Catheter Ablation to Suppress Atrial Fibrillation: Evolution of Technique at a Single Center

Background: Catheter ablation of atrial fibrillation is a rapidly evolving art. There is currently no consensus as to optimal methodology. We report a sequential experience, during which three distinct ablation techniques were utilized. Methods: A cohort of 112 patients in whom atrial fibrillation onset was precipitated by ectopy arising solely from myocardium investing the pulmonary veins underwent catheter ablation using one of three techniques: focal (Group A); individual vein encircling (Group B); vestibule encircling (Group C). In each group, non-fluoroscopic guidance of the mapping and ablation process was provided by the tandem use of CARTO^RM and intracardiac echocardiography. Results: In all groups, endocardial topography was complex, and ablation electrode-endocardial contact was often unstable. Maximal electrode temperatures were low, despite frequent echocardiographic evidence of myocardial boiling. A significant progression in the number of radiofrequency energy applications between groups A and C was observed. Although acute suppression of atrial fibrillation inducibility was observed uniformly, chronic suppression rates were significantly different: Group A = 47%; Group B ; 69%; Group C = 87%. Conclusions: In this non-concurrent cohort, the rate of chronic suppression of atrial fibrillation correlated with the amount of myocardium ablated or electrically isolated. Prospective data will be required to further evaluate whether more is better.     

Non-invasive characteristics of atrial fibrillation: the value of Holter recordings for the treatment of AF

Atrial fibrillation (AF) is the most common arrhythmia in man associated with significantmorbidity and excess mortality. AF can be lone but is frequently associated with underlying heartdisease while in some patients a genetic cause has been identified. In the past decade our knowledge about themechanisms of AF and our options for (non)pharmacological treatment of AF have increased importantly.Since the success rate of drug therapy is frequently disappointing hybrid therapy is oftennecessary (e.g., drugs in combination with cardioversion, pacemaker implantation or an ablationprocedure). Therapy should focus on identifying the specific substrate (underlying heart disease)and triggers for AF in each patient, making a more individualized therapy possible. For this, non-invasivetesting becomes more and more important. Holter recordings may show focal activity (monomorphic atrialpremature beats, atrial tachycardia) or other supraventricular arrhythmias (AV-nodal reentranttachycardia, circus movement tachycardia) which can successfully be treated. In addition, AF may transientlyconvert to atrial flutter (AFL), either spontaneously or after administration of (class IC)drugs. Recent studies have shown that ablation of the flutter circuit or ectopic activity can cure AF in many ofthese patients.     

Retrograde Inversion Stripping as a Complication of the Clarivein? Mechanochemical Venous Ablation Procedure

The endovenous revolution has accelerated the development of new techniques and devices for the treatment of varicose veins. The ClariVein^® mechanochemical ablation device offers tumescentless treatment with a rotating ablation tip that can theoretically become stuck in tissue. We present the first report of retrograde stripping of the small saphenous vein without anaesthesia following attempted use of the ClariVein^® device, without adverse sequelae.     

肠系膜静脉血栓形成的临床特点分析

目的分析急性肠系膜静脉血栓(acute mesenteric venous thrombosis,AMVT)和慢性肠系膜静脉血栓(chronic mesenteric venous thrombosis,CMVT)的临床特点。方法对首都医科大学附属友谊医院1980年10月至2005年12月确诊的33例肠系膜静脉血栓(MVT)患者的临床资料进行了分析,并结合文献,总结MVT的临床特点和治疗方法。结果33例MVT中,慢性肠系膜静脉血栓11例,年龄32~78岁(平均46.6岁),无急腹症的表现,均是在腹部CT检查中发现肠系膜静脉血栓;另22例为AMVT患者,年龄19~75岁(平均48.9岁)。主要症状和体征为腹痛、腹胀、腹部膨隆、腹膜刺激征,呕吐68.2%(15/22),发热36.4%(8/22)。误诊率59.1%(13/22),手术治疗17例,死亡7例,治愈10例;溶栓治疗5例痊愈。结论早期腹部CT结合肠系膜上动脉造影可对早期AMVT做出正确的诊断,早期溶栓或手术治疗可以降低病死率。     

肺静脉隔离术后心房颤动早期复发和延迟愈合的相关因素分析

目的探讨Lasso标测导管指导下行节段性肺静脉电隔离术后心房颤动(房颤)早期复发和延迟愈合的相关因素。方法120例[男性104例,女性16例;平均年龄(50．4±8．9)岁]行节段性肺静脉电隔离术的房颤患者,单因素和多因素分析老龄(≥60岁)、性别、房颤类型、病史、合并高血压、左心房直径、射血分数、P波离散度、被隔离肺静脉数及手术时间与早期复发和延迟愈合的相关性。结果早期复发率为48．3％(58／120),左心房扩大(P=0．004)和老龄(P=0．033)与早期复发显著相关,左心房直径是早期复发的独立预测因素(OR=1．16,95％CI为1．04～1．28,P=0．005);延迟愈合率为29．3％(17／58),与延迟愈合显著相关的变量为:P波离散度(P<0.001)、左心房直径(P=0．016)、老龄(P=0．001)。P波离散度是延迟愈合的独立预测因素(OR=0．92,95％CI为0．87-0．97,P=0．005)。结论左心房扩大、老龄与肺静脉隔离术后房颤早期复发有关,左心房直径是早期复发的独立预测因素;P波离散度较小、左心房无扩大的低龄患者延迟愈合的可能性较大,P波离散度是延迟愈合的独立预测因素。     

达比加群酯治疗脑静脉血栓形成的有效性和安全性:与华法林的比较

目的比较达比加群酯与华法林治疗脑静脉血栓形成(cerebral venous thrombosis,CVT)安全性和有效性。方法回顾性分析2017年1月至2018年12月在河南省人民医院神经内科住院治疗的CVT患者的病历资料,根据用药情况分为达比加群酯组和华法林组。主要转归指标为治疗后6个月时的功能转归良好,定义为改良Rankin量表评分0~2分。次要转归指标包括受累静脉窦再通率以及出血发生率。结果共纳入152例CVT患者,其中达比加群酯组34例,华法林组118例。两组人口统计学和基线资料比较均差异无统计学意义。治疗6个月时,达比加群酯组和华法林组功能转归良好率(94.1%对93.2%;χ^2=0.043,P=0.836)以及受累静脉窦再通率(94.1%对93.2%;χ^2=0.043,P=0.836)均差异无统计学意义。达比加群酯组出血发生率显著低于华法林组(8.8%对27.1%;χ^2=4.985,P=0.026),两组轻微出血发生率差异无统计学意义(8.8%对16.1%;χ^2=0.618,P=0.432),但达比加群酯组严重出血发生率有显著低于华法林组的趋势(0%对11.0%;Fisher精确检验P=0.074)。达比加群酯组无死亡病例,华法林组死亡2例,其中1例妊娠期女性患者在治疗4个月时死于CVT复发,1例男性患者在治疗2个月时死于急性心肌梗死。两组病死率差异无统计学意义(0%对1.7%;Fisher精确检验P=1.000)。结论达比加群酯治疗CVT的有效性不逊于华法林,且出血并发症风险更低。     

Pulmonary vein firing initiating atrial fibrillation in the horse: Oversized dimensions but similar mechanisms

Atrial fibrillation is triggered by the pulmonary veins in humans. Although atrial fibrillation is known to occur in other species, the mechanisms of disease in these are not known. Here we present evidence for pulmonary vein triggers in the horse, where 3D HD Grid mapping was undertaken in the conscious state in the absence of fluoroscopy.     

液氮冷冻联合Nd:YAG激光对兔耳静脉作用的效果观察

目的:观察液氮冷冻联合Nd:YAG激光照射对兔耳静脉的作用,评估该方法治疗静脉畸形的可行性。方法:将65只白兔随机分为4组。A、B、C为实验组,每组20只;D组为空白对照组,5只。以兔耳背中央静脉为实验模型,A组行液氮冷冻及Nd:YAG激光照射,B组行液氮冷冻,C组行Nd:YAG激光照射,D组不做处理。分别于实验处置后1、3、7、14、21 d对兔耳背中央静脉进行大体、光镜及电镜观察。结果:A组静脉血管内皮细胞、管壁平滑肌及构架结构均有明显损伤破坏,管腔内血栓形成,最终静脉闭锁。B、C组虽有血管内皮细胞损伤及血栓形成,但随后血栓逐渐溶解,血管修复。结论:冷冻联合激光照射对兔耳静脉有较强的损伤作用,具有治疗静脉畸形的可能性。     

阵发性心房颤动患者心房及肺静脉不应期离散度的变化

目的探讨阵发性房颤患者房颤相关组织的电生理特性改变情况。方法选取阵发性房颤患者10例(房颤组)和无房颤病史的左侧旁路有显性预激波患者15例(对照组)。将大头电极分别放置在两组患者左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉开口及左心房顶壁、前壁、后壁、高位右心房,分别测定各部位有效不应期(EPR)。结果①房颤组心房及肺静脉EPR离散度指数(DI)为0.117±0.028,对照组为0.074±0.029,两组比较,P<0.05。②房颤组左心房ERP为(234.00±28.72)ms,肺静脉ERP为(230.75±32.69)ms;对照组左心房ERP为(248.00±25.99)ms,肺静脉ERP为(244.33±26.78)ms,两组比较,P均<0.05。结论阵发性房颤患者DI明显增大,左心房、肺静脉ERP显著缩短。