无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

倒“U”法导管消融治疗右心室流出道室性心律失常的有效性及安全性

目的比较倒U法与传统方法消融右心室流出道(right ventricular outflow tract,RVOT)起源室性心律失常(ventricular arrhythmias,VAs)的有效性及安全性。方法回顾性分析2013年1月至2016年12月于广东省心血管病研究所住院并行导管消融术的RVOT VAs患者的临床资料。根据术中消融方法分为传统消融组及倒U组,结合两组随访结果对比两组之间消融成功率、并发症发生率有无差异。结果共有1 086例患者符合入选标准。其中834例患者使用传统方法消融,252例患者使用倒U法消融。常规消融组消融成功率88.37%(737/834),倒U法消融组成功率94.05%(237/252),倒U法消融组手术成功率明显高于传统消融组(P=0.009)。传统消融组有50例进行再消融,其中36例患者使用倒U法消融成功且随访无复发,2例倒U法消融后仍复发。传统消融法术中严重并发症3例,均为心脏压塞,消融靶点均位于右心室游离壁。倒U组无严重并发症发生。结论相比传统消融方法,倒U法消融成功率明显增加,减少了再消融次数,并发症少。倒U法消融RVOT VAs安全有效。     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

右室流出道特发性室速的射频消融治疗体会

目的 总结不同起源部位特发性右室流出道室性心动过速（ＩＲＶＯＴ）经导管射频消融（ＲＦＣＡ）治疗的方法和结果。方法 对３５例ＩＲＶＯＴ进行ＲＦＣＡ治疗,男性１８例、女性１７例,平均年龄（３９．１±１８．３）岁（８～７２岁）。其中１５例用常规方法消融,２０例用非常规方法消融,非常规方法加用８Ｆ ＳＢ０ Ｓｗａｒｔｚ鞘并在右室流出道放置参考电极。两者均采用起搏与激动标测来确定消融靶点。结果ＲＦＣＡ治疗ＩＲＶＯＴ的总成功率为８８．６％（３３／３５）,常规方法组成功率为８６．７％,复发率为１５．３％,非常规方法组分别为９０．１％和５．６％;常规方法组的导管操作时间为（７１±１２）ｍｉｎ,Ｘ线曝光时间平均为（３２±８）ｍｉｎ,非常规组分别为（４０± ９）ｍｉｎ和（１６ ±５）ｍｉｎ。ＩＲＶＯＴ起自右室流出道近间隔部１３例、游离壁１０ 例及介于两者之间 １２例。成功消融部位激动标测 Ｖ波提前 ＱＲＳ波 １８～３８ｍｓ,起搏标测与心动过速时１２导联心电图（ＥＣＧ）之ＱＲＳ波形态完全相同。结论ＩＲＶＯＴ非常规方法消融可以明显缩短导管操作时间、减少Ｘ线曝光时间及降低复发率;ＩＲＶＯＴ采用ＲＦＣＡ治疗具有较高的成功率和较低的复发率及并发症。     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

Predictors for recurrent atrial tachyarrhythmia after ablation for patients with persistent atrial fibrillation:A long-term follow-up outcome

Catheter ablation of persistent atrial fibrillation (AF) remains a challenging task.The long-term clini-cal outcome and predictors for the recurrence of atrial arrhythmias after ablation has not been consistent.Methods We analyzed the clinical outcome of 103 consecutive patients with a follow-up > 12 months who underwent catheter ablation for persistent AF.We studied their clinical data in terms of age,AF duration,concomitant dieases (hypertension,dia-betes or mitral insuffciency) ,left atrial diameter,cath...     

经三尖瓣瓣上与瓣下消融治疗右侧希氏束旁室性早搏的对比观察

目的比较右侧希氏束旁室性早搏(简称室早)在三尖瓣瓣上与瓣下行导管射频消融的疗效性和安全性。方法选择于2010年5月至2017年12月间在广东省人民医院接受射频消融术治疗的右侧希氏束旁室早患者。回顾分析病历资料,将在三尖瓣下进行射频消融的患者纳入瓣下组,在三尖瓣上进行射频消融的患者纳入瓣上组,收集患者临床基线、电生理资料及长期随访结果。结果共50例纳入本研究,男性30例,女性20例。其中瓣下组21例,瓣上组29例。经导管射频消融治疗后,两组即时成功率无显著差别(90.5%vs 79.3%,P=0.276)。在随访中位时间为32个月后,瓣下组的远期成功率显著高于瓣上组(81.0%vs 48.3%,P=0.016)。结论射频消融是治疗右侧希氏束旁室早的有效手段;三尖瓣下消融治疗能显著提高患者的远期成功率。     

单独心房颤动综合治疗的单中心经验与入路演变

目的探讨单独心房颤动综合治疗的临床经验、手术入路的演变及各种术式的优劣。方法回顾性分析2015年1月至2017年5月于本中心行单独心房颤动外科消融手术69例患者的临床资料,其中男50例、女19例,平均年龄57.2岁。根据手术入路将患者分为3组:正中开胸组9例,左后外侧腔镜组7例,双前外侧腔镜组53例。3组分别有1例(11.1%)、3例(42.9%)和26例(49.1%)于外科消融术后行导管标测和补充射频消融。结果开胸组平均随访10.2个月,随访中9例(100.0%)维持窦性心律;左后外侧腔镜组平均随访7.4个月,5例(71.4%)维持窦性心律;双前外侧腔镜组平均随访5.0个月,47例(88.7%)维持窦性心律。全组无围术期死亡,随访期间无死亡、卒中、大出血和肺静脉狭窄等。结论经典迷宫Ⅳ手术成功率高,是治疗心房颤动的基础术式,而新式迷你迷宫手术有微创、可重复性强等优点,联合导管射频消融可取得与经典迷宫Ⅳ手术相近的治疗效果。单独心房颤动综合治疗是非阵发性心房颤动治疗的最佳方案。     

对DF-6A型心脏电生理刺激仪终止阵发性室上速的急诊应用评价

目的:探讨DF-6A型心脏电生理刺激仪终止阵发性室上速(PSVT)的急诊应用效果。方法:采用DF-6A型心脏电生理刺激仪对35例PSVT急诊患者进行了食道心房调搏术(TEAP),用双极食管电极导管进行食道插管,选用超速刺激法和亚速刺激法发放频率脉冲,每次刺激时间5～20s。结果:17例患者经该心脏电生理刺激仪TEAP1次起搏终止PSVT发作,11例患者经3次以上刺激终止发作,4例患者用亚速起搏终止发作,治疗有效率为91.43%。3例患者经TEAP不能终止发作,使用药物治疗终止发作。结论:DF-6A型心脏电生理刺激仪较其前三代刺激仪新增了多项功能,应用该仪器进行TEAP,具有见效快、成功率高、可反复应用的优点,因此可在急诊急救中较安全使用。     

穿间隔法成功消融左前间隔旁道三例

左侧前间隔旁道被认为是罕见旁道。因为主动脉瓣与二尖瓣环连接处是连续的纤维环。在过去的3年中我们共进行了270例左侧隐匿性旁道病人的射频消融治疗,其中有三例有隐匿性左前间隔旁道。在顺向型房室折返性心动过速发作中,P波方向在下壁导联呈正向,Ⅰ、aVL导联呈负向或正负双向。通过穿间隔法成功消融旁道,射频能量为50～55℃,30～35W。