Carto标测系统指导下射频消融治疗心房颤动的护理

目的:探讨房颤患者在Carto标测系统指导下射频消融治疗心房颤动的护理体会。方法:对35例患者在Carto标测系统指导下行射频消融术。结果:32例患者手术一次成功3,例患者一次射频消融未成功,3个月后再次行射频消融术后成功。结论:通过加强术前术后护理,有效减少及预防了疾病并发症,促进了患者的康复。     

三维标测系统指导下射频消融治疗室性早搏的护理

目的 探讨在(CARTO)三维标测系统指导下进行射频消融治疗室性早搏的护理方法.方法 对28例行射频消融术治疗的室性早搏患者进行观察和护理.术前做好准备和心理护理,术后密切观察患者的生命体征,加强并发症的观察和护理.结果 28例均完成了射频消融治疗.随访2～20个月,治愈率92.9％.结论 Carto三维标测系统指导下行射频消融治疗室性早搏安全有效.合理、细致的护理,可消除患者的恐惧心理,提高手术耐受性,且能及早发现和防治并发症,增加手术的安全性.     

Carto3系统指引零射线下导管射频消融治疗特发性室性心律失常的有效性和安全性

目的 通过比较Carto3系统指引零射线与X线下导管射频消融治疗特发性室性心律失常,评估零射线方法的有效性和安全性。方法 前瞻性收集由2017年1月至2018年3月于广西医科大学第一附属医院连续在Carto3系统指引下行导管射频消融术的特发性室性心律失常(包括特发性室性期前收缩和特发性室性心动过速)患者106例,根据手术日期的单双号进行分组。其中39例手术日为单号,纳入零射线组;67例手术日为双号,纳入射线组。所有手术均由2名术者完成,均使用强生导航星压力监测灌注消融导管。比较两组手术时间、首次标测时间、放电次数、放电时间、靶点位置、即刻成功率、并发症发生率、复发率。结果 两组年龄、性别、病程、超声心动图等基线资料差异无统计学意义。射线组使用X线时间为168.0(44.8, 541.3) s。两组在手术一般资料方面,手术时间、首次标测时间、放电次数、放电时间、靶点位置等差异均无统计学意义。两组在手术的有效性和安全性方面,即刻成功率、并发症发生率、复发率方面差异均无统计学意义（P＞0.05）。结论 Carto3系统指引零射线下导管射频消融治疗特发性室性心律失常有效、安全,没有增加手术时间、首次标测时间及放电次数。     

Carto三维标测系统指导下射频消融治疗心房颤动患者的护理

目的 探讨Carto三维标测系统指导下射频消融治疗心房颤动患者的护理.方法 对34例Carto三维标测系统指导下射频消融治疗心房颤动患者进行术前准备、术中配合、术后观察与护理.结果 88.2%以上患者转为窦性心律,患者临床症状明显减轻,生活质量明显提高.结论 术前严谨的告知制度,充分的术前准备,必要的心理支持;术中注重心理护理,熟练配合;术后严密的监护和观察,是减少并发症、提高手术成功率的重要保证,对提高护理质量及促进患者的康复起到非常重要的作用.     

经导管射频消融治疗特发性室性心动过速患者的护理

目的探讨经导管射频消融治疗特发性室性心动过速患者的护理方法。方法回顾性分析75例行导管射频消融治疗的特发性室性心动过速患者的临床资料。结果发生术后并发症3例,其中穿刺点血肿2例、心脏压塞1例,经精心治疗和护理后均痊愈出院。结论经导管射频消融治疗特发性室性心动过速患者安全有效,手术前后需要密切观察、精心护理、及时发现并协助处理各种并发症。     

Carto标测系统指导下射频消融治疗心房颤动患者的术中配合与护理

目的 探讨Carto标测系统指导下射频消融治疗房颤的术中配合经验及护理措施.方法 对13例实施Carto标测系统指导下射频消融的房颤患者进行手术,配合要点包括术前探访,进入导管室后的心理干预,特殊设备仪器的连接使用,术中及时提供专用器械,全过程严密监护,根据手术进程密切配合医生操作及时提供有效信息,对发生的异常情况进行分析并迅速采取护理措施.结果 13例患者手术成功率100%,术中发生并发症3例,其中呼吸、心脏骤停1例,因疼痛致迷走神经反射出现血压降低、心率减慢、恶心呕吐2例,经积极治疗护理后均转危为安.结论 术中注重患者心理护理,准备完善,熟练配合,严密监护和观察是手术顺利进行,减少并发症和提高手术成功率的重要保证.     

射频消融治疗特发性室性心动过速的临床观察

目的观察射频消融(RFCA)治疗9例特发性室性心动过速(IVT)方法和结果。方法分别行激动顺序标测法和起搏标测法,对左室特发性室速(ILVT)7例,右室特发性室速2例,行射频消融治疗。结果6例ILVT射频消融治疗成功,均起源于左室间隔面,有效消融靶点处P电位较体表心电图QRS起始点提前(34.6±8.9)m s(25~58 m s),2例IRVT射频消融成功,有效消融靶点处与心动过速时的12导联心电图QRS波形完全相同。无一例出现并发症。结论射频消融是治疗特发性室性心动过速的有效方法。     

Carto 3系统指导下射频消融治疗心房颤动的护理

[目的]了解Carto 3标测系统指导下射频消融治疗心房颤动的临床护理要点。[方法]对95例采用Carto 3系统指导下行射频消融术治疗心房颤动病人的临床资料采用回顾性分析。[结果]对心房颤动射频消融术病人按照临床护理要点实施术前准备、术后护理,无一例病人出现严重并发症,病人均康复出院。[结论]对采用射频消融术治疗的心房颤动病人密切监测、重点观察,可及时发现并有效处置并发症,缩短住院时间。     

Carto三维标测指导下室性心律失常射频消融术的护理难点与对策

目的 探讨Carto三维标测指导下室性心律失常射频消融术围手术期护理难点与对策。 方法 对24例动员行Carto三维标测射频消融术患者的资料进行分析,总结术前动员成败的原因、术中术后护理难点及其对策。 结果 Carto三维标测射频消融术围手术期护理难点有：患者对新技术缺乏信任感,拒绝率高;术中配合要求高,配合难度大;术后卧床时间长,患者舒适度低。对策：术前强化健康教育和心理干预是保证患者依从性和手术顺利进行的基础;术中熟练的配合技巧是手术安全的保障;术后提供精细化护理服务是提高患者舒适度的必要条件。结论 Carto三维标测射频消融术是一项新兴技术,需要对患者围绕Carto三维标测新技术进行强化健康教育和心理护理干预,对参与手术的护士需要进行专项技能培训才能顺利完成对Carto三维标测射频消融术的密切配合。     

三维心脏电解剖标测结合CT影像融合技术指导复杂房性心律失常的射频消融治疗

对于复杂的房性心律失常,常规电生理标测困难,消融成功率较低,X线曝光时间延长。在三维心脏电解剖标测结合CT影像融合技术（Carto-Merg）指导下提高了标测的准确性和消融的成功率。本研究报道42例复杂房性心律失常应用Carto—Merg指导下行射频消融手术,旨在探讨Carto—Merg指导复杂房性心律失常射频消融治疗的作用和优势。     

三维电生理导航系统指导下导管射频消融术治疗阵发性室上性心动过速的效果及安全性

目的分析三维电生理导航系统(Carto3)指导下导管射频消融术(RFA)治疗阵发性室上性心动过速(PSVT)的效果及安全性。方法将我院收治的64例PSVT患者按手术方案不同分为研究组与参照组,各32例。研究组给予Carto3指导下导管RFA,参照组给予X线透视下常规消融法。比较两组的消融成功率、临床相关指标及并发症发生率。结果研究组消融成功率为96.88%,高于参照组的81.25%(P<0.05);研究组的肺静脉定口时间、环肺静脉消融时间、X线辐射时间均短于参照组(P<0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。结论Carto3指导下导管RFA治疗PSVT患者可提高消融成功率,缩短肺静脉定口时间、环肺静脉消融时间、X线辐射时间。     

Idiopathic Left Ventricular Tachycardia: New Insights, into Electrophysiological Characteristics and Radiofrequency Catheter Ablation

KOTTKAMP, H., et.al .: Idiopathic Left Ventricular Tachycardia: New Insights into Electrophysiological Characteristics and Radiofrequency Catheter Ablation . Objectives: This study was performed to investigate the electrophysiological characteristics of idiopathic left ventricular tachycardia and to determine the feasibility of radiofrequency catheter ablation for nonpharmacological cure. Background: The underlying electrophysiological mechanism of idiopathic left ventricular tachycardia with right bundle branch block morphology and left-axis deviation is presently not known. Additionally, only limited data describing the results of radiofrequency catheter ablation for treatment of idiopathic left ventricular tachycardia so far exist. Methods: Electrophysiological studies and radiofrequency catheter ablation were performed in 5 patients (3 male and 2 female, mean age 31 ± 10 years) with idiopathic left ventricular tachycardia (cycle length 376 ± 72 msec). The patients had a history of recurrent palpitations of 4 ± 1 years and had been treated unsuccessfully with 2 ± 1 antiarrhythmic drugs. Sustained ventricular tachycardia with right bundle branch block morphology and left- or right-axis deviation was documented in all patients. Results: Inducibility with critically timed ventricular extrastimuli, inverse relationships of the coupling interval of the initiating extrastimulus and the interval to the first beat of the tachycardia, continuous diastolic or mid-diastolic electrical activity during ventricular tachycardia, and fragmented late potentials during sinus rhythm suggested reentrant activation as the underlying mechanism in three patients. On the other hand, induction dependent on isoproterenol infusion and rapid ventricular pacing and exercise inducibility indicated different electrophysiological characteristics in the remaining two patients. During electrophysiological study, intravenous verapamil terminated ventricular tachycardia in all patients, whereas ventricular tachycardia did not respond to intravenous adenosine, autonomic maneuvers, or intravenous β-blocking agent esmolol. Catheter mapping revealed earliest endocardial activation during ventricular tachycardia in different areas of the left ventricular septum being distributed from the base to the midapical portion of the septum in all patients. In 4 of 5 patients, radiofrequency catheter ablation (median number of pulses 4, range 1–9) resulted in complete abolition of idiopathic left ventricular tachycardia during a follow-up of 4–43 months (median 10) without antiarrhythmic drugs. Successful target sites for catheter ablation included continuous diastolic or mid-diastolic electrical activity during ventricular tachycardia and late potentials during sinus rhythm (2 patients), polyphasic fragmented presystolic potentials during ventricular tachycardia (1 patient), and pace mapping with identical QRS morphology compared to the ventricular tachycardia and “earliest” detectable activity during tachycardia (1 patient). No procedure related complications occurred. Conclusions: Two different patterns of electrophysiological properties of idiopathic left ventricular tachycardia were observed, indicating that this arrhythmia entity does not represent a homogeneous group. The “origin” of the tachycardias as identified by successful radiofrequency catheter ablation was located in different areas of the left ventricular septum and was distributed from the base to the mid-apical region. Radiofrequency catheter ablation was an effective and safe treatment modality in most of these patients. Distinct target site characteristics for successful catheter ablation including polyphasic diastolic activity during tachycardia and fragmented late potentials during sinus rhythm could be identified.     

Recent advances in radiofrequency catheter ablation

Radiofrequency catheter ablation has been established as a first-line treatment of various paroxysmal tachycardias, and its developments are still ongoing. As recent advances of radiofrequency catheter ablation, we can point out the following issues: 1) transaortic approach for idiopathic ventricular tachycardia(VT) of LBBB-form with inferior axis, 2) new approach guided by mid-diastolic potential for verapamil-sensitive VT, 3) pulmonary vein(PV) isolation technique guided by PV ostial circular electrogram mapping for paroxysmal atrial fibrillation, 4) new ablation strategies for macro-reentry tachycardia such as incisional atrial tachycardia and VT post old myocardial infarction guided by electro-anatomical mapping, and 5) cooled-tip ablation technique for atrial flutter and VT resistant to conventional system.     

经导管射频消融治疗儿童阵发性心动过速65例护理体会

目的:探讨经导管射频消融治疗儿童阵发性心动过速的护理方法。方法:对65例阵发性心动过速患儿行经导管射频消融治疗,并给予精心术前准备和术后护理。结果:本组65例经导管射频消融治疗成功率为92.3%。2例房室结改良术后发生迟发性房室传导阻滞(AVB),其中1例术后24h出现高度AVB,1例术后4h出现Ⅰ度、Ⅱ度Ⅰ型AVB,经积极治疗和护理,均完全恢复。结论:儿童阵发性心动过速行经导管射频消融治疗具有自身的临床护理特点,重视护患沟通,给予精心术前准备,术后进行严密的心电监护与观察,可保证手术顺利进行,减少并发症发生,促进患儿康复。     

Radiofrequency ablation of cardiac arrhythmias using a three-dimensional real-time position management and mapping system

A recently developed three-dimensional real-time position management system (RPM) uses an ultrasound ranging technique that enables multiple distance measurements between two reference catheters and a mapping catheter each equipped with ultrasound transducers. In addition to three-dimensional representation of the catheters and ablation sites it displays real-time movements of catheters (including the tip and shaft). A recently released version of the system enables additional geometry reconstruction of the heart chamber and activation mapping. This study included 21 patients (mean age 59 +/- 14.5 years) referred for radiofrequency catheter ablation of various arrhythmias. Geometry was reconstructed by tracing the endocardial contour of the respective heart chambers. Global and local color coded activation maps were constructed to confirm the nature of arrhythmia and to guide ablation. Spontaneous or induced arrhythmias were typical atrial flutter (n = 8), atypical atrial flutter (n = 3), atrioventricular nodal reentrant tachycardia (n = 3), atrial tachycardia (n = 2), atrial fibrillation (n = 2), ventricular tachycardia (n = 2), and Wolff-Parkinson-White syndrome (n = 1). Geometry reconstruction and mapping of arrhythmias were possible in 20 of 21 patients. RPM-guided radiofrequency ablation was successful in 19 (95%) of 20 patients. Due to difficulties in steering the RPM mapping/ablation catheter, in 6 (28%) successfully mapped patients, radiofrequency ablation was performed using another catheter. In one patient, the RPM-guided map was inconclusive and in another patient, ablation failed due to multiple reentrant circuits. No complications were observed. In conclusion, the new RPM system enables geometry reconstruction and three-dimensional positioning of the ablation catheters, reconstruction of the activation maps, marking of anatomic structures and reproducible tracking of multiple ablation sites. The system could be used to guide radiofrequency ablation of atrial and ventricular arrhythmias.     

Right Ventricular Radiofrequency Ablation of Ventricular Tachycardia After Myocardial Infarction

Radiofrequency transcatheter ablation of ventricular tachycardia in the setting of a prior myocardial infarction is typically performed with application of energy to the left ventricular endocardium. In this article, two cases are described in which successful radiofrequency transcatheter ablation of ventricular tachycardia occurred with energy delivery to the right ventricular septum after failed ablation attempts from the left ventricle. Both patients had tachycardias with a left bundle branch block morphology and markedly presystolic activity recorded from the right ventricular septum. Right ventricular septal activation mapping during ventricular tachycardia should be performed in patients with left bundle branch block tachycardia morphology and coronary artery disease to maximize efficacy of the catheter ablation procedure.     

特发性室性心动过速射频导管消融方法探讨

目的：探讨特发性室性心动过速（IVT）的消融方法。方法：对12例IVT患者进行射频消融治疗，源于右心室IVT采用消融导管起搏标测法，以起搏时与VT发作时的12导联心电图QRS波形态与振幅完全相同的起搏部位为消融靶点。并在周围做巩固消融，起源于左心室IVT以激动标测法或寻找P电位。结果：IVT消融成功率91．6％（11／12），1例ILVT在第3次复发射频消融后发生双束支阻滞而安装了VVI永久起搏器。结论：起源于左心室的IVT宜采用激动顺序标测法，起源于右心室的IVT宜采用起搏标测法。对有效靶点周围进行线状或环状消融，有利于提高手术成功率。     

剖宫产术后寒战的相关因素分析及护理对策

目的探讨Carto标测系统指导下射频消融治疗房颤的术中配合经验及护理措施。方法对13例实施Carlo标测系统指导下射频消融的房颤患者进行手术，配合要点包括术前探访，进入导管室后的心理干预，特殊设备仪器的连接使用，术中及时提供专用器械，全过程严密监护，根据手术进程密切配合医生操作及时提供有效信息，对发生的异常情况进行分析并迅速采取护理措施。结果13例患者手术成功率100％，术中发生并发症3例，其中呼吸、心脏骤停1例，因疼痛致迷走神经反射出现血压降低、心率减慢、恶心呕吐2例，经积极治疗护理后均转危为安。结论术中注重患者心理护理，准备完善，熟练配合，严密监护和观察是手术顺利进行，减少并发症和提高手术成功率的重要保证。