预激综合征合并心房纤颤心电图分析

目的 分析探讨预激综合征合并心房纤颤的心电图特征及鉴别诊断。方法 分析11例预激综合征合并心房纤颤的心电图的心室率、 f波、RR间距的变化范围以及QRS波的表现。结果 11例心室率为160－230次／分,平均180次／分;当心室率＞180次／分时,全部导联见不到f波;RR间距的变化范围为0．18－0．76s;QRS波绝大多数表现为完全预激图形,少数为典型预激图形及正常QRS图形。结论 预激综合征合并心房纤颤的心电图特征是：极快速的心室率,RR间距绝对不等,QRS波增宽呈delta波,QRS波表现为完全预激图形、典型预激图形及正常QRS的不同组合。     

心房纤颤的心电图

前几期我们曾谈到心电图产生的原理，这里不妨再复习一下，对理解心房纤颤(简称“房颤”)将会有帮助。正常的一个心跳是由窦房结开始，首先由窦房结发出电冲动，然后传导到右心房、左心房，引起心房收缩，这时产生心电图上的P波。电冲动继     

阵发性心房纤颤的非药物治疗对策

有效地控制房颤是当前的一项重要课题，近年来非药物治疗阵发性房颤是房颤研究领域的热点。心脏起搏器、埋藏式心房纤颤除颤器、射频消融、心外科手术厦心外科射频消融均有各自的特点，也有其局限性。本文对阵发性心房纤颤的非药物治疗对策进行综述。     

阵发性心房纤颤32例临床分析

心房纤颇（atrial fibrillation，AF）为常见的心律失常。阵发性AF为持续性AF的前驱表现，可持续数分钟至数小时甚至数周。此类AF对非器质性心脏病患者的病死率无影响，但可增加冠状动脉硬化性心脏病及瓣膜病患者的病死率。急性心血管病事件的发生存在24h节律变化已被确认，但对阵发性AF的发生、持续和结束是否存在节律性变化很少报道。如果能发现阵发性AF的发生规律，对其药物预防和复律治疗将起到一定的借鉴作用。现就32例孤立性阵发性AF住院患者进行的临床观察报道如下。     

十二导联动态心电图在阵发性房颤中的应用

目的 采用12导联动态心电图对心血管病患者和非心血管病患者进行房颤(AF)及阵发性房颤(PAF)检测分析,评价12导联动态心电图对AF及PAF的诊断价值.方法 对2275例住院及门诊患者进行12导联动态心电图检测,诊断AF及PAF并对“房颤负荷”指标作定量分析.结果 ①12导联动态心电图共检出AF 364例,占总数16...     

老年心房纤颤的诊断与鉴别诊断

心房纤颤（简称房颤）是临床常见的心律失常之一，其发生率仅次于过早搏动。房颤的发生与年龄密切相关，年龄越大发生率越高。在美国的一项调查表明，在４０～６５岁人群中，房颤发生率为２．３％。而在大于６５岁人群中，其发生率增至５．９％。Ｆｅｉｎｂｅｒｇ等报道７...     

老年人心房纤颤的临床特点

目的：探讨老年人心房纤颤（AF）的临床特点。方法：回顾性分析98例老年人心房纤颤的临床情况。结果：本组资料中冠心病54例，占55.1%，居病因之首；阵发性AF41例，永久性AF57例；57例永久性AF中以心力衰竭为其主要临床表现29例，占51％；并存其他心律失常24例，占24.5%；发生缺血性脑卒中12例，占12.2%；治疗时多以控制心室率为主；转复均以药物维持窦性心律；预后差。结论：老年人心房纤颤在病因，临床表现及治疗等方面具有一定的临床特点。     

心房纤颤与冠心病

引起心房纤颤（房颤）的病因很多。尽管近些年冠心病心房纤颤的发病率已居首位，且随着年龄的增长和潜在心血管疾病发生而发病率逐年升高，但临床上诊断为冠心病房颤的患者中，有一部分患者阵发性房颤持续几年，十几年甚至二十几年并无冠状动脉事件发生。为此本文分析126例临床     

老年心房纤颤118例临床分析

心房纤颤（ＡＦ）是临床上最常见的心律失常之一，且随年龄的增长发病率也逐年增高，ＡＦ的病因与不同时代及不同年龄有关。本文旨在对老年人ＡＦ的病因及临床资料作初步分析。１资料与方法１．１研究对象所有病例均为１９８６年３月～１９９８年７月在广东省老年医学研究...     

阵发性心房颤动进展为永久性心房颤动的临床观察

通过对阵发性心房颤动 (简称房颤 )患者的长期观察 ,分析阵发性房颤进展为永久性房颤的影响因素。 35 8例阵发性房颤患者 ,男 178例、女 180例 ,年龄 6 6 .86± 12 .2 7岁。当患者经心电图和动态心电图均未再记录到窦性心律 ,时间持续 6个月以上时判定转归为永久性房颤。结果 :随访 4 .9± 2 .7年 ,共有 6 4例阵发性房颤进展为永久性房颤 (17.9% ) ,永久性房颤组与阵发性房颤组比较 ,瓣膜性心脏病 (2 9.3%vs 16 .4 % ,P =0 .0 4 3)和心力衰竭明显增多 (P =0 .0 0 1) ,孤立性房颤较少。在合并用药中 ,永久性房颤组应用地高辛明显多于阵发性房颤组(P <0 .0 0 1)。超声心动图结果显示永久性房颤组左房内径≥ 4 0mm明显多于阵发性房颤组 (P =0 .0 2 4 )。多因素回归分析 :左房扩大 (OR 2 .0 73,95 %CI 1.80 1～ 3.4 94 ,P =0 .0 4 7)和服用地高辛 (OR 4 .15 3,95 %CI 2 .0 13～ 8.5 71,P =0 .0 0 1)为阵发性房颤进展为永久性房颤的独立危险因素。结论 :左房扩大和应用地高辛可能是预测阵发性房颤进展的危险因素。     

房性早搏始动的阵发性心房颤动的动态心电图分析

了解房性早搏 (简称早搏 )与阵发性心房颤动 (简称房颤 )的关系。通过 2 4h动态心电图分析 2 4例阵发性房颤患者 ,观察其 2 4h房颤的发作阵数 ,房早的发作情况 ,诱发和未诱发房颤的房早的联律间期、房早前周长、房早前12 0s房早频率等。结果 :诱发房颤的房早比未诱发房颤的房早显著提前 (35 5 .9± 32 .8msvs 4 0 8.4± 4 1.7ms,P <0 .0 1) ,房早是否诱发房颤还与房早前周长长 (85 4± 10 6msvs 74 2± 113ms ,P <0 .0 1)及房早前 12 0s的房早频率快 (2 1.7± 15 .3次 /分vs9.79± 7.92次 /分 ,P <0 .0 1)有关。结论 :房早是否始动阵发性房颤不仅与房早的联律间期有关 ,而且与房早前周长及其前 12 0s房早的频率有关。     

阵发性心房颤动发生的相关研究进展

尽管对阵发性心房颤动的认识已增加了不少,但是对自然状态下发作的阵发性心房颤动的触发方式的细节研究还是少之又少。通过对其相关心电图特征的研究以更好的了解阵发性心房颤动的发生。     

Paroxysmal Atrial Fibrillation on Flecainide Therapy

Flecainide pill-in-the-pocket therapy is a pharmacologic treatment option for patients with infrequent episodes of symptomatic atrial fibrillation. We report a case of wide complex tachycardia due to atrial flutter with 1:1 atrioventricular conduction in a patient who took pill-in-the-pocket flecainide without concomitant atrioventricular nodalblockade.     

胺碘酮联合稳心颗粒转复阵发性心房纤颤的疗效研究

目的观察胺碘酮联合稳心颗粒转复阵发性心房纤颤（房颤）的临床疗效。方法将90例阵发性心房颤动的患者随机分为胺碘酮治疗组、稳心颗粒治疗组、胺碘酮和稳心颗粒联合治疗组,每组各30例患者,疗程均为8周。观察3组治疗后的转复率、症状改善情况及不良反应。结果胺碘酮组转复率为50.0%,稳心颗粒组转复率为45.2%,联合治疗组的转复率为80.0%,联合治疗组与单用药物比较差异有统计学意义。胺碘酮和稳心颗粒治疗组症状改善有效率分别为66.7%、56.7%,联合治疗组症状改善有效率76.7%,联合治疗组与单用药物比较差异有统计学意义。结论胺碘酮联合稳心颗粒可提高阵发性房颤的转复率,改善患者症状。     

Right Atrial Mapping and Linear Ablation for Paroxysmal Atrial Fibrillation

Objective: Catheter ablation techniques to cure atrial fibrillation (AF) are under investigation. This study evaluates a mapping-based, individualized approach to right atrial (RA) linear ablation in patients with paroxysmal AF. Methods: In this prospective observational study, 29 patients with recurrent symptomatic AF refractory to medical therapy, underwent linear ablation between May 1998 and December 1999. Inclusion criteria were symptomatic paroxysmal AF, failure of at least 2 antiarrhythmic medications, and informed consent. Radiofrequency ablation was performed in the RA using a 3.3 French multielectrode catheter, ablating through sequential electrodes to establish linear lesions. Lesions were delivered during sustained AF, guided by an empiric mapping scheme, targeting arrhythmogenic areas noted during electrophysiologic testing in sinus rhythm and areas of most disorganization during AF. Reinduction of AF was attempted at the end of successful ablation. Results: The mean age was 58 years. There were 15 male and 14 female patients. Sustained AF was inducible in all patients at electrophysiology study. Acute success was achieved in 24 patients (83%). Long term success (maintaining sinus rhythm off antiarrhythmic medications) was seen in 23 (79%) over a mean follow-up of 19.7 months. Ablation lines varied from patient to patient. There were no complications. Conclusions: Individualized linear ablation in the RA using a multielectrode catheter system can produce effective suppression of paroxysmal AF. Ablation during AF, and testing to reinduce AF at the end of the procedure, make this study unique.     

Long-term Efficacy of Flecainide in Paroxysmal Atrial Fibrillation

Abstract. The efficacy and safety of flecainide for long-term prevention of paroxysmal atrial fibrillation (AF) were studied in an open trial. Twenty patients with very frequent attacks (mean 13 per month) of paroxysmal AF for many years (mean 8 years) participated. Before inclusion, the patients had unsuccessfully been treated with an average of 3.3 antiarrhythmic drugs. Efficacy was jugded from a carefully kept diary in which the patients made daily notes of any AF attacks and possible side-effects from 1 month before treatment until the end of a follow-up period of 6 months. Twelve patients (60%) were completely free from AF and 11 of these are still successfully treated with flecainide after 11–38 months (mean 24 months). Flecainide plasma levels did not differ between responders and non-responders. Eleven patients (55%) had adverse effects but these were usually mild and well tolerated, necessitating withdrawal or dose reduction resulting in relapse of AF only in three patients (15%). No proarrhythmic events were seen.