我国儿童青少年群体性风湿热一级预防方法的建立

风温热/风心病(RF/RHD)至今仍是一个全球性重大社会保健问题,目前仍无妥善的解决办法。我国每年学龄儿童初发RF(ARF)有8万例,新发RHD近6万例。据世界卫生组织估计,发展中国家患RF/RHD1200万例,年死亡40万例,成千上万人致残,主要是儿童和青年。造成上述严重情况的原因很多,但最根本的是至今尚无有效简易可行的群体性风湿性一级预防方     

高血压患者合并阵发性房颤心脏超声指标的变化及其与房颤发生的关系

目的 研究高血压合并阵发性房颤患者左右心房内径、室间隔厚度、左心室内径和左室射血分数的变化及与高血压患者房颤发生的关系.方法 高血压合并阵发性房颤患者41例和单纯性高血压患者45例.经胸心脏超声测量两组患者收缩期左房前后径(Lad)和右房上下径(Rad)、舒张期左室内径(LVIDd)和室间隔厚度(IVSd)、左室射血分数(LVEF)与有无明显的二尖瓣返流(MR),所有房颤患者在窭性心律下做超声测量.结果 单纯性高血压患者相比,高血压合并阵发性房颤患者Lad(mm)和IVSd(mm)显著增大(Lad:36.1±5.8 vs 31.0±3.9,P<0.00l;IVSd:10.7±1.3 vs 9.9±1.5,P=0.001),MR发生率显著增高(52.5% vs 11.1%,P<0.001).两组Rad、LVIDd和LVEF差异均无显著性,其中两组Rad(mm)为46.4±7.1 vs 44.0±4.0(P=0.065).Logistic回归分析显示,Lad、IVSd和MR发生率均与高血压患者房颤发生有显著性关联[OR(95% CI):Lad,1.375(1.135～1.665);IVSd,1.98(1.183～3.313);MR,4.708(1.126～19.685)].结论 高血压合并阵发性房颤患者较单纯性高血压患者左心房显著扩大、室间隔显著增厚和二尖瓣返流发生率显著增高,这三者是高血压患者发生房颤的预测因素.     

心房颤动导管消融术并发症的处理

<正> 1 急性心脏穿孔/心脏压塞急性心脏穿孔/心脏压塞是心房颤动(房颤)导管消融术致命性的严重并发症,与术前术中抗凝、导管操作损伤等有关,术中或术后均可能发生。因此,术中术后必须仔细观察,一旦发现,需要立即抢救。在房间隔穿刺时需注意避免损伤右心房、冠状窦、主     

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.     

Ebstein畸形并预激综合征射频消融

Ebstein畸形常并预激综合征并引发房室折返性心动过速，旁路多位于右侧，成为射频消融的难点，国内仅见个别报道。本文报道4例Ebstain畸形并预激综合征的射频消融。1对象与方法4例Ebstein畸形患者男3例、女1例，平均年龄42岁（24～59岁），均为显性预激并房室拆返性心动过速。平均病虫10年。B超提示右房明显扩大，2倒后居下移，2例后辨并隔辩下移，下移最大距离4．8cm，其中2例并房缺。按常规方法分别于冠状静脉窦、高位右心房、希氏束、右室放置电极导管，并于右室放置6F猪尾导管先行右室造影．在后前位和左前斜位观察二尖瓣下移情况及三…     

经导管标测和消融儿童快速心律失常方法的改进和新技术应用

目的　总结应用改进的标测和消融方法以及新技术治疗儿童快速心律失常的经验。方法　①Swartz长鞘 :在 35例右侧旁道、慢径路、房性心动过速 (局灶性 +折返性 )和房扑消融中应用。②参考电极 :右室流出道和右室流入道分别放置 2根电极 ,采用“蛙跳”方法标测较早的心室激动点 ,然后用射频导管在该点附近标测。③在窦性心律时在左室间隔部记录到较局部室波提前的高频低幅电位激动晚于希氏束电位 2 0ms以上处为靶点消融左室特发性室速。④应用CARTO系统治疗 :3例AT(局灶性 +折返性 )、1例AF和 1例ILVT。结果　 40例患儿均成功消融 ,放电次数和透视时间分别为 (5 0± 3 8)次和 (2 5± 12 4)min。结论　改进的标测和消融方法以及新技术的应用 ,减少放电次数 ,缩短X线透视时间 ;尤其CARTO系统的应用解决以往的难题。     

右室特发性室性心动过速的射频消融

目的 报道5例右室间隔特发性室性心动过速的电生理标测及射频消融治疗。方法 用7F EPT温控大头电极导管进行消融，心动过速时在右室后间隔标侧到明显提前的P电位处为消融靶点，以温控50～55℃、功率30～35W放电。3s心动过速终止，巩固放电40s，然后行常规心内电生理检查，不能诱发心动过速作为消融终点。术后口服Aspirin0．1g／d1个月。结果 放电消融5s内心动过速终止，巩固放电40s，消融前后体表心电图无明显改变。术后心室S1S2程序刺激，静脉滴注异丙肾上腺素后，重复上述刺激，均不能诱发心动过速，射频消融成功。随访4～22个月，无心动过速发作，无并发症出现。结论 (1)在右室后间隔也能形成类似于左室后间隔的特发性室性心动过速，在标测到明显提前的P电位处消融容易获得成功。(2)右室特发性室性心动过速在心动过速时也有典型的体表心电图特征。(3)此型室性心动过速应与束支折返性室性心动过速相鉴别。     

Carto系统电解剖标测和射频消融治疗致心律失常性右心室心肌病的室性心动过速

目的 评价在致心律失常性右心室心肌病(ARVC)患者,应用Carto系统进行电解剖标测并指导射频消融治疗室性心动过速(室速)的有效性.同时探讨其室速发生机制.方法 伴有室速反复发作的19例ARVC患者入选,平均年龄(35±13)岁,男性15例,女性4例.消融术前1例植入植入型心律转复除颤器(ICD),因放电频繁行消融治疗.1例为无休止型室速,发作持续2 d.在窦性心律和/或心动过速时,电解剖标测三维重建右心室,根据双极电压高低确定疤痕区、正常心肌和临界边缘区.对于折返性室速,在关键峡部或在疤痕区与三尖瓣环之间或两疤痕区间行线性消融,对于局灶性室速,在局部最早激动区域点消融.结果 每个患者有1～5种室速,共在19例患者记录到36种室速.16种血流动力学稳定的室速于心动过速发作时行电解剖标测.可确定为折返性12种(75%),其中8种室速围绕三尖瓣环,另4例患者4种室速为局灶性.即时消融成功率为74%(14/19).随访1～46个月,原成功消融的4例室速复发.无消融术相关并发症发生.结论 应用Carto系统电解剖标测可安全有效指导射频消融治疗.ARVC患者的室速,有相对较高的失败和复发率.折返性和局灶性室速均可发生该类器质性心脏病患者,折返性多见.     

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.