射频消融治疗室上性心动过速13例报道

目的 :推广应用射频消融治疗快速心律失常。方法 :穿剌动静脉 ,置入刺激和消融电极 ,经多导电生理仪明确消融靶点 ,在局部引入射频电流 ,破坏折返路径。结果 :经电生理检查诊断为室上性心动过速12例 ,特发性室性心动过速1例 ,在20～40W射频功率下经5～200s的放电消融 ,13例均获得成功(成功率100 %)。结论 :射频消融术是治疗室性心动过速 ,室上性心动过速的有效方法 ,且创伤小 ,安全可靠 ,有较高的推广价值     

Adenosine for the management of patients with tachycardias--a new protocol

We developed a new protocol for diagnosis and treatment of patientswith sustained tachycardias (heart rate > 150 beats. min^–1).The patients first underwent vagal manoeuvres; if those remainedunsuccessful, i.v. adenosine in increasing doses of 6, 12, and18 mg was administered until sinus rhythm (SR) or transientatrioventricular (AV) block, unmasking the underlying rhythm,was recorded. In the latter and in the non-responding casesother antiarrhythmics were applied. Ninety-three episodes of tachycardia in 46 patients were treatedaccording to this protocol. Six episodes (6%) were terminatedby carotid massage, 64 of the remaining 87 episodes (74%) respondedto adenosine with return to SR. Conversion to SR occurred moreoften in episodes with narrow- than in wide-complex tachycardia(81 vs 59%, P<005). To achieve SR, the mean adenosine dosewas lower in narrow- than in wide-complex tachycardia (13±8vs 21 ± 10 mg; P<0.01). The duration of asystole afteradenosine did not differ between these two groups, whereas theduration of arrhythmia after adenosine differed significantly(8.5 ± 5.8 vs 18.6 ± 22.9 s; P<0.05). Sideeffects of adenosine such as flush, dyspnoea, and chest paindid not seem to be dose dependent and occurred in about 20%. According to our protocol, in more than 75% SR was achievedin patients with sustained tachycardias after vagal manoeuvresand adenosine.     

房室结折返性心动过速射频消融后的电生理改变与复发率的关系

目的：探讨房室结折返性心动过速（ＡＶＮＲＴ）射频消融术后的电生理改变及不同手术终点与复发率的关系。　方法：本组５６ 例ＡＶＮＲＴ患者慢径消融前、后作各项电生理参数测定,并随访观察远期疗效。　结果：３８ 例慢径消失者（Ａ组）无一例复发,残存慢径１２ 例（Ｂ组）有一例复发（８．３３％ ）,残存慢径有１～２ 个心房回波者６例（Ｃ组）有２例复发（３３．３％ ）。５３ 例无复发者消融前后的房室束最大值（Ａ－Ｈｍ ａｘ ）分别为（２８０±２７）和（１９６±５６）ｍ ｓ（Ｐ＜０．０１）,快径不应期分别为（３３０±４４）和（２８７±３１）ｍ ｓ（Ｐ＜ ０．０１）。而３ 例复发者消融前、后的Ａ－Ｈｍ ａｘ分别为（２８７±３１）和（２６２±３８）ｍ ｓ（Ｐ＞ ０．０５）,快径不应期分别为（３２４±３８）和（３１３±２８）ｍ ｓ（Ｐ＞ ０．０５）。　结论：ＡＶＮＲＴ的复发与慢径残存和Ａ－Ｈｍ ａｘ 及快径不应期无明显改变有关。     

射频能量时间递增法治疗房室结折返性心动过速

目的：评估射频能量时间递增法治疗４０ 例房室结内折返性心动过速的疗效及安全性。　方法：标测到理想的慢径路靶点后,从小功率（１０～１５ Ｗ）、短时间（５～１０ ｓ）放电开始,如出现交界区早搏或交界区心律,逐渐增加放电功率（２０～２５ Ｗ）和持续时间（３０～６０ ｓ）,并密切观察房室传导阻滞的迹象和先兆。　结果：临床治愈率９７．５％ ,无一例产生严重并发症。　结论：射频能量时间递增法是一种安全、高效的治疗方法。     

正常人收缩期左侧房室平面位移的超声心动图检测

目的：利用超声心动图检测正常人左侧房室平面位移幅度。方法：被检对象为１４４ 例正常人,男７２ 例,女７２ 例。按不同年龄分为６ 组,分别为：Ⅰ组（ｎ＝ ２４ ,３～６ 岁）;Ⅱ组（ｎ＝２４ ,７～１４ 岁） ;Ⅲ组（ｎ＝２４,１５～１９ 岁） ;Ⅳ组（ｎ＝ ２４,２０～３９ 岁）;Ⅴ组（ｎ＝２４ ,４０ ～５９ 岁） 及Ⅵ组（ｎ＝ ２４ ,≥６０ 岁）。结果：①左心收缩期房室平面位移测值在Ⅰ组～Ⅴ组之间无显著性差异（ Ｐ＞０－０５）,而Ⅵ组测值较Ⅰ组～Ⅴ组的测值均低（ Ｐ＜ ０－０５）;②左心收缩期房室平面位移测值不受心率、血压、体表面积及性别的影响。结论：①左侧房室平面位移测值受年龄因素影响;②制定正常左侧房室平面位移测值可以不考虑心率、血压、体表面积及性别的影响     

微波消融犬室性心动过速的实验研究

观察微波消融犬室性心动过速（简称室速）疗效和微波消融对血液动力学的影响。健康犬４０只,随机分成５组,Ⅰ组（对照组,ｎ＝８）,Ⅱ、Ⅲ、Ⅳ和Ⅴ组（消融组,ｎ＝８）,由股动脉、股静脉穿刺进行血液动力学监测。用０．０１ｍｌ０．０３％乌头碱注入心室壁诱发室性心动过速。消融释放功率和时间Ⅱ组为４０Ｗ×３０ｓ,Ⅲ组为４０Ｗ×６０ｓ,Ⅳ组为８０Ｗ×３０ｓ,Ⅴ组为８０Ｗ×６０ｓ。结果：自发放微波能量至室速终止时间Ⅱ、Ⅲ组为（１０．１±２．４）ｓ,与对照组比,Ｐ＜０．００１;Ⅳ、Ⅴ组为（５．３±１．５）ｓ,与对照组比,Ｐ＜０．００１。消融前后血液动力学各项指标差异无统计学意义（Ｐ＞０．０５）,消融后组间血液动力学各项指标差异无统计学意义（Ｐ＞０．０５）。微波产生的心肌损伤,显微镜下观察均为凝固性坏死,与周围组织存在清晰的界限。结论：微波消融室速具有较好的疗效,消融能量与时间在一定范围内对血液动力学无明显影响,可望成为室速治疗的１种新方法。     

Radiofrequency ablation in children

Radiofrequency (RF) catheter ablation has ushered in a new era in the management of patients with symptomatic tachyarrhythmias. By providing the ability to cure the underlying arrhythmic substrate, RF catheter ablation obviates the need for life-long antiarrhythmic drugs. In the reported series, the success has been high and the complications have been infrequent and relatively minor. Not unexpectedly, RF catheter ablation has become the treatment of choice for patients with symptomatic paroxysmal tachyarrhythmias. The role of radiofrequency catheter ablation in infants and small children remains controversial, and awaits a larger experience and longer follow-up data.     

胎儿房室结微血管构筑的扫描电镜观察

用血管铸型结合扫描电镜方法观察了7例胎儿房室结微血管构筑.微动脉反复分支呈树状,行走方式呈波浪形或螺旋形.毛细血管网可分为内外两层:外层纵行为主,以"H"或"Y"形吻合;内层弯曲行走为主,并互相交错吻合.以房室结动脉主干为界,其下方毛细血管密度较大,其上方及前方较小.房室结的上方、前下方和后下方均有微动脉连接毛细血管网.整个结的毛细血管大致可分为结后部上方、下方及前部三个区域.靠毛细血管网外层处可见管径较粗、呈袋状的微静脉.     

Fascicular tachycardia sensitive to calcium antagonists

Five patients with recurrent tachycardias exhibiting right bundlebranch block with left axis deviation were referred for investigation.In each case, a supraventricular mechanism was suspected. Duringsinus rhythm, the QRS morphology and axis (–10 to +60degrees) and HV intervals were normal. Tachycardia was initiatedby timed ventricular premature stimuli in 4 patients, rapidventricular pacing in 3 patients and rapid atrial pacing in2 patients. The tachycardia cycle length varied from 275 to380 ms with right bundle branch block and a leftward axis changeof 30 to 125 degrees at the onset of the tachycardia. The HVinterval ranged from +15 to –20 ms. In each patient ventriculoatrialdissociation occurred spontaneously or could be induced. Alltachycardias could be terminated or greatly slowed by calciumantagonists. These data are consistent with an unusual reentrantmechanism of tachycardia located in the posterior fascicle ofthe left bundle branch.     

Effects of DPI 201-106, a novel cardiotonic agent,on hemodynamics,cardiac electrophysiology and arrhythmias induced by programmed ventricular stimulation in dogs with subacute myocardial infarction: A comparative study with dobutamine

Summary DPI 201-106 (DPI), a novel and potent cardiotonic agent, exhibits its effects by prolonging the open state of Na⁺ channels, resulting in an increase in action potential duration, and thus, is supposed to share the class III antiarrhythmic activity. The effects of DPI on the hemodynamics, intraventricular conduction and refractoriness of heart, and the incidence of arrhythmias induced by programmed electrical ventricular stimulation (PES) were compared with (±)-dobutamine. Dogs which survived for 5 to 7 days after the induction of myocardial infarction were used as the model. The presence of sub-acute myocardial infarction caused by occluding the left anterior descending coronary artery elicited a mild left ventricular dysfunction represented by a significant decrease in peak LV dp/dt by about 20%.Both i.v. bolus injection of DPI (1, 3 and 5 mg/kg) and i. v. continuous infusion of dobutamine (3, 5 and 10 g/kg/min), which were administered in a cumulative manner, dose-dependently improved the hemodynamic parameters. At the higher doses of both DPI (3 and 5 mg/kg) and dobutamine (5 and 10 g/kg/min) the control values were reached or even exceeded. DPI dose-dependently increased the effective refractory period (ERP) of both non-infarcted and infarcted ventricular myocardia to a similar degree, but the conduction time showed a frequency-dependent increase in the infarcted myocardium to a greater degree than in the non-infarcted myocardium after DPI. In contrast, dobutamine decreased the ERP in both non-infarcted and infarcted myocardia, and slightly increased the difference of refractoriness between the non-infarcted and infarcted zones with no effect on the intraventricular conduction. In the PES study, DPI (3 and 5 mg/kg) produced a significant decrease in the incidence of ventricular tachycardia, whereas dobutamine (5 and 10 g/kg/min) tended to worsen the arrhythmias. These findings suggest that cardiotonic agents with a class III antiarrhythmic property such as DPI may be potentially useful for the management of heart failure accompanied by ischemic heart disease.Abbreviations DPI, DPI 201-106; PES programmed electrical ventricular stimulation - LV dp/dt the rate of rise of left ventricular pressure - ERP effective refractory period - RVOT right ventricular outflow tract - VT ventricular tachycardia - LAD left anterior discending coronary artery Send offprint requests to T. Uematsu at the above address