应用冷冻球囊进行上腔静脉电隔离治疗心房颤动的初步探索

目的探索冷冻消融治疗心房颤动(简称房颤)中应用冷冻球囊进行上腔静脉电隔离的安全性和有效性。方法 4例房颤患者在局麻下接受第二代冷冻球囊冷冻消融手术。在肺静脉隔离后进行上腔静脉冷冻消融达到电隔离。观察术中电隔离相关冷冻参数和膈神经麻痹等主要并发症。术后3个月后进行临床随访观察冷冻消融治疗房颤效果。结果患者均为男性,其中2例为阵发性房颤,2例为持续性房颤。4例患者均在第一次冷冻开始后(36.3±19.3)s达到上腔静脉电隔离,即刻温度(-33.3±5.0)℃,冷冻消融总时间(61.8±26.9)s,最低温度(-40.5±4.4)℃。术中均无血流动力学障碍、穿孔、迷走神经反应、膈神经麻痹和窦性心动过缓等主要并发症发生。术后3个月随访均未见快速型房性心律失常事件发生。结论采用第二代冷冻球囊进行上腔静脉冷冻电隔离治疗房颤的初步经验是安全有效的。     

心房颤动患者行节段性射频消融隔离上腔静脉的有效性和安全性评价研究

目的:分析心房颤动（房颤）患者导管 三维电生理方法确定功能性窦房结、右侧膈神经及上腔静脉-右心房肌束的分布,探讨房颤节段性射频消融隔离上腔静脉的有效性和安全性。方法:本研究为回顾性研究,选取2018年7月至2019年6月于郑州大学第一附属医院首次行导管射频消融术并且接受上腔静脉隔离术的房颤患者为研究对象,收集患者的基线...     

二代冷冻球囊消融老年心房颤动患者的有效性和安全性研究

目的:探讨老年患者行二代冷冻球囊消融（CBA）治疗心房颤动（房颤）的安全性和有效性。方法:连续纳入2016年8月至2018年12月于北部战区总医院应用二代冷冻球囊行肺静脉电隔离（PVI）的房颤患者共760例,并对这些患者进行回顾性分析,随访记录各年龄人群围术期并发症及术后房颤复发率。对其中≥75岁的老年组患者与年龄<7...     

冷冻球囊消融治疗高龄阵发性心房颤动患者的安全性和有效性

目的 评价冷冻球囊消融在高龄阵发性心房颤动(AF)患者中应用的有效性和安全性.方法 通过单中心的回顾性研究,分析我院2019年1月1日至2020年1月1日行冷冻球囊消融的高龄阵发性AF患者,统计其1年随访的AF复发率和严重并发症发生率,评价冷冻球囊消融在高龄阵发性AF患者中应用的有效性和安全性.结果 本研究共60例患者...     

冷冻球囊消融治疗阵发性心房颤动

目的:探讨冷冻球囊消融治疗阵发性心房颤动（房颤）的方法、策略及近期结果。方法: 对2013年12月~2014年1月在本院开展的5例冷冻球囊治疗阵发性房颤进行分析。结果: 5例患者手术时间100~210（153±44） min,X线曝光时间为33~72（51±15） min。每根肺静脉平均冷冻消融时间为29~300（209±75） s ,温度-27℃~-61（-44±9）℃,每根肺静脉冷冻次数2~6（3.0±1.3）次/根。术中及术后未发生肺静脉狭窄、血栓栓塞、膈神经麻痹等并发症。术中1例患者未达到完全肺静脉隔离,用普通射频导管补点消融成功。术后3例患者出现上腹部不适,24 h内逐渐缓解。术后随访1~2个月,均无房颤发作,无相关并发症。结论: 冷冻球囊消融治疗房颤操作相对简单、无需三维标测、学习曲线可能较短;但早期X光曝光时间较长,有待进一步缩短。     

冷冻球囊消融治疗心房颤动研究进展

心房颤动是临床最常见的持续性心律失常,在心律失常相关就诊和住院中为主要病因,与活动能力、生活质量、心功能以及总生存率的下降密切相关。药物及射频消融是当前治疗心房颤动的主要方式。近几年大量临床研究及实践表明冷冻球囊消融能安全有效隔离肺静脉,从而治疗心房颤动。     

两代冷冻球囊心房颤动导管消融疗效及安全性对比的Meta分析

目的探讨第一代冷冻球囊与第二代冷冻球囊导管消融治疗房颤的疗效及安全性。方法计算机检索The Cochrane Library、Pubmed、EMBASE、中国知网、万方等数据库关于两代冷冻球囊导管消融疗效及安全对比的文献,根据纳入及排除标准,对符合要求的文献进行质量评价,提取数据,对两代球囊关于肺静脉电隔离成功率、膈神经麻痹发生率、手术时间、曝光时间、3月及1年无复发率等采用Rev Man 5.0软件进行Meta分析。结果共纳入8篇文献(共2094名患者),Meta分析结果显示两代冷冻球囊肺静脉电隔离成功率没有统计学差异(RR=0.99,95%CI:0.99~1.00,P=0.03),手术时间、曝光时间、3月及1年无复发率优于第一代冷冻球囊,而膈神经麻痹发生率却高于第一代球囊(RR=0.57,95%CI:0.41~0.80,P0.05)。结论第二代球囊能带来更好的手术疗效,而膈神经麻痹却高于第一代球囊。     

冷冻球囊导管消融术的临床疗效及安全性分析

【】　目的　评价冷冻球囊导管消融术术的临床疗效及安全性。 方法　入选2014年6月至2015年6月华中科技大学附属同济医院就诊的38例阵发性房颤患者采用冷冻球囊技术进行房颤消融治疗。结果　房颤消融手术平均时间(125.5±38.2)min,平均透视时间(27.4±13.0)min,平均冷冻消融时间(36.9±12.8)min,导管消融即时成功率92.7%,平均每根肺静脉冷冻次数2～6(4. 0±1.2)次/根,各肺静脉即时成功率：左上肺静脉95.3%,左下肺静脉92.5%,右上肺静脉93.2%,右下肺静脉89.7%;术中行右上肺静脉消融时,并发膈神经麻痹1例,发生率2.6%;术后回访1例患者12个月内复发,复发率3%。结论　冷冻球囊消融术安全性高,具有良好的临床疗效     

采用第二代冷冻球囊消融治疗阵发性心房颤动四例

采用第二代新型冷冻球囊对4例症状性阵发性心房颤动(简称房颤)患者进行冷冻消融治疗。结果:4例患者总共16条肺静脉电位被冷冻消融隔离。手术时间为(74±21)min,射线下曝光时间为(22±6)min。术中有3例患者出现明显胸痛,均在冷冻下肺静脉复温过程中发生,2例位于左下肺静脉,1例位于右下肺静脉。1例术中出现一过性膈神经麻痹。随访4个月,未见房颤复发。结论:第二代冷冻球囊消融治疗阵发性房颤安全。     

Pulmonary vein isolation combined with superior vena cava isolation for atrial fibrillation ablation: a prospective randomized study

Aims: Circumferential pulmonary vein isolation (CPVI) is an establishedstrategy for atrial fibrillation (AF) ablation. Superior venacava (SVC), by harbouring the majority of non-pulmonary vein(PV) foci, is the most common non-PV origin for AF. However,it is unknown whether CPVI combined with SVC isolation (SVCI)could improve clinical results and whether SVCI is technicallysafe and feasible. Methods and results: A total of 106 cases (58 males, average age 66.0 ± 8.8years) with paroxysmal AF were included for ablation. They wereallocated randomly to two groups: CPVI group (n = 54) and CPVI+ SVCI group (n = 52). All cases underwent the procedure successfully.Pulmonary vein isolation was achieved in all cases. The proceduraltime and fluoroscopic time were comparable between the two groups.The mean ablation time for SVC was 7.8 ± 2.7 min. Superiorvena cava isolation was obtained in 50/52 cases. In the remainingtwo cases, SVCI was not achieved because of obviating diaphragmaticnerve injury. During a mean follow-up of 4 ± 2 months,12 (22.2%) cases in the CPVI group and 10 (19.2%) cases in theCPVI + SVCI group had atrial tachyarrhythmias (ATa) recurrence(P = 0.70). Nine of 12 cases in the CPVI group and 8/10 casesin the CPVI + SVCI group underwent reablation (P = 0.86), andPV reconnection occurred in 7/9 cases in the CPVI group andin 8/8 cases in the CPVI + SVCI group. All PV reconnection wasreisolated by gaps ablation. There was no SVC reconnection inthe CPVI + SVCI group. In two cases without PV reconnectionfrom the CPVI group, SVC-originated short run of atrial tachycardiawas identified and eliminated by the SVCI. At the end of 12months of follow-up, 50 cases (92.6%) in the CPVI group and49 (94.2%) in the CPVI + SVC group were free of ATa recurrence(P = 0.73). Conclusion: In our series of paroxysmal AF patients, empirically addingSVCI to CPVI did not significantly reduce the AF recurrenceafter ablation. Superior vena cava isolation may be useful,however, in selected patients in whom the SVC is identifiedas a trigger for AF. However, because of the preliminary propertyof the study and its relatively small sample size, the impactof SVCI on clinical results should be evaluated in a large seriesof patients.     

起源于上腔静脉阵发性心房颤动的特点和射频导管消融治疗

目的 分析上腔静脉(SVC)起源的异位冲动诱发阵发性心房颤动(PAF)的特点，总结射频导管消融电隔离SVC治疗PAF的经验。方法 在连续收治的130例射频导管消融电隔离心脏大静脉治疗PAF的患者中，11例患者的PAF由SVC起源的异位冲动所诱发(8．5％)，其中2例因合并慢一快综合征而植入心脏起搏器。结果 房性早搏(房早)和房性心动过速(房速)时，P′波在Ⅱ、Ⅲ、aVF导联直立，振幅高于窦性P波；在aVL和V．导联与窦性P波相比，正向波幅度降低、负向波加深。心内电生理检查发现，房早时SVC电位跃至心房电位之前，早于体表P′波和心房内其他部位电活动，并可诱发房颤；有时心房内呈规律的快速电活动，而SVC内为频率更快的电活动，或者两者之间呈1：1的关系，但SVc电位早于心房内任何部位，提示SVC为诱发房颤的靶静脉。所有患者均成功电隔离了SVC，术后即刻4名患者SVC内仍有自发快速电活动，6名患者SVC内有自发慢频率电活动，但心房内为稳定的窦性心律。随访3～24个月，2例患者PAF复发，再次消融后症状消除，多次复查动态心电图，无PAF的证据。结论 起源于SVC的异位冲动也可诱发PAF，SVC起源的房早和房速体表心电图P′波有一定特征。射频导管消融可以成功电隔离SVC，预防PAF的复发。在部分诊断为慢．快综合征的患者，PAF也可能由一局灶异位冲动所诱发。     

起源于上腔静脉的房性快速心律失常的电生理特点和消融治疗

目的 报道4例起源于上腔静脉的房性心律失常的电生理特点和消融治疗。方法 分析4例病人房性心律失常的心电图特点，标测上腔静脉和心房确定房性心律失常的激动起源，局灶点消融上腔静脉内异常电活动最早起源点或消融电隔离上腔静脉-右心房连接以终止心律失常，临床随访评估疗效。结果 4例病人均有频发房性早搏和短阵房性心动过速，1例病人有短阵心房颤动。心律失常的异常P波在Ⅰ、Ⅱ、Ⅲ、aVF和V1导联直立，aVR导联倒置。房性心律失常的最早起源位于上腔静脉内，距其口部0．4—4．0cm。局灶消融和电隔离消融分别有效终止房性心动过速(2例)和完全电隔离上腔静脉-右心房传导(2例)。随访4～14个月无临床症状发作。结论 起源于上腔静脉的房性心律失常有特殊的心电图表现，射频消融治疗有良好的临床效果。     

Electrical remodeling of the canine superior vena cava after chronic rapid atrial pacing

Background The superior vena cava (SVC) might serve as the trigger and/or substrate for paroxysmal atrial fibrillation (AF). However, the electrophysiological properties of the SVC with chronic AF are unknown. The purposes of this study were to investigate the electrophysiological properties of the SVC and the electropharmacological effects of intravenous dl–sotalol on the canine SVC after chronic rapid atrial pacing (RAP). Methods and results In the control group, the effective refractory period (ERP), conduction velocity, and AF inducibility of the SVC were assessed in 6 normal dogs before and after an infusion of dl–sotalol. In the experimental group, the ERP, conduction velocity, and AF inducibility of the SVC were assessed before and after dl–sotalol administration in 10 dogs after 8 weeks of RAP. The SVC showed a shorter ERP, decreased slope of rate–adaptation of the ERP, increased ERP dispersion, a decreased conduction velocity, and increased inducibility and duration of AF initiated from the SVC in the RAP dogs. In the RAP dogs, intravenous dl–sotalol significantly increased the ERP, but dlsotalol did not change the slope of rate–adaptation of the ERP, dispersion of the ERP, conduction velocity, inducibility, or duration of AF initiated from the SVC. Conclusions The present study demonstrates that the canine SVC shows significant electrical remodeling and increased AF vulnerability after chronic RAP. Intravenous dl–sotalol was unable to decrease the inducibility or duration of AF initiated from the SVC.Supported in part by grants from the National Science Council (NSC 93-2314- B-341-001) and Shin Kong Wu Ho-Su Memorial Hospital (SKH-TMU-92-28, SKHTMU- NSC-93-01), Taipei, Taiwan, R.O.C.     

Remodeling of myocardial sleeve and gap junctions in canine superior vena cava after rapid pacing

Objective We studied the response of the superior vena cava (SVC) myocardial sleeve to atrial fibrillation (AF). Methods and results We examined adult male dogs without pacing (N=6) and after rapid atrial pacing (600 bpm) for 2 weeks (P2w; N=5) and 6–8 weeks (P6–8w; N=5). After pacing, the sleeve was increased in thickness (non-paced vs. either paced group, both P<0.05). This was associated with an increase in proliferative activity, which was higher in the P2w than the P6–8w animals (P < 0.05). In addition, collagen content increased, and the component cardiomyocytes become more unevenly oriented and shorter and narrower in shape (non-paced vs. either paced group, both P < 0.05). Pacing had different effects on connexin40 (Cx40) and Cx43 gap junctions. There was a 98% increase in Cx43 signal in P2w, and a 74% increase in P6–8w animals (non-paced vs. each paced group, both P < 0.05). In contrast, Cx40 signal decreased 47% in P2w but increased 44% in P6–8w animals (non-paced vs. each paced group, both P < 0.05). Conclusions Rapid atrial pacing results in a specific pattern of remodeling of the canine SVC sleeve, including changes in size and shape, spatial orientation, and gap junction expression profile of the component cardiomyocytes. These changes may co-operatively affect the electrical properties and contribute to the formation and maintenance of the arrhythmogenic substrate of AF.     

Sinus node injury as a complication of superior vena cava isolation

We report a case with SVC ectopy initiating AF; the origin and breakout point of the sinus node was inside the SVC, and the SVC ectopy was conducted through the same path as the sinus node activation to depolarize the right atrium. Injury to the sinus node happened after successful isolation of SVC.     

Case report of fatal complication of superior vena cava tear from balloon dilatation of iatrogenic superior vena cava narrowing

The treatment options for superior vena cava (SVC) obstruction depends on the cause and severity of SVC narrowing. It ranges from conservative medical management to more elaborate endovascular and surgical repair of obstruction. There has always been a concern regarding the possibility of rupture of SVC during balloon dilatation, if the obstruction is secondary to the surgical cause. Very few cases are reported in the literature. We report a case of fatal complication of SVC tear in a 2-month-old child who had iatrogenic SVC narrowing.