复律后左心房功能恢复与心房颤动持续时间相关性的临床研究

目的:应用心肌组织多普勒技术结合M型超声、脉冲血流多普勒和心尖搏动图评价心房颤动(房颤)复律后心房功能的变化及其相关因素。方法:正常对照组20例,房颤复律患者34例。根据房颤持续时间分成短期房颤组(n=18)和长期房颤组(n=16),于复律后1小时、1天、1周和1个月行超声检查。采用心肌组织多普勒技术测量二尖瓣环侧壁心房收缩期心肌组织运动峰速(Am)和舒张早期运动峰速(Em)并计算Am/Em比值,M型超声测量瓣环侧壁舒张晚期心肌最大运动幅度(DAD)和舒张早期最大运动幅度(DED)并计算DAD/DED比值,脉冲血流多普勒测量心房收缩期跨瓣血流最大流速(A)和心室舒张早期血流最大流速(E)并计算A/E比值,心尖搏动图记录心房收缩压力波。并筛选出与复律后1小时、1天、1周左心房心肌组织运动速度有关的临床变量。结果:复律后1小时、1天、1周与Am相关的临床变量均为房颤持续时间。左心房功能与房颤持续时间的关系:复律后1小时及1天,Am、Am/Em,A/E,DAD、DAD/DED在两房颤组均低于正常对照组(P<0.05);长期房颤组低于短期房颤组(P<0.05);复律后1周,长期房颤组仍低于正常对照组和短期房颤组(P<0.05);短期房颤组与正常对照组无差异(P>0.05)。复律后1个月,除长期房颤组DAD/DED仍低于正常对照组(P<0.05),其余指标3组间无差异(P>0.05)。复律后左心房顿抑仅发生于长期房颤组,其发生率于1小时为43.8%,1天为25%,1周为12.5%。结论:房颤复律后左心房功能的恢复及左心房顿抑的发生与房颤持续时间有明显相关性。     

吸食海洛因患者血浆中心钠素的变化

本文研究了57例吸食海洛因患者血浆ANF浓度变化,并与健康对照组进行比较结果显示海洛因成瘾组显著高于对照组(P<0.01),作者认为测定血浆ANF水平可以作为海洛因对心肌损害的一种判断指标。     

Right atrial myxoma mistaken for recurrent pulmonary thromboembolism

A 69 year old man was admitted for investigation of right sided pleuritic chest pain and dyspnoea, both of which began suddenly four days before admission. Acute pulmonary embolism was diagnosed. Six months after discharge while on warfarin he died. Necropsy found a 50 mm diameter myxoid tumour arising on the right atrial side of the interatrial septum. This lesion may have been discovered earlier by echocardiography although there were no clear indications for this investigation. Presentation was that of recurrent pulmonary embolism with no obvious source or cause of thrombosis. Patients who are thought to have idiopathic pulmonary embolism should undergo early echocardiography to exclude the rare but treatable diseases of the right heart that may be responsible

Keywords: atrial myxoma     

Ballon atrial septostomy under transesophageal echocardiographic guidance

Summary Balloon atrial septostomy is an established method of palliation for several forms of congenital heart disease. Previously performed under fluoroscopic x-ray control, recent reports have demonstrated the utility of transthoracic echocardiographic monitoring. We report the first application of uniplane transesophageal echocardiography (TEE) (6.7-mm probe) as an alternative imaging modality for control of ballon atrial septostomy on neonates in the intensive care unit.     

高血压患者左室构型和房性心律失常的关系

目的了解高血压患者左室构型和房性心律失常关系。方法应用超声心动图及动态心电图，测定左室结构及房性心律失常发生率。结果Ｋｌｅｉｇｅｒ３～６发生和构型有联系（Ｐ＜０．００１）。结论左室构型影响房性心律失常。     

Acute Efficacy and Chronic Follow-Up of Patients with Non-Thoracotomy Third Generation Implantahle Defibrillators

Non-thoracotomy implantation of implantable cardioverter defibrillators (ICDs) has simplified the process of device inserfion, promising to decrease associated procedural coniplications while providing sudden death protection at least equal to epicardial systems. This study presents the acute and chronic results of 110 patients who underwent attempted non-thoracotomy ICD impiuntation wiih the Medtronic Transvene lead system and PCD model 7217 or 7219. Of the 110 patients attempted, 100 (91%) had the system successfully implanted without the need for an epicar-dial patch. One patient died 1 week postoperatively of septic shock related to the implantation (0.9% perioperative mortality). During folloiv-up of 16 ± 11 months, 45% of the patients had an event detected as ventricular tachycardia; 26% of these detections were felt clinically to be due to supraventricular rhythms. Of the remainder, 87% were successfully treated with the first VT therapy, and 98% were terminated by the final therapy; 66% of the patients had at least one episode of ventricular fibrillation, of which 5% were felt to be inappropriate detections; 65% of the appropriate episodes were successfully treated with the first VF therapy, and all were converted by the final therapy. Total mortality at 6, 12, and 24 months was 3%, 11%, and 19% respectively. Only one patient had sudden cardiac death, occurring at 13 months postimplant. Overall, the non-thoracotomy lead system for this ICD displayed infrequent implant complications and proved to be reliable ai terminating arrhythmias and maintaining a low rate of sudden cardiac death in this high risk popuiation.     

射频消融迷宫术治疗心房纤颤

作者采用射频消融迷宫术治疗心房纤颤２０例，其中１９例合并风湿性二尖瓣病的患者，同时行瓣膜替换术，１例合并房间隔缺损患者进行修复。射频消融的路线采用小板井嘉夫的手术径路。术后１６例恢复窦性心律，占８０％，未恢复窦性心律的４例，２例为房颤，１例为房扑，另１例为结性心律。射频消融迷宫术耗时短，仅增加钳闭主动脉时间平均２０．５分钟，无术后出血的潜在危险。但术后７～１０天之内，有１８例出现过房颤、房扑、房速等室上性心律失常，可能由于射频消融不均匀，干扰心房的心电活动所致。     

Quantification of the Modifications in the Dominant Frequency of Ventricular Fibrillation under Conditions of Ischemia and Reperfusion: An Experimental Study

The characteristics of ventricular fibrillatory signals vary as a function of the time elapsed from the onset of arrhythmia and the maneuvers used to maintain coronary perfusion. The dominant frequency (FrD) of the power spectrum of ventricular fibrillation (VF) is known to decrease after interrupting coronary perfusion, though the corresponding recovery process upon reestablishing coronary flow has not been quantified to date. With the aim of investigating the recovery of the FrD during reperfusion after a brief ischemic, period, 11 isolated and perfused rabbit heart preparations were used to analyze the signals obtained with three unipolar epicardial electrodes (E1-E3) and a bipolar electrode immersed in the thermostatizfid organ bath (E4), following the electrical induction of VF. Recordings were made under conditions of maintained coronary perfusion (5 min), upon interrupting perfusion (15 mini, and after reperfusion (5 min), FrD was determined using Welch's method. The variations in FrD were quantified during both ischemia and reperfusion, based on an exponential model AFrD = A exp (-t/C). During ischemia ΔFrD is the difference between FrD and the minimum value, while t is the time elapsed from the interruption of coronary perfusion. During reperfusion ΔFrD is the difference between the maximum value and FrD, while t is the time elapsed from the restoration of perfusion, A is one of the constants of the model, and C is the time constant. FrD exhibited respective initial values of 16.20 ± 1.67, 16.03 ± 1.38, and 16.03 ± 1.80 Hz in the epicardial leads, and 15.09 ±1.07 Hz in the bipolar lead within the bath. No significant variations were observed during maintained coronary perfusion. The fit of the FrD variations to the model during ischemia and reperfusion proved significant in nine experiments. The mean time constants C obtained on fitting to the model during ischemia were as follows: El =294.4 ± 75.6, E2 = 225.7 ± 48.5, E3 = 327.4 ± 79.7, and E4 = 298.7 ± 43.9 seconds. The mean values of C obtained during reperfusion, and the significance of the differences with respect to the ischemic period were: El = 57.5 ± 8.4 (P ± 0.01), E2 = 64.5 ± 11.2 (P0.01), E3 = 80.7 ± 13.3 (P < 0.01), and E4 = 74.9 ± 13.6 (P < 0.0001). The time course variations of the FrD of the VF power spectrum fit an exponential model during ischemia and reperfusion. The time constants of the model during reperfusion after a brief ischemic period are significantly shorter than those obtained during ischemia.     

小剂量氨茶碱治疗缓慢室率性房颤的长期疗效观察

目的研究小剂量氨茶碱对老年缓慢心室率性心房纤颤的长期疗效。方法１５例有症状的老年缓慢心室率性房颤病人口服氨茶碱（１５０ｍｇ／ｄ）。治疗前及治疗后第７天、第１、３、６、９及１２个月行心电图及动态心电图检查。结果以均数±标准差表示，采用秩和检验分析差异显著性。结果治疗后第７天静息心率、２４小时平均心率、最慢心率及最快心率分别增加３８％（Ｐ＜０．０１）、２８％（Ｐ＜０．０１）、２６％（Ｐ＜０．０５）及１６％（Ｐ＜０．０１），２４小时＞２５００ｍｓ的心脏停搏次数减少９４％（Ｐ＜０．０１），室性早搏次数增加６％，但差异不显著。随访１２个月（中位数），各项参数与治疗后第７天的结果相似，临床症状明显减轻或消失。结论小剂量氨茶碱治疗老年缓慢心室率性房颤有效。