心脏起搏治疗缓慢性心律失常最新进展

心脏起搏器旨在以人工电脉冲发生器发放有一定频率、一定能量的脉冲波 ,刺激心肌的某一部分 ,引起心肌兴奋并传导整个心脏 ,使心脏按照脉冲波频率有规律地进行舒缩活动 ,完成心脏泵的功能。从而纠正或改善严重心律失常所致的血流动力学变化。 1932年Hyman首先创用一台用弹力电动机驱动的电脉冲发生器 ,刺激停搏 15min的心脏 ,使其重新起搏获得成功 ,并把这一机器命名为人工心脏起搏器。以后经不断改进 ,已经发展为安全可靠、小型化、使用寿命长、多功能、顺序起搏、体外遥测及可调节程控等性能的起搏器。目前 ,各类起搏器已广泛应用于临床…     

心律失常心脏起搏治疗

心律失常是心内科常见病,特别是一些严重的缓慢性心律失常在药物治疗无效的情况下,心脏起搏治疗则成为唯一有效的治疗手段。此外对一些心律失常如在严重缓慢心律失常基础上发生室速和/或室颤而引起晕厥发作和/或猝死,亦为有效的预防措施。现将我院30例心律失常心脏起搏治疗结果报告如下:     

心脏起搏在快速性心律失常防治中的用应

<正> 70年代以来,心脏起搏技术已由治疗房室传导阻滞发展至防治快速性心律失常,并已至应用阶段,本文略作一慨要介绍。一、异位快速性心律失常发生的主要机理 1.异位起搏点存在增高的自律性,自动去极化作用明显增强,激动发放频率加快。可表现为早搏、心动过速。 2.激动传导异常系指激动的折返传导或环形运动。亦可表现为早搏、心动过速或扑动、颤动等。二、心脏起搏防治快速性心律失常的原理及方法。心脏起搏治疗快速性心律失常的机理,取决于起搏刺激的类型,心律失常发生的机理,异位心律发生的部位(即室上性还是室     

双房同步起搏治疗房性快速性心律失常

双房起搏是心脏起搏技术的一项最新进展 ,可用于治疗由房间传导阻滞引起的房间折返性房性快速性心律失常。在常规右房、右室双腔起搏的基础上 ,植入冠状窦电极起搏左房 ,建立双房右室三心腔起搏系统 ,实现双房电活动的同步化 ,消除房间传导阻滞和房间折返 ,防治由房间传导阻滞引起的房性快速性心律失常。     

双房同步起搏治疗房性快速性心律失常

双房起搏是心脏起搏技术的一项最新进展,可用于治疗由房间传导阻滞引起的房间折返性房性快速性心律失常。在常规右房、右室双腔起搏的 基础上,植入冠状窦电极起搏左房,建立双房右室三心腔起搏系统,实现双房电活动的同步化,消除房间传导阻滞和房间折返,防治由房间传导阻滞引起的房性快速性心律失常。     

双房起搏对房性快速性心律失常的治疗

目的 :评价双房起搏治疗伴房间传导阻滞 (IACB)患者的阵发性房性快速性心律失常的疗效和安全性。方法 :15例患者均行左锁骨下静脉穿刺 ,X线采用正位和左前斜位 ,依次置入冠状窦、右室、右房电极 ,测试起搏参数满意后 ,经Y型转接器将冠状窦电极和右房电极组成新的双极电极 ,置入后分别行AAT、DDD或DDTA起搏。结果 :1例术中冠状窦电极脱位而放弃双房起搏 ,2例术后冠状窦电极脱位 ,均成功复位 ,2例由于程控不当造成起搏器介导性心动过速 ,其余病例未出现并发症。随访 2～ 32个月 ,9例显效 (6 4 .3% ) ,2例有效 ,3例无效。结论 :双房起搏能有效防治并发高度房间传导阻滞患者的阵发性心房扑动、心房颤动。普通心室电极经冠状窦行永久左房起搏安全、有效、脱位率低 ,值得推广和应用     

起搏预防阵发性快速性房性心律失常

阵发性快速性房性心律失常主要包括阵发性房性心动过速 (房速 )、心房扑动 (房扑 )及心房颤动 (房颤 ) ,临床较常见 ,呈反复、交替、频繁发作。这一方面可抑制窦房结自律性 ,导致窦房结功能障碍 ;另一方面可使心房发生电重塑 ( electrical remodeling)及收缩功能障碍。这些结果又反过来促进快速性房性心律失常发作 ,形成恶性循环。多数患者最终将演变成永久性房颤 ,使心功能明显减退 ,可诱发或加重心力衰竭 ,严重影响患者的生活质量。另外 ,房颤尤其是阵发性房颤是血栓栓塞的主要原因。抗心律失常药物对此类心律失常疗效较差 ,长期服用抗心…     

双房同步起搏预防和治疗房性快速性心律失常

目的 观察双房同步起搏技术对伴有房间传导阻滞的阵发性快速性房性心律失常的疗效。方法 病态窦房结综合征合并房间传导阻滞的阵发性快速性房性心律失常患者7例，男4例、女3例，年龄58～78岁。其中4例行双房起搏(AAT)，3例行双房右室三腔起搏(DDD)，经穿刺左锁骨下静脉插入右房、右室和冠状静脉窦起搏电极导线，分别用于起搏右房、右室和左房。结果 起搏器及电极导线均顺利植入，未发生任何并发症。冠状静脉窦电极顶端距冠状静脉窦口2．5—3．5cm，P波振幅为1．6—5．5mV、阻抗624—808Ω,、单极起搏阈值0．5—0．7V。随访2—31个月，7例均健在，房性心律失常的临床发作得到明显控制。结论：双房同步起搏技术是房间传导阻滞合并快速房性心律失常的有效预防和治疗方法。     

双房起搏治疗快速性房性心律失常的疗效探讨

目的：探讨具有自动模式转换功能（AMS）的DDD起搏器进行双房三腔心脏起搏治疗房内传导阻滞并快速性房心律失常患者的疗效及随访要求。方法：对2例例患者植Medtronic THERA DR7964iDDD起搏器,进行双房－右室三腔起搏治疗,定期起搏器程控和Holter复查了解近期及远期起搏各参数变化、起搏与自身心律的关系及对房性心律失常影响。结果：2例阵发房颤、房扑者、房颤发作明显减少,双房－右室近期及远期起搏阈值测定良好,起搏器AMS发挥正常,但起搏程控检测冠状窦电极参数受限并且起搏器自动模式转换详情观察具有一定局限性。结论：双房心脏起搏器能有效地治疗因房内传导阻滞引起的快速房性心律失常;AMS的DDD起搏器适用于具有快速房性心律失常的双房心脏起搏患者,为了更好地观察冠状窦电极的稳定性及更确工判断该起搏术对快速房心律失常的疗效,有待使用新型的转换器,并进一步探讨起搏器的连接方式。     

经皮冠状动脉介入术后心脏康复的新进展肖小林(综述)[1] 班努.库肯[2] 王敏敏 [1] 严金龙(审校者)[2]

随着经济的发展,经皮冠状动脉介入术后的患者越来越多。一个多学科的综合的,可以降低心脏风险的康复计划是PCI术后预防和管理的一个重要组成部分。尽管心脏康复在PCI术后的二级预防方面有很充分的证据,但其充分利用仍存在很多的障碍。目前心脏康复模式的推广需要国家政策的支持和各级医务工作者不断的探索。     

常规起搏升级为心脏再同步治疗研究进展

常规起搏器治疗作为病态窦房结综合征、高度房室传导阻滞等症状性心动过缓的唯一有效的治疗方式,在临床上得到广泛的应用。但大量研究显示,高比例的右室起搏可导致心室结构重构、心功能恶化,而心脏再同步化治疗(CRT)在常规起搏治疗并发心功能不全的患者中的升级应用,在提高患者的生活质量,降低患者心衰住院率和全因死亡率方面有重要意义。然而,由于缺乏大规模的临床试验进行探究及升级疗效难以预测,2016年欧洲心脏病学会更新了关于心衰治疗的临床指南,其中对于常规起搏器升级治疗指征的把握仍较为严格。为探究关于起搏器升级的指征和时机、升级治疗的疗效和预测,本综述分析了近年来相关方面的相关临床试验结果及相关问题的探讨,更好地指导常规起搏器的升级治疗。     

Temporary pacing in the prevention and treatment of tachyarrhythmia

In this article cardiac pacing is approached as a method to prevent and treat tachyarrythmias. The authors describe both the ways and places of stimulation as well as the indication to its use. The risks and complications associated to this method are also mentioned. In conclusion they refer to it as an available alternative to the other forms of antiarrythmic therapy, emphasising its efficacy and safety.     

Interference with cardiac pacing

Most exposures to electromagnetic interference are transient and pose no threat to patients with pacemakers and implantable cardioverter defibrillators. Prolonged exposure may be catastrophic in pacemaker dependent patients. New technologies (wireless phones, electronic antitheft surveillance) are safe if proper precautions are takes. Radiofrequency ablation requires concomitant temporary pacing. MR imaging remains contraindicated in patients with these devices until further study is undertaken.     

The best of cardiac pacing in 2005

In 2005, the main subject of interest in the field of pacing was cardiac resynchronisation. The results of CARE-HF (Cardiac Resynchronisation on Morbidity and Mortality in Heart Failure), a large multicentre trial, were published. The investigators set out to establish whether resynchronisation pacing had a favourable effect on morbidity and mortality in patients with advanced cardiac failure and desynchronised compared with an identical population treated medically. The results showed that resynchronisation decreased the interventricular desynchronisation, decreased mitral regurgitation and, above all, improved symptoms and quality of life with a reduction in the incidence of complications and the risk of death. This publication is too recent for evaluation of the eventual repercussions of these results on the implantation of resynchronising pacemakers in France. The indication recommended by the scientific societies is still based on criteria which do not take echocardiographic data into account. However, the recommendations will probably change in the near future when the conclusions of trials currently under way, are published. From the technical point of view, the advances in cardiac pacing were mainly the new algorithms which avoid inappropriate ventricular stimulation of dual chamber pacemakers. It is well known that patients implanted with dual chamber pacemakers may, despite optimal adjustment of pacing parameters, have ineffective ventricular stimulation as the impulse falls in the phase of spontaneous ventricular depolarisation or effective but absolutely valueless. Several manufactures now propose pacemakers with algorithms which "search" for ventriculogrammes in order to avoid these situations of inadequate stimulation. Their efficacy has been demonstrated. Finally, in 2005, the diffusion of defibrillators equipped with a resynchronisation function has been confirmed. The conclusions of the COMPANION trial have been influential in promoting this usage although the results are mainly observed abroad.     

The present status of cardiac pacing

At the time of its inception, pacemaker treatment only had the goal of reliably maintaining a regular ventricular rhythm. After solving technical problems of detection, function and introduction of AV-sequential pacing (1962), cardiac hemodynamics have become the central issue of interest. While, at low heart rates atrial contraction contributes meaningfully to cardiac output, it has been shown that for physiologic needs and high rates, rate-adaptive single-chamber stimulation is hemodynamically more favorable than non-rate adaptive AV-sequential pacing. A rate-adaptive stimulation, more suited to physiologic needs with incorporation of a combination of various control parameters will improve pacing technology in the future. Anti-tachycardia stimulation, now integrated into the function of the implantable cardioverter/defibrillator has substantially widened the scope of this aspect of pacing.     

经食道心房调搏术诊治快速型心律失常的应用价值

目的探讨经食道心房调搏诊治快速型心律失常的价值。方法对278例快速型心律失常患者行经食道心房调搏术。结果278例患者检出阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)218例、室性心动过速5例、心房扑动31例、心房纤颤24例,其中PSVT中房室折返性心动过速109例,房室结折返性心动过速65例,阵发性房性心动过速44例。以超速抑制法终止室上性心动过速发作208例(95.4%),失败10例,心房扑动成功27例(87.1%);药物终止快速型心律失常对心脏电生理参数有影响(P0.05)。结论经食道心房调搏术是一种简便、高效和安全的快速型心律失常诊治方法,值得临床推广。