心房颤动冷冻球囊消融与磁导航指导下消融放射暴露对比研究

目的对比分析心房颤动(房颤)冷冻球囊(CRYO)消融术与磁导航(RMN)指导下房颤消融术两种消融方式, 探讨房颤消融术中减少放射暴露的方法。方法回顾性分析本院144例冷冻消融患者(CRYO组)和121例磁导航指导下房颤消融患者(RMN组)术中在线随机参考点累积皮肤表面入射剂量(CD)和X射线照射时间, 分析不同类型患者辐射剂量及手术效果之间的差异。结果与RMN组相比, CRYO组患者的手术时间明显缩短[(165.0±23.6)、(97.8±18.4)min, t=26.05,P<0.001], 但X射线暴露时间明显延长[(8.1±3.1)、(23.4±6.2)min,t=-24.57, P<0.001]、CD值明显增加[(232.3±130.7)、(669.0±387.5)mGy, Z=-12.29,P<0.001]。随访两组患者总体维持窦性心律比例未见明显差异(71.9%、75.7%, P=0.618)。多元回归分析提示, 肥胖患者、非阵发性房颤患者、肺静脉存在变异患者与CRYO组患者CD值增加有关(t=5.47、2.23、3.39, P<0.05), 且CR...     

不同类型心血管介入手术辐射剂量分析

目的 分析不同类型心血管介入手术患者所受X射线辐射剂量以及影响辐射剂量的因素.方法 按照甲、乙、丙3位术者的患者资料,抽取本院接受心血管介入手术的患者442例,包括单行冠状动脉造影术(CAG)、冠状动脉介入术(PCI)、射频消融术(RFCA)、先天性心脏病介入术(CHD)和永久性心脏起搏器植入术(PCPI).采集患者的皮肤表面累积入射剂量(CD)、剂量面积乘积(DAP)、透视时间.结果 CAG、PCI、RFCA、CHD、PCPI各组患者的CD值分别为(0.34 ±0.23)、(1.33±0.76)、(0.71±0.43)、(0.27±0.22)和(0.92±0.42) Gy,DAP值分别为(34.18±23.33)、( 135.92±81.14)、( 79.79±50.66)、(27.93±23.66)和(94.60±48.11) Gy.cm2.透视时间分别为(4.82±3.73)、(16.64±9.01)、(17.04±15.29)、(9.60±5.97)和(7.31±6.45) min.DAP值与透视时间呈高度相关性(r =0.84,P＜0.05).结论 不同类型心血管介入手术患者所受的平均辐射剂量不同.辐射剂量和透视时间与手术难易度和术者操作熟练程度有关,可通过提高操作技术水平、减少透视时间降低患者辐射剂量.     

心血管介入手术工作人员受照剂量监测与分析

目前我国心血管介入手术开展的较为普及。在心血管介入手术操作的过程中，医生和护士长时间暴露在X射线辐射场中，全身各部位都受到不同程度的X射线照射。国内外报道心血管介入手术医生体表剂量明显高于其他介入手术。本研究对心血管介入手术的辐射场进行了测量和分析，得到了一些对心血管介入手术辐射防护设计有意义的数据。     

经导管射频消融治疗心房颤动的回顾性分析

目的探讨经导管消融治疗心房颤动的有效性和安全性。方法对我科自1999年开始行导管消融治疗的80例房颤病例资料进行回顾性分析,比较肺静脉节段性消融术(SPVA)20例和肺静脉环形消融术(CPVA)60例两组的操作相关指标安全性及临床效果。结果显示80例病例中两组的基线资料和平均操作时间差异无统计学意义。但SPVA组的平均X线透视时间长(P<0.05),平均操作时间相似(P>0.05)。术后随访6～12月时,总成功率73.3%,消融过程中出现严重并发症(急性心包填塞)1例,经抢救存活。结论在条件成熟的导管室,经导管消融阵发性房颤是可行的,对大部分患者有效。     

基于蒙特卡罗数学模型两种脊柱全景X射线成像技术受检者辐射剂量的对比研究

目的 比较两种脊柱全景X射线成像技术对受检者产生的辐射剂量。方法 使用仿真体模进行实验,摸索出该体模在日本岛津Sonialvision safire17设备Slot scan脊柱全景成像的适宜成像条件,然后在GE Discovery XR650型DR系统上对该体模进行不同曝光条件的DR脊柱全景成像,3位有经验的放射科医生对两种成像技术的图像进行评分,选择图像质量评分均值最接近的对应成像参数为实验成像参数。将相关成像参数及X射线机信息输入PCXMC 2.0软件,计算受检者脊柱全景成像的器官吸收剂量和有效剂量。结果 Slot scan脊柱全景成像的适宜成像条件为高质量全景成像模式(HQ模式)、SID 150 cm、100 kVp和2 mAs, DR手动曝光模式脊柱全景成像相当图像质量的成像条件为SID 200 cm、100 kVp和3.2 mAs。Slot scan HQ模式、DR手动曝光模式和DR自动曝光模式脊柱全景成像的有效剂量(E)分别为(0.118 7±0.001 4)、(0.084 7±0.000 8)和(0.158 0±0.001 5) mSv,DR手动曝光模式的有效剂量明显低于其余2种模式(F=3 007.293,P<0.05);除乳腺以外,DR手动曝光模式的器官剂量均低于Slot scan HQ模式的器官剂量(P<0.05);除甲状腺、食管、肺以外,DR自动曝光模式的器官剂量均高于另外两种成像方式的器官剂量(P<0.05)。结论 两种手动全景成像技术的辐射剂量均处于较低水平,合理选择全景成像技术的曝光参数和模式可实现低剂量全景X射线成像。     

KODEX-EPD三维标测系统指导冷冻球囊导管消融治疗阵发性心房颤动2例

心房颤动(简称房颤)为我国最常见的心律失常之一,且发病率逐年增加[1].冷冻球囊导管消融是治疗房颤的标准方法之一[2] ,在疗效及安全性方面不劣于经导管射频消融治疗.但冷冻球囊对肺静脉封堵效果评估手段有限,且对消融术中心房基质无法做到实时评估,影响消融效果评价.此外,冷冻球囊导管消融的X线曝光时间显著高于射频消融[3]...     

护患两版临床路径对心房颤动导管消融的效果评价

目的 探讨临床路径在导管消融治疗心房颤动（下称房颤）中的实践效果.方法 以我科2010年3月～2013年7月期间181例行导管消融治疗的房颤患者为研究对象,并将其随机分为实验组和对照组,对照组90例采用一般护理方法按常规进行诊疗、护理和健康教育指导,实验组91例采用CNP护理方法,即根据导管消融治疗房颤患者病情制定健康教育临床路径,由经过统一培训的责任护理人员从入院到出院全程负责,有计划、有组织地对患者实施健康指导和护理.结果 两组患者的平均住院日、平均住院费用、两组患者术后舒适度及不良反应的比较、两组满意度调查问卷结果比较、两组患者健康指导测评的比较均有显著性差异（P ＜0.01或P＜0.05）.结论 导管消融治疗房颤中应用临床路径可显著缩短平均住院日,降低平均住院费用,减少术后并发症,提高了患者的满意度,提高了患者康复知识水平.     

CARTO系统标测指导下射频消融治疗心房颤动患者的术中护理

目的：探讨CARTO系统标测指导下加冷盐水灌注射频消融治疗房颤的术中配合经验、护理措施及预防并发症发生的方法。方法：对16例接受射频消融术治疗房颤的患者进行回顾性分析,包括术中配合与监护,并针对各自的并发症实施相应的护理对策。结果：16例患者介入手术成功率100％,术中1例因疼痛出现迷走反射,经即刻心室起搏、注射咪唑安定后症状缓解,继续手术,术后1～3天均康复出院。结论：通过准确的术前决策,充分的术前准备,注重患者的心理护理,术中娴熟的操作技术配合及严密监护,对发生的异常情况进行分析并迅速采取护理措施,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。     

数字乳腺机自动曝光与手动曝光辐射剂量对比研究

数字乳腺机具有自动曝光与手动曝光两种模式.自动曝光的优点是乳腺摄影时不用进行摄影条件的选择,而手动曝光则完全依靠技师的工作经验进行摄影条件的选择,若摄影条件选择不当,会造成照片质量下降,影响诊断.但数字乳腺机又具有大宽容度和强大后处理功能的特点,在自动曝光与手动曝光都使照片达到诊断要求的情况下,其辐射剂量有无差别值得探讨,本研究对两种曝光模式进行辐射剂量对比研究,以便在实际工作中选择最正当和最优化的曝光模式进行乳腺摄影.     

CT辐射剂量所面临的挑战

尽管CT检查仅占所有检查的2%,而对于公众诊断性成像的接收剂量,CT却占20%左右。具有10mSy有效剂量的成人腹部检查会增加致癌风险1/2000。儿童对于放射线影响的灵敏度是中年人的10倍多,女孩比男孩更敏感。剂量增加的原因有:CT应用的偏差、使用方便的结果、多层CT的危机、未意识到"非耦合效应"。医护人员要进行很好的培训,要意识到不断涌现的资料及实践中潜在的变化,根据进展修正方案。像进行传统X射线摄影一样,"合理使用低剂量(as low as reasonably achievable,ALARA)"原则也很适合于CT的应用。     

EnSite3000指导下7字线射频消融治疗房颤临床分析

目的：评价EnSite3000指导下7字线射频消融治疗房颤的临床疗效和安全性。方法：68例房颤患者（阵发性房颤46例,持续性房颤22例）在EnSite三维标测系统和肺静脉造影联合指导下重建肺静脉和左心房模型,后采用7字线消融术式予以射频治疗,观察并记录围术期和出院后患者房颤治疗效果和并发症发生情况。结果：术后随访12月,59例消融成功,总消融成功率86．8％,术中出现急性心包填塞1例,术后血管迷走神经反射2例,穿刺点血肿1例,经有效抢救后均脱离危险。结论：EnSite三维标测系统引导下的房颤7字线射频消融术具有较高的成功率和安全性,应用前景广阔。     

Carto三维标测系统指导导管射频消融治疗心房纤颤6例

心房纤颤（房颤）是最常见的心律失常之一,其发生率随年龄而增加,常可导致心悸、心力衰竭、脑卒中和肢体栓塞等。治疗房颤的理想目标是恢复窦性心律,这是防范继发心血管事件和血栓并发症的最佳手段。 最常见的复律方法是药物复律,有时还会采用电复律。但许多房颤患者常难以通过药物或直流电恢复窦性心律而只能控制室率,这些患者常因不能耐受或依从而使用抗凝药物,成为并发栓塞的高危患者。近10年来,有关房颤电生理机制和治疗手段的研究取得了令人鼓舞的成果。     

MR evaluation of pulmonary vein diameter reduction after radiofrequency catheter ablation of atrial fibrillation

Fifty consecutive patients aged 52±12 years suffering from drug refractory atrial fibrillation (AF) underwent baseline and post-ablation MR angiography (MRA) at a mean follow-up of 4±3.5 months. Pulmonary vein (PV) disconnection was performed with a maximum energy delivery of 30 W. MRA allowed a two-plane measurement of each PV ostium. After ablation, no significant stenosis was observed, and only 1/194 (0.5%) and 3/194 (2%) PVs had a diameter reduction of 31–40% in the coronal and axial planes, respectively. There was a significant overall post-procedural PV narrowing of 4.9% in the coronal plane and 6.5% in the axial plane (P=ns between both planes). MRA is an efficient technique that can be used in pre- and postoperative evaluation of AF patients. Using a maximal power delivery limited to 30 W, no significant PV stenosis was observed at mid-term follow-up. Late PV anatomical assessment is needed to confirm these results on long-term follow-up.     

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

One of the recognised complications of catheter ablation is pulmonary venous stenosis. The aim of this study was to compare two methods of evaluation of pulmonary venous diameter for follow-up assessment of the above complication: (1) a linear approach evaluating two main diameters of the vein, (2) semiautomatically measured cross-sectional area (CSA). The study population consists of 29 patients. All subjects underwent contrast-enhanced magnetic resonance angiography (CeMRA) of the pulmonary veins (PVs) before and after the ablation; 14 patients were also scanned 3 months later. PV diameter was evaluated from two-dimensional multiplanar reconstructions by measuring either the linear diameter or CSA. A comparison between pulmonary venous CSA and linear measurements revealed a systematic difference in absolute values. This difference was not significant when comparing the relative change CSA and quadratic approximation using linear extents (linear approach). However, a trend towards over-estimation of calibre reduction was documented for the linear approach. Using CSA assessment, significant PV stenosis was found in ten PVs (8%) shortly after ablation. Less significant PV stenosis, ranging from 20 to 50% was documented in other 18 PVs (15%). CeMRA with CSA assessment of the PVs is suitable method for evaluation of PV diameters.     

左房线性消融治疗阵发性心房颤动患者术后的左房功能心超评价

目的:动态观察阵发性心房颤动患者射频消融术前及消融后不同时段左房结构和功能的变化,探讨射频消融术对左房功能的影响及其临床意义。方法:37例阵发性房颤患者接受左房线性消融+肺静脉电隔离术,药物治疗维持窦律的患者为对照组,平均随访(10.5±4.7)个月(3~19个月),应用超声心动图观察治疗前及治疗后不同时段左房结构及功能的变化,采用M型和二维超声测量左房内径,多普勒测量二尖瓣血流频谱,以及组织多普勒测量二尖瓣环舒张晚期运动速度(Va)。结果:①药物组20例成功维持窦律,消融治疗组26例成功维持窦律,9例复发;②药物治疗组长期维持窦性心律者左房容积有所变小,治疗后各个时期与治疗前比较差异无统计学意义。消融成功组术后左房容积逐渐减小,术后6个月时与术前水平比较有统计学差异,至12个月,无进一步缩小;与治疗前相比,治疗后12月左房前后径、左右径及上下径皆有统计学差异。消融后复发组6个月时未见明显变化;③消融治疗后1月,LAAEF、A-VTI、VA及AFF均与术前有统计学差异,至随访12月恢复至治疗前水平。消融治疗后心房侧的心肌组织运动速度Va皆有一定程度的降低。结论:左房线性消融是治疗阵发性房颤的有效方法,消融成功者可一定程度逆转左房结构重构,复发者无明显变化;射频消融引起左房局部收缩功能降低。     

CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation

To characterize pulmonary vein (PV) anatomy and the relative position of the PV ostia to the adjacent thoracic vertebral bodies, two readers reviewed 176 computed tomography pulmonary venous studies. PV ostial dimensions were measured and PV ovality assessed. Anatomical variations in PV drainage were noted. The position of the PV ostium relative to the nearest vertebral body edge was recorded. Right PV ostia were significantly more circular than the left (p<.001). Anatomical variability was greater for right PVs: 82% of patients had 2 ostia, 17% had 3 ostia, 0.5% had 4 ostia and 0.5% a common ostium. For left PVs, 91% of patients had 2 ostia, 8.5% a common ostium and 0.5% 3 ostia. Mean ostial distances from vertebral margin were: right PVs 3.62±7.48 mm; left PVs 3.84±8.46 mm (p=.72). 65% of right upper PV, 60.5% of right lower PV, 51% of left upper PV and 57% of left lower PV ostia were positioned lateral to vertebral bodies. Right PV ostia are rounder than left-sided and right PV drainage is more variable. As a significant proportion of PV ostia overlap the vertebral bodies, prior anatomical evaluation by CT can assist catheter ablation procedures for atrial fibrillation (AF), especially when performed under fluoroscopy.     

The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation

ObjectiveCatheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort.MethodsAn analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63 ± 8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed.ResultsIn overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3 ± 5.42 mm vs. 19.1 ± 7.0 mm and 14.9 ± 3.6 mm vs. 18.7 ± 7.0 mm; p < 0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236 mm² [IQR = 97] vs. 222 mm² [IQR = 71]; p = 0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102 ± 20° vs. 95 ± 10°; p = 0.03). Three-years' responders had smaller ostium area of the right superior pulmonary vein (248 ± 94 mm² vs. 364 ± 282 mm²; p = 0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, p = 0.010) and 0.747 (95%CI 0.591 to 0.944, p = 0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, p = 0.002) and 0.365 (95%CI 0.148 to 0.899, p = 0.028) respectively.ConclusionsThe anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.