老年持续性房颤患者驱动灶消融与传统消融的不同及预后比较

目的 探讨老年持续性房颤患者经不同消融方式治疗的效果及预后情况.方法 回顾性分析接受消融术治疗的89例老年持续性房颤患者临床资料,依据不同消融方式将入选者分为传统组(43例)与驱动灶消融组(46例),传统组使用单纯肺静脉隔离治疗,驱动灶消融组经单纯肺静脉隔离后对其双侧心房进行高密度标测,并对驱动部位进行消融.对比分析两...     

不同消融终点对持续性心房颤动晚期复发率的影响

心房颤动是临床上最常见的心律失常之一,约占所有心律失常患者的1／3,我国人群的患病率约为0．77％。随着人口老龄化,心房颤动的发病率逐年上升。     

持续性心房颤动导管消融策略

心房颤动(房颤)是常见的快速性心律失常之一,其发病率随着年龄递增,我国人口老龄化逐步凸显,房颤的发病率增加,其卒中发生风险明显升高。2014年美国心脏协会(AHA)、美国心脏病学会(ACC)、美国心律学会(HRS)房颤指南将持续性房     

长期持续性心房颤动导管消融策略的临床研究

目的：比较导管消融治疗长期持续性心房颤动（房颤）不同消融策略的临床疗效。方法2009年5月至2011年3月,入选240例于上海市胸科医院房颤诊治中心接受三维标测系统（ Carto）指导下的导管消融治疗的长期持续性房颤患者,男138例,女102例。随机分为3组,A组：80例患者行环肺静脉前庭电隔离（ CPVA）及心房碎裂电位（ CFAE）消融,B组：80例患者行CPVA＋CFAE＋左心房线性消融,C组：80例患者行CPVA＋CFAE＋左心房线性消融＋三尖瓣峡部线性消融,消融后未能转复窦性心律患者均行直流电复律。消融术后随访心电图和24 h动态心电图评价疗效,比较3组的安全性及临床效果。结果所有患者均顺利完成导管消融术,平均随访（36±7）个月,单次消融后成功率 A 组37．5%、B组52．5%、C组55．0%,多次消融后成功率A组60．0%、B组75．0%、C组76．3%（ P〈0．05）。各组间并发症发生率差异无统计学意义。结论对于长期持续性房颤患者,在CPVA＋CFAE的基础上行左心房线性消融有助于提高成功率,而三尖瓣峡部线性消融效果不确切。     

心房耳尖部持续性房性心动过速的临床特点和射频消融

目的：报道心房耳尖部房性心动过速（房速）的临床特点和射频消融结果。方法：对7例[男性2例，女性5例，平均年龄（24．8±7．9）岁]房速患者进行体表心电图和动态心电图检查。采用三维电解剖（Carto）标测系统，确定房速病灶的起源部位和指导经导管射频消融。结果：7例房速均为持续性发作（5～432个月，中位数96个月），未发现器质性心脏病。房速起源于右心房耳尖部（1例）和左心房耳尖部（6例），呈局灶性和异常自律性增高机制。7例房速均消融成功，无并发症。随访7～28个月（中位数15个月），无一例房速复发。结论：心房耳尖部房速表现为持续性发作和异常自律性增高机制。采用三维电解剖标测系统和盐水灌注消融导管，可提高病灶定位的准确性和消融的成功率。     

以终止持续性心房颤动为手术终点的递进式消融200例总结

目的总结递进式消融术式治疗持续性心房颤动(简称房颤)的手术过程及临床转归。方法采用递进式消融策略治疗连续200例持续性房颤患者,手术终点为通过单纯消融终止房颤。按以下顺序进行消融:环肺静脉前庭消融达肺静脉电学隔离;心房碎裂电位消融;左房顶部和二尖瓣环峡部线性消融;针对房颤转变而成的房性心动过速(简称房速)行激动标测结合拖带技术明确其机制,并进一步消融终止。经术后3个月空白期,对复发房性心律失常(房颤/房速)的患者进行再次消融。结果 136例患者(68%)术中房颤被消融终止,消融终止房颤组首次术后房性心律失常复发率显著低于未终止组[19.9%(27/136)vs 51.6%(33/64),P<0.01],复发患者经再次消融后,平均随访12.8±7.2个月,本组病例总体手术成功率78.5%(157/200)。消融终止房颤组手术总体成功率高于未终止组[(86.8%(118/136)vs 60.9%(39/64),P<0.01)]。结论递进式消融可能是治疗持续性房颤的一种有效术式。     

持续性心房颤动递进式消融术中房性心动过速的标测和消融

目的 阐明持续性心房颤动(房颤)递进式消融术中产生的房性心动过速(房速)的电生理机制.方法 持续性房颤行递进式消融术中房颤转化为房速的92位患者入选.通过三维标测系统指导下的电激动标测和拖带标测方法确定房速的机制,并针对心动过速的关键峡部或最早激动点进行消融.结果 共标测124例房速,6例(4.8％)为局灶性房速,118例(95.2％)为折返性房速,其中99例(83.9％)为大折返(折返环直径≥3 cm),19例(16.1％)为局部小折返(折返环直径＜3 cm),17例存在双环或多环折返.术中即刻114例房速(91.9％)消融成功,首次消融术后22位患者复发房速,18位接受多次消融治疗,平均随访(14±8)个月,共79位(85.9％)患者维持窦性心律.结论 对持续性房颤递进式消融术中出现的房速准确标测其机制是可行的,对指导成功消融有重要意义.     

消融术中规律性房性心动过速消融对持续性心房颤动远期复发率的影响

目的探讨消融术中规律性房性心动过速消融与持续性心房颤动远期复发率的相关性。方法持续性心房颤动消融术中出现规律性房性心动过速患者81例分为房性心动过速消融成功组和房性心动过速消融失败组,比较两组患者心房颤动远期复发率。结果 49例房性心动过速消融成功组15例(30.61%)心房颤动复发,32例房性心动过速消融失败组12例(38.40%)复发,两组比较差异有统计学意义(P<0.05)。局灶性房性心动过速、折返性房性心动过速消融成功组与失败组对持续性心房颤动术后复发率比较差异均无统计学意义(P>0.05)。结论消融持续性心房颤动消融术中出现的规律性房性心动过速,可降低持续性心房颤动的远期复发率。     

2012心房颤动消融治疗主要进步

2012年发表了多篇有关经皮或外科治疗的重要资料。FAST随机化临床试验开展于2个欧洲单位。比较极小创伤的外科消融与射频导管消融（RFCA）。观察对象为124例药物治疗无效的心房颤动（AF）病人[曾用导管消融（67％）或左房扩张另加高血压等中危险因子（33％）]。第一终点为不用抗心律失常药而无复发性房性心律失常持续〉30s。结果RFCA病人和外科手术病人达到第一终点者分别为36．5％和65．6％（P=0．0022）。值得注意的是,外科手术组的重大不良事件多于RFCA组（分别为34．4％及15．9％;P=0．027）。研究者的结论：外科手术在维持窦律一年者优于RFCA,但该组病人操作不良事件危险较高。     

心房颤动的导管消融治疗

心房颤动(简称房颤)是常见的快速性心律失常,也是卒中、心功能障碍的重要危险因素.近年来经导管射频消融的成功应用使房颤的治疗取得了重大进展.     

Ablating Persistent Atrial Fibrillation Successfully

The ablation of persistent atrial fibrillation (AF) poses many challenges compared with ablation for paroxysmal AF, including greater procedural complexity, longer procedural time, unclear endpoints, increased patient comorbidity with a greater risk of procedural complications, and lower success rate. Nevertheless, using a combination of patient selection, careful procedural planning of both ablation strategy and endpoints, and by setting realistic patient expectations, successful ablation may be achieved. Further improvements will come from continued technical advances as well as from greater mechanistic understanding of persistent AF, including the physiologically-targeted ablation of localized rotors and focal sources that have recently been shown to maintain human AF.     

Catheter Ablation for Long-Standing Persistent Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines).     

Evaluation of Atrial Refractoriness and Atrial Fibrillation Inducibility Immediately after Internal Cardioversion in Patients with Chronic Persistent Atrial Fibrillation

Summary. Objective: To prospectively evaluate right atrial refractoriness and sustained atrial fibrillation (AF) inducibility at programmed electrical stimulation in two groups of patient: a series of patients with chronic persistent AF, studied immediately after successful low energy internal atrial cardioversion, and a group of control patients without history of supraventricular arrhythmias.Patients: Nineteen patients with chronic persistent AF (mean AF duration 11 ± 10 months, range 2–61 months) submitted to successful internal low energy atrial cardioversion in fully conscious state and 11 control patients without history of supraventricular arrhythmias.Methods: An electrophysiological evaluation was performed to measure atrial refractoriness and AF inducibility, by delivering single atrial extrastimuli in high right atrium, at decremental coupling, during spontaneous sinus rhythm and after 8 beats at 600, 500, 400 and 330 ms cycle length. If sustained AF was induced the protocol was terminated.Results: During programmed atrial stimulation sustained AF was induced in 8 out 19 (42%) of the AF patients but in none of the control group. Atrial effective refractory period was significantly shorter in AF patients compared to controls both at basic cycle length, at 600 ms, 500 ms and 400 ms cycle length, meanwhile no statistically significant differences were found at 330 ms cycle length. An altered relationship between atrial effective refractory period and cycle length was found in AF patients compared to controls: the slope of linear correlation slope was significantly lower in AF group than in controls (0.04 ± 0.07 vs 0.17 ± 0.10, p < 0.002).Conclusions: Marked abnormalities of atrial refractoriness and of its heart rate relationship are observed after internal cardioversion of chronic persistent AF in humans and these abnormalities are associated with an high vulnerability to AF. These observations may explain the high risk of AF recurrences in the early phases following successful cardioversion. In this scenario antiarrhythmic drug therapy seems to be mandatory for reducing arrhythmia relapses.     

持续心房颤动对山羊心房大小和功能影响的时间进程

探讨持续心房颤动(AF)对左右房容积及左房功能的影响及其时间进程。运用起搏方法建立AF模型,在AF前和AF后的第1,2,4,8周对左右房容积、左房射血分数(EF)、左房射血力(LAEF)、A峰、E峰及E/A比值进行测量。结果:AF后1,2,4,8周左右房容积逐渐增加、心室舒张末左房容积(LAEDV)在起搏后1周有显著增加(P<0.05);心室收缩末左房容积(LAESV)、心室收缩末右房容积(RAESV)及心室舒张末右房容积(RAEDV)在AF4周时显著增加(P<0.05)。随着AF持续,左房EF值、A峰值及LAEF逐渐降低,左房EF在AF1周后显著降低(P<0.05);A峰值及LAEF在AF2周后显著降低(P<0.05);E/A值逐渐增高,AF2周后显著增高(P<0.05);E峰值无明显变化。结论:持续AF可引起左右房增大,左房功能障碍。     

持续性心房颤动导管消融方法及策略

心房颤动是临床上最常见的心律失常,其节律控制治疗主要有药物治疗和非药物治疗两种方式。目前非药物治疗心房颤动发展迅速,其中导管消融作为非药物治疗心房颤动手段之一已被人们广泛接受。肺静脉电隔离作为阵发性心房颤动的消融终点已经得到共识,而持续性心房颤动消融术式及终点尚未统一,现就目前持续性心房颤动消融方法及策略做一简要介绍。     

他汀类药物在心房颤动治疗中的作用

他汀类药物可以减少心房颤动的发生率.现对其治疗心房颤动的作用及可能的作用机制作一综述.     

他汀类药物抗心房颤动作用

他汀类药物可以减少心房颤动的发生率,其确切作用机制不明,可能与改变心肌离子通道与载体; 抗炎作用;延缓心肌组织、电重构; 改善自主神经功能等有关.