射频消融术后肌钙蛋白测定与心肌损伤的关系

近年来对心肌钙蛋白 (Ｔ或Ｉ)的研究非常活跃 ,但大多数的研究集中在急性心肌梗死 (ＡＭＩ)、不稳定型心绞痛 (ＵＡＰ)、心肌炎等方面 ,关于应用肌钙蛋白监测射频消融 (ＲＦＣＡ)术后心肌损伤的文献报道尚少。我们监测了 39例ＲＦＣＡ治疗的患者术后血清心肌钙蛋白Ｔ(ｃＴｎＴ)、心肌钙蛋白Ｉ(ｃＴｎＩ)、肌酸激酶同工酶 (ＣＫ ＭＢ)的动态变化 ,旨在比较这三项生化指标诊断轻微心肌损伤的灵敏度和特异性 ,同时了解ＲＦＣＡ引起心肌损伤的情况和影响因素。1　资料和方法1 1　研究对象　ＲＦＣＡ组 :39例接受ＲＦＣＡ患者 ,男 2 3例 ,女 16例…     

射频消融术对心脏损伤标识物的影响

射频消融术 (ｒａｄｉｏｆｒｅｑｕｅｎｃｙｃａｔｈｅｔｅｒａｂｌａｔｉｏｎ ,ＲＦＣＡ)已成为根治心动过速的有效治疗方法 ,但关于ＲＦＣＡ的研究多集中在操作技术和治疗效果上 ,对其所造成的心脏损伤尚未引起重视 ,现就其有关问题加以综述。1　ＲＦＣＡ对肌钙蛋白的影响ＲＦＣＡ是以心导管技术将导管电极置于引起心律失常的“病灶”处或异常传导径路区域 ,通过电场能作用于组织中的带电离子 ,使之运动并与组织及液体介质磨擦生热 ,使心肌细胞内、外液迅速蒸发 ,产生组织凝固性坏死 ,从而阻断折返激动传导途径 ,达到根治心律失常的目的。…     

射频消融术后尿潴留患者的护理

分析86例射频消融术后患者出现尿潴留的不同原因，包括不习惯床上排尿、精神因素、疼痛等。护理对策包括：减少卧床时间，心理护理，变换体位，物理诱导，术后多饮水等，结果81例患者排尿成功，只有5例(5．8％)男性前列腺肥大患者需要导尿。     

射频消融术对心脏自主神经的影响及其与心肌细胞损伤的关系

目的　观察射频消融术 (RFCA)患者术前、术后心率变异性及血清心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶 (CK MB)的变化 ,探讨RFCA对心脏自主神经的影响以及与心肌细胞损伤的关系。方法　选择 80例接受RFCA治疗的阵发性室上性心动过速患者 ,于术前、术后测定心率变异性 (HRV)及cTnI及CK MB水平。结果　RFCA后R R间期差值均方根 (rMSSD)、R R间期差值 >5 0ms百分率 (PNN50 )、极低频功率谱密度 (VLF)、低频功率谱密度 (LF)、和高频功率谱密度 (HF)明显降低 (P <0 .0 5 )。房室结双径路、间隔旁道及左侧旁道HF较术前有显著性下降 (P <0 .0 5 )。右侧旁道HF、VLF下降 ,但差异无统计学意义。HRV各参数变化与消融能量、消融时间、消融次数及cTnI、CK MB的升高倍数均无显著相关性 (P >0 .0 5 )。结论　射频消融术后心脏交感神经和迷走神经活性均有不同程度的损伤 ,迷走神经损伤较交感神经损伤严重 ,右侧旁道迷走神经受损不明显 ,心脏自主神经损伤与心肌细胞损伤无关。     

射频消融术心肌损伤的评价

射频消融术（radiofrequency catheter ablation,RFCA）是目前根治快速性心律失常最有效的方法,它主要是通过射频电流对心肌组织产生热效应引起心肌组织脱水、干燥、凝固、坏死从而破坏心脏内导致快速心律失常的特殊部位或构成心动过速折返通路的关键部位.因此,RFCA不可避免的会对心肌细胞产生一定影响.而RFCA所造成的心肌损伤仅靠常规的临床方法难以诊断.近年来研究发现,血清心肌肌钙蛋白T（cTnT）的浓度比其他心肌酶类对于心肌损伤诊断的敏感性高且特异性强.本研究通过连续动态监测RFCA前后血清cTnT及心肌酶学变化,探讨其诊断心肌微小损伤的灵敏性和特异性,并进一步了解射频消融术所致心肌损伤的程度和相关因素.     

阵发性房颤射频消融术后心功能的变化

目的 探讨阵发性房颤射频消融术对患者心功能的影响.方法 对150例某院行射频消融术治疗的阵发性房颤患者的手术效果进行评价,所有患者均随访12个月,根据复发情况对患者左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)以及前后径、上下径、左右径、LVAmax水平进行评价.结果 所有...     

心脏手术前后心肌肌钙蛋白T和心肌酶谱的变化

目的：探讨血清心肌肌钙蛋白T（cTnI）和心肌酶谱在心肌手术损伤前后的变化及其临床意义。方法：动态观察20例二尖瓣瓣膜置换术患手术前,术后2h及24h血清cTnI和心肌酶谱变化。另制备家兔心肌损伤模型,检测动物模型伤前和伤后4,8,24h血清cTnI的变化特点。结果：二尖瓣瓣膜置换术患血清cTnI含量,心肌酶谱尖性在术后2,24h较术前显升高（P＜0．01）,其中血清cTnI含量术后2h增加倍数高于其他指标。家兔心肌损伤模型伤后4,8,24h血清cTnI含量较伤前或高非常显（P＜0．01）,呈后期大峰值双基线。结论：血清cTnI含量及心肌酶谱活性均对心肌损伤的诊断有意义,但cTnI的心肌特异性及早期灵敏度更高,cTnI后期峰值对心肌损伤的预后判断有重要价值。     

20例射频导管消融术的护理

经导管射频消融术(radiofrequency catheter ablation，RFCA)1987年应用于临床，我国1991年引进RFCA。十多年来这一技术在国内快速发展，使快速性心律失常的治疗发生了根本变化，被推选为某些快速心律失常的首选治疗方法。2001年10月～2002年8月，我院心血管介入治疗中心用RFCA治疗快速性心律失常患者20例，取得了良好的效果，现将护理体会报道如下。     

心脏导管射频消融术

心脏导管射频消融术（消融术）是在心内电生理检查的基础上,对引起心律失常的关键部位进行精细标测,然后通过导管输入一定能量的射频电流,使靶点及邻近的心肌组织发生凝固性坏死,从而消除心律失常。该文件对消融术进行了简介,并介绍了房室折返性心动过速、房室结折返性心动过速、房性心动过速等常见快速心律失常的射频消融治疗。     

Right diaphragm paralysis following cardiac radiofrequency catheter ablation for inappropriate sinus tachycardia

We describe a case of permanent right diaphragm paralysis following a radiofrequency cardiac ablation procedure. The relationship between the procedure and the phrenic nerve lesion is discussed with respect to the possible pathogenetic mechanisms. Radiofrequency current used in cardiac electrophysiology may cause serious thoracic nerve injuries. Means to avoid this complication are pointed out.     

心房颤动导管消融的地位和进展

心房颤动(房颤)是临床常见的心律失常之一,最大风险是血栓栓塞,常见是脑卒中。随着人口的老龄化,房颤人数持续增加,治疗问题也逐渐成为人们关注重点。房颤导管消融是其重要治疗方法之一,可明显改善房颤患者预后。且随着技术发展,消融方法也日趋成熟,故导管消融术治疗房颤地位正在逐步提升。但消融方法尚无固定术式,发生机制尚未完全明确,尤其对于持续房颤。因此房颤消融术仍存在一些问题有待进一步探索。     

The results of radiofrequency catheter ablation of supraventricular tachycardia in children

BACKGROUNDS: Radiofrequency (RF) catheter ablation represents a major advance in the management of children with cardiac arrhythmias and has rapidly become the standard of care for the first-ling therapy of supraventricular tachycardias (SVTs). The purpose of this study was to investigate the results of the RF catheter ablation of SVTs in pediatric patients. METHODS: From December 1989 to August 2005, a total of 228 pediatric patients (age: 9 +/- 7 years, range: 5-18 years; male:female = 117:111) with clinically documented SVT underwent an electrophysiologic study and RF catheter ablation at our institution. RESULTS: The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 140, 61%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 66, 29%), atrial tachycardia (AT; n = 11, 5%), and atrial flutter (AFL; n = 11, 5%). The success rate of the RF catheter ablation was 92% for AVRT, 97% for AVNRT, 82% for AT, and 91% for AFL, respectively. Procedure-related complications were infrequent (8.7%; major complications: high grade AV block (2/231, 0.9%); minor complications: first degree AV block (6/231, 2.6%), reversible brachial plexus injury (2/231, 0.9%), and local hematomas or bruises (10/231, 4.3%)). The recurrence rate was 4.7% (10/212) during a follow-up period of 86 +/- 38 months (0.5-185 months). CONCLUSIONS: The RF catheter ablation was a safe and effective method to manage children with paroxysmal and incessant tachycardia. The substrates of the arrhythmias differed between the pediatric and adult patients. However, the success rate of the ablation, complications, and recurrence during childhood were similar to those of adults.     

Effect of radiofrequency catheter ablation on plasma B-type natriuretic peptide

The study was designed to investigate the impact of radiofrequency catheter ablation on the plasma level of B-type natriuretic peptide (BNP). In 36 patients who underwent catheter ablation of paroxysmal supraventricular tachycardia, the plasma level of BNP was analyzed before and after the ablation procedures. The plasma BNP at baseline, 30 minutes after the ablation, 3 and 24 hours after the ablation was 12.78 +/- 2.47, 18.45 +/- 4.02 (P = 0.446), 43.54 +/- 8.12 (P = 0.0001), and 17.88 +/- 4.71 (P = 0.493) pg/mL, respectively. Plasma troponin I was also increased 3 and 24 hours after the ablation (n = 10, P < 0.05). Multivariate regression analysis showed a significant correlation between the levels of BNP 3 hours after ablation and the preablation BNP and the total radiofrequency energy used for the ablation. We conclude that radiofrequency catheter ablation of supraventricular tachycardia increases the plasma level of BNP. The clinical significance of the ablation-induced increase in BNP needs to be further investigated.     

B型预激综合征射频消融后心功能变化

目的：比较射频消融前后B型预激综合征心功能变化，方法：根据QRS波时间将46例B型预激综合征患者分为两组，A组27例，QRS波时间0．11－0．13s；B组19例，QRS波时间0．14－0．16s。射频消融前及术后3－5天测左室的心功能。结果，术后A组的每搏量（SV）、射血分数（EF）、峰射血率（PER）、峰充盈率（PFR）及B组的SV、EF均略高于术前（P＞0．05）。尤其B组的PER、PFR明显高于术前（P＜0．05）。结论射频消融后，随着预激成分的消失，心功能可得到一定程度的改善，且术前预激成分越多，QRS流越宽，术后改善越明显。     

Electrophysiologic characteristics and radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome

BACKGROUND: The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome. METHODS: From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome. RESULTS: The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P=0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P<0.001).Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients. CONCLUSION: This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.     

射频消融治疗阵发性室上性心动过速复发原因分析

目的：分析阵发性室上性心动过速患者行射频消融术后复发的原因，探讨降低术后复发的方法。方法：132例阵发性室上性心动过速患者，行射频消融术，术后每3～6个月随访1次，随访4～24个月。结果：132例患者中，复发10例，总复发率7．58％，其中房室结折返性心动过速复发率为6．52％，左侧房室旁路介导心动过速复发率5．89％，右侧旁路介导心动过速复发率14．28％。行射频消融术患者中，前70例复发率11．43％，后62例复发率3．22％。结论：精确的靶点标测、熟练的操作技巧以及消融方式的正确运用是降低射频消融术复发率的关键。