起源于右心室流出道憩室室性心动过速的导管消融一例

目前为止,人们对右心室流出道（rightventricularoutflowtract,RVOT）起源的室性心律失常已经有较好的认识^[1]。大多数情况下,这些患者心脏结构、功能正常,因此被称之为特发性室性心律失常。实际上这些“正常”心脏结构也包括心脏疾病早期、或现有检查难以发现的异常。本文报道1例起源于RVOT憩室的室性心动过速（ventriculartachycardia,VT）的心电图、电生理特征与导管消融。     

心房颤动患者窦房结分布及上腔静脉肌袖的三维电解剖标测

目的:通过三维电解剖标测系统观察心房颤动(房颤)患者上腔静脉肌袖结构,了解窦房结分布特点。方法:选取2018年1月至2020年1月于南京医科大学第一附属医院心血管内科接受射频导管消融隔离上腔静脉的房颤患者80例,男49例,女31例,年龄(59.3±8.9)岁,年龄范围18~75岁。其中阵发性房颤55例,持续性房颤25例...     

磁导航遥控导管射频消融治疗快速性心律失常的护理体会

射频消融(RFCA)是治疗各种快速性心律失常的成熟技术.近年来,磁导航系统(MNS)被成功用于遥控RFCA,其工作原理和模式与常规RFCA术有较大变化,对围手术期护理提出了新的要求.本文总结63例MNS遥控RFCA术的护理体会,报道如下.资料与方法2007年3月～2010年1月我科应用MNS遥控RFCA治疗快速性心律失常患者63例,男18例,女45例,年龄13～75(43.9±15.2)岁.63例中,室上性心动过速45例,右室流出道室性早搏或室性心动过速18例.     

特发性右心室流出道室性心律失常起源部位的三维分布

目的:观察右心室流出道室性心律失常(RVOT-PVC/VT)消融靶点的三维分布规律?方法:60例右心室流出道室性心律失常消融术中,在EnSite-Array非接触标测系统指导下构建右心室流出道三维模型,以心内膜最早激动点设为靶点,以射频消融结果加以证实,观察靶点三维分布?结果:消融靶点在右心室流出道肺动脉瓣下的49例均消融成功,其中17例分布在游离壁,32例分布在间隔部;15例分布在上部,34例分布在下部; 30例分布在前部,19例分布在后部?消融靶点分布于肺动脉瓣上11例,9例消融成功?结论:非接触标测系统有助于确定右心室流出道室性心律失常消融靶点的位置?     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

起源于左下肺静脉和左心耳之间异位引流口的房性心动过速一例

局灶性房性心动过速（房速）通常发生于无结构性心脏病患者中。左心房起源的房速多起源于二尖瓣环、左心耳和肺静脉。本文报道1例罕见的起源于左下肺静脉和左心耳之间异位引流口的局灶性房速。     

典型逆钟向心房扑动特征性扑动波的电解剖研究

目的 通过对典型逆钟向心房扑动(房扑)左右心房的电解剖标测,阐明其体表扑动波的产生机制.方法 2012年10月至2014年2月于南京医科大学第一附属医院住院患者中入选15例典型逆钟向房扑患者,平均年龄(60±14)岁,男性14例,女性1例.对15例患者进行心脏超声检查、电生理检查及三维标测系统指导下的双心房激动标测,观察体表扑动波的形成与左右心房心内膜激动模式的关系.结果 15例患者的平均左心室射血分数为(60.8±6.6)％,平均左心房内径为(39.0±3.4)mm,平均扑动周期为(220±24) ms,均完成房扑节律下右心房、左心房的电解剖重建.在下壁导联,可将体表扑动波分为3个部分:缓慢下降区,快速下降区及终末正向成分,分别对应心腔内右心房峡部、间隔由下而上和左心房激动及右心房游离壁由上而下的激动.左心房激动始于快速下降区,终于终末正向成分.结论 典型逆钟向房扑体表扑动波与其特殊的大折返激动组成部分一一对应,是其特征性激动模式的心电反映.左心房激动参与了扑动波中下降部分的形成.