembrane action potentials were recorded at various distances from the ablation lesion; these were compared with seven control pigs. Endocardial RE ablation induced a transient (< 5 min) change of 6.1 ± 2.4 m V in T wave amplitude (baseline: 12.8 ± 5.6 mV, P < O.OOl) in 141 out of 269 epicardial electrodes. T wave changes were associated with shortening in local activation time (20.1 ± 2.3 ms at baseline vs 18.5 ± 2.5 ms at 60 s after ablation, P = 0.03). RE current caused persistent ST segment elevation at the center of the ablation lesion with no transmural expansion. Intracellular potentials along a 2-6-mm wide myocardial band bordering the RE lesion showed lower amplitude (101 ± 7.0 mV vs 71 ± 23 mV, P < 0.01) and shorter duration (254 ± 44 ms vs 156 ± 29 ms, P < 0.01) than control hearts. The center of the ablation lesion was electrically anexcitable. We concluded that RF ablation alters cellular electrophysiology in small areas surrounding the ablation lesion and this causes short-lasting transmural changes in T wave amplitude and nontransmural ST segment elevation.     

Impedance Monitoring During Radiofrequency Catheter Ablation in Humans

Radiofrequency catheter ablation of accessory pathways and the atrioventricular junction often requires multiple applications of energy. The inability to determine the effects of any given application on the underlying tissue may contribute to this problem. In the present study, impedance was monitored in 20 patients undergoing radiofrequency catheter ablation, and the relationship between an initial decrease in impedance and subsequent effects were examined. An initial fall in impedance of more than 10 omega was 78% sensitive and 88% specific for predicting subsequent evidence of tissue heating (interruption of conduction or an abrupt rise in impedance due to coagulum formation). In contrast, initial values of voltage, current, or impedance did not distinguish between effective and ineffective applications of radiofrequency energy. Continuous monitoring of impedance may facilitate radiofrequency catheter ablation.     

Radiofrequency Ablation of a Posteroseptal Accessory Pathway Via the Middle Cardiac Vein in a Six-Year-Old Child

Although radiofrequency ablation is highly successful in patients with the Wolff-Parkinson-White syndrome, certain patbways remain refractory to ablation. In particular, subepicardial pathways often fail ablation via an endocardial approach. In adult patients, left-sided subepicardial pathways bave been treated successfully using energy delivery within the coronary sinus. To document the safety and efficacy of this approach in children, we present the case of a 6-year-old boy who underwent radiofrequency ablation of a posteroseptal pathway via energy delivery within tbe middle cardiac vein. Follow-up study showed no evidence of recurrence or gross coronary vascular injury.     

Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children

Radiofrequency (RF) catheter ablation has been widely used in the treatment of cardiac arrhythmias. In atrioventricular nodal reentrant tachycardia (AVNRT), the experience has been predominantly in adults. The cardiac electrophysiological records of 18 consecutive children undergoing RF catheter AV node modification for AVNRT were reviewed. The patients (10 females, 8 males) were 8.2–17.9 years of age (mean 13.6 ± 3.0), weight 15.2–88.1 kg (mean 52.2 ± 20.8), and height 103–190 cm (mean 157.1 ± 21.7). Thirteen were on antiarrhythmic medications (1–3, average 1.5 drugs/day). All drugs were discontinued 48 hours prior to the ablations. The procedures were performed under sedation and local anesthesia. Pre- and post-AV node modification electrophysiological studies were performed in all procedures. The 18 patients underwent a total of 25 procedures (1.39 ± 0.61 per patient): the anterior approach aimed at the antegrade fast pathway in the first four patients and the posterior approach aimed at the slow pathway in the remainder. Thenumber of energy applications was 8–54 (19.8 ± 10.7) per procedure. The maximum energy used in each procedure was 30–50 watts (33.8 ± 8.4). The average energy was 24–50 watts (33.0 ± 6.8). The fluoroscopy time was 7.1–73.4 minutes (29.9 ± 20.0) per procedure, for a total catheterization time of 228–480 minutes (300.3 ± 59.1). Preablation spontaneous or induced AVNRT (cycle length 310.4 ± 55.0 msec) was seen in all except one who had the arrhythmia (cycle length 270 msec) on surface ECG. In 22 of 25 studies, the AH interval measured 67.4 ± 13.2 msec pre- and 98.7 ± 58.4 msec post-AV node modification (P < 0.02). Procedures were initially successful in 16 (89%) of 18 patients. One patient developed complete AV block requiring DDD pacemaker and has since recovered normal AV conduction. Transient third- or second-degree block was seen in four. Other complications included airway obstruction in one and excessive emesis in another. In follow-up of 2–26 months (13.0 ± 7.3), one patient underwent surgical ablation for failed initial RF catheter ablation, and two underwent successful RF procedures for recurrences. RF catheter AV node modification for AVNRT in children is a useful technique. Under ideal circumstances, it is safe and efficacious. Follow-up to determine the potential long-term complications is necessary.     

Upper Rate Pacing After Radiofrequency Catheter Ablation in a Minute Ventilation Rate Adaptive DDD Pacemaker

A 58-year-old man with an implanted minute ventilation rate adaptive DDD pacemaker underwent RF ablation of the AV junction because of symptomatic supraventricular tachyarrhythmias. Immediately after ablation, while the pacemaker was programmed in the DDDR mode, AV sequential pacing at upper rate was observed. After programming the pacing system to the DDD mode and repeated ablation, no abnormalities were observed. It was concluded that AV sequential upper rate pacing was caused by false interpretation of the RF current by the sensor measuring transthoracic impedance as an indicator for minute ventilation.     

Radiofrequency Ablation Therapy in Three Patients with Paroxysmal Atrial Tachycardia

Radiofrequency ablation therapy was performed in three patients with paroxysmal atrial tachycardia. There were two females and one male, aged 80, 63, and 75 years, respectiveiy. All three patients had induction of sustained atrial tachycardia. The tachycardia could be terminated by overdrive atrial pacing or atrial premature stimulation; it could also be terminated by intravenous bolus of adenosine triphosphate. In all three patients, there was no fragmented atrial electrograms recorded within the right atrium, and there was no ventriculo-atrial conduction during ventricular pacing. Tiie earliest atrial activation during tachycardia in these three patients was registered, respectively, at a site slightly posterior and inferior to the His-bundle recording site, at the anterior-superior border of Koch's triangle slightly posterior to the His-bundle recording site, and at the mid-lateral aspect of the right atrium over the crista terminalis at the junction of right atrial appendage and sinus venarum. Radiofrequency current was deiivered to the site of the earliest atrial activation during tachycardia through a 4-mm tip electrode catheter. It resulted in termination of tachycardia and ablation of the tachycardia focus. FoIIow-up observation over a period of 16, 15, and 4 months, respectively, in these three patients showed no recurrence of tachycardia. A repeat eiectrophysiological study was performed 52 and 63 days after ablation in two patients and revealed no induction of atrial tachycardia.     

经导管射频消融治疗快速型心律失常效果分析

目的:总结分析经导管射频消融(RFCA)治疗快速型心律失常的效果及并发症,以进一步指导临床治疗。方法:对我院行RFCA治疗快速型心律失常1 268例的临床资料进行回顾性分析。结果:本组1 268例中,房室折返性心动过速682例,房室结折返性心动过速453例,室性心动过速和室性期前收缩62例,房性心动过速18例,心房扑动17例,心房颤动36例。RFCA总成功率为97.5%,并发症发生率为0.79%。术中出现一过性房室传导阻滞10例,其中2例因并发永久性Ⅲ度房室传导阻滞予安置永久性心脏起搏器,发生心包填塞、气胸、下肢动脉栓塞及深静脉血栓形成各1例;术后发生假性动脉瘤1例。均经相应处理后治愈,未出现瓣膜损伤、感染等并发症,无与RFCA相关的死亡病例。结论:RFCA治疗快速型心律失常具有安全、有效、成功率高、并发症发生率低等优点,如术前认真准备、术中仔细操作、术后细心观察可提高手术的成功率,减少并发症的发生。