导管射频消融治疗持续性心房颤动的体会

目的研究持续性心房颤动(房颤)导管射频消融最佳手术方式及复发心律失常的处理策略。方法2005年3月~2007年8月共40例持续性房颤患者接受导管射频消融治疗,三维电解剖标测系统指导下行环同侧肺静脉左心房线性消融;2005年的12例患者部分附加左心房峡部、右心房峡部、左心房顶部线性消融;2006年的12例患者常规进行左心房峡部、右心房峡部射频消融,部分患者附加碎裂电位、左心耳或根据术中的房性心律失常附加其他部位射频消融;2007年的16例患者则在上述基础上进行冠状窦左心房心内膜面射频消融。结果2005年复发8例(66.7%),2006年复发3例(25.0%),2007年复发4例(25.0%)。复发的患者中8例接受第二次导管射频消融术,其中5例维持窦性心律。平均随访(17.6±10.4)个月,总治疗成功率82.5%。结论持续性房颤患者在以肺静脉口为核心的导管射频消融前提下,适当改进导管射频消融策略,可以显著提高成功率。     

评价致心律失常性右室心肌病右室功能超声指标与磁共振的相关性

目的用目前公认的5个超声指标评价致心律失常性右室心肌病（ARVC）患者的右室功能,研究其与磁共振（MRI）结果的相关性。方法对11例ARVC患者行超声及MRI检查,测量右室功能指标并行相关分析。本研究除了运用传统的心尖四腔心法测量右室面积改变分数（RVFAC 4C）外,增加了胸骨旁右室三腔心切面法测量右室面积改变分数（RVFAC RV 3C）。结果 5个指标中胸骨旁短轴RVFAC RV 3C、三尖瓣环收缩峰值速度、三尖瓣环收缩位移与MRI结果相关,r值分别为0.72、0.65、0.67。结论胸骨旁短轴RVFAC RV3C是评价ARVC患者右室功能的重要指标并且其与MRI测量的结果具有高度的相关性。     

风湿性心脏病瓣膜置换术后心房颤动的导管消融病例总结

目的：评价风湿性心脏病瓣膜置换术后心房颤动（房颤）消融的效果和安全性。方法入选2008年至2013年在广东省人民医院心内科接受房颤导管消融治疗的风湿性心脏病瓣膜置换术患者,分析其临床特征、消融策略及消融成功率。结果共纳入23例患者,男8例,女15例,平均年龄（51.0＆#177;9.2）岁。单纯二尖瓣置换术患者13例（56.5%）,二尖瓣、主动脉瓣双瓣置换术10例（43.5%）,其中5例同时进行三尖瓣置换或整形术。外科术后阵发性房颤患者14例（60.9%）,非阵发性房颤9例（39.1%）;这些患者在外科术前心律情况为9例窦性心律,4例阵发性房颤,10例非阵发性房颤。导管消融距离外科手术时间为（6.9＆#177;5.8）年,外科术后发生房颤病程（3.1＆#177;3.2）年,左、右心房内径分别为（44.1＆#177;5.9）mm、（48.1＆#177;9.0）mm,左心室射血分数64.0%＆#177;8.3%。平均消融手术时间（156.8＆#177;46.6）min,X线曝光时间（27.3＆#177;11.2）min。随访（29.7＆#177;21.2）个月,其中4例（17.4%）患者接受再次消融术;14例（60.9%）维持窦性心律（6例服用胺碘酮）,1例死亡,2例失访,6例复发（包括2例持续性房颤,1例阵发性房颤,2例偶发性心房扑动,1例阵发性房性心动过速）。结论风湿性心脏病瓣膜置换术后房颤导管消融有效、安全,步进式导管消融策略可能较为合适。     

杞菊地黄丸快检方法研究

目的:制定杞菊地黄丸的快检方法.方法:采用乙醇研磨制备供试品溶液,经薄层展开后,分别对丹皮酚、熊果酸、马钱苷进行定性鉴别.结果:丹皮酚、熊果酸和马钱苷均可用薄层色谱法(thin layer chromatography,TLC)快速检出.结论:所建立的方法快速、简便,可准确地对丹皮酚、熊果酸、马钱苷进行定性鉴别,可作为该制剂的快速筛检方法.     

小儿奇应丸质量标准的研究

目的建立小儿奇应丸的质量标准。方法采用薄层色谱法对处方中牛黄、黄连进行定性鉴别;采用高效液相色谱法,以C18化学键合硅胶为固定相,乙腈-0.05 mol/L磷酸二氢钾-十二烷基磺酸钠(45∶55∶0.1)为流动相,检测波长:265 nm,测定盐酸小檗碱的含量。结果薄层色谱均检出牛黄与黄连的特征斑点,其阴性无干扰;含量测定盐酸小檗碱的平均回收率为98.7%(n=6),RSD=0.8%,在0.156μg~0.936μg范围内,进样量与吸收峰面积积分值呈良好的线性关系。结论该方法简便、快速、结果准确、重现性好,可有效控制小儿奇应丸的质量。     

丹参素对豚鼠心室肌细胞L-型钙通道的影响

目的　研究丹参素对豚鼠心室肌细胞膜L 型钙通道的影响 ,探讨丹参素在离子通道水平的药理机制。方法　急性酶解法获得豚鼠的单个心肌细胞 ,用标准的全细胞膜片钳技术记录钙电流。结果　在保持电位 (Holdingpoten tial,HP)为 - 80mV ,预先去极化至 - 4 0mV ,再去极化至0mV ,波宽为 30 0mS的刺激参数下 ,可记录到一具有电压和时间依赖性内向的电流 ,当用含 1μmol/L硝苯地平的台氏液灌流时该电流被迅速消除 ,在灌流液中加入丹参素 1mg/mL和 10mg/mL ,1mg/mL组对钙电流无明显改变 (P >0 0 5 ,n =5 ) ,10mg/mL组使钙电流减少 [- (7 76± 0 85 )pA/pFvs - (2 6 2 6± 0 5 9)pA/pFP <0 0 5 ,n =8],并使心肌细胞钙电流 -电压曲线上移 ,原有的电流 -电压依赖特征不变。结论　丹参素浓度依赖性地抑制心肌L 型钙通道     

经冠状静脉系统导管射频消融心外膜室性心律失常

目的探讨冠状静脉系统(CVS)心外膜起源室性早搏(PVCs)/室性心动过速(VT)的心电图特征和标测消融的有效性及安全性。方法 12例无器质性心脏病患者,男10例,女2例,年龄49.08±15.26岁。体表12导联心电图(ECG)、动态心电图示频发PVCs或短阵VT。12例术中均先行心内膜标测,均未标测到理想消融靶点,考虑PVCs/VT源自心外膜,置入冠状静脉窦(CS)电极至心大静脉(GCV)、前室间隔静脉(AIV)。确定PVCs/VT起源于CVS后,应用盐水灌注消融导管,以15～30 W放电(温控43℃、盐水速度17～30 ml/min)。分析体表ECG特征。结果 10例即刻消融成功,消融靶点分别位于GCV(7例)、AIV(2例)、后侧支静脉(PLV)(1例),局部V波较体表心电图QRS波提早28.67±5.35 ms,消融部位阻抗212.8±45.2Ω;2例因消融导管无法到达AIV中段靶点,消融失败;无标测与消融并发症。PVCs/VT的QRS波时限为148.33±18.09 ms,起始部见"delta"波4例,最大偏差指数(MDI)0.67±0.27。PLV消融成功病例Ⅰ导联QRS波呈R型,另外9例PVCs/VT时的Ⅰ导联QRS波以负向波为主,其中5例GCV消融成功患者的Ⅰ导联QRS波起始部见q波(QWLⅠ)。GCV消融成功的PVCs/VT心电图呈右束支传导阻滞图形,胸前导联R波移行较早,移行于V1导联;AIV消融成功PVCs/VT心电图呈左束支传导阻滞图形,胸前导联R波移行于V3导联。随访1～10个月,1例PVCs 24 h 3 982个,余病例未见复发,成功率75%。结论QWLⅠ、MDI≥0.6是GCV起源的PVCs/VT重要诊断标准之一;约75%CVS起源的心外膜PVCs/VT可以经CVS安全、有效地进行标测和消融。     

经右锁骨下静脉途径导管射频消融三尖瓣环下的室性心律失常

目的探讨经右锁骨下静脉途径结合应用长鞘(SR0)导管射频消融三尖瓣环下起源的室性心律失常有效性及安全性。方法 8例患者,根据心电图和/或动态心电图诊断为三尖瓣环附近起源室性早搏(PVC)/室性心动过速(VT),均接受心脏电生理检查及射频消融治疗。术前曾经或术中采取常规下腔静脉途径消融失败后,改经右锁骨下静脉途径并辅用长鞘SR0进行标测与消融。消融成功后,结合靶点位置分析心电图及消融结果。结果 8例消融均获成功。根据消融导管的X线影像特征、电解剖证实其起源于三尖瓣环下6～9点。12导联体表心电图的PVC/VT的QRS波均呈左束支传导阻滞伴电轴左偏图形,Ⅰ、aVL导联主波向上,Ⅱ、Ⅲ、aVF导联主波向下,2例肢体导联见切迹,QRS波时限174.75±13.44 ms,消融靶点局部V波较体表心电图QRS波提早27.5±3.16 ms。8例成功消融靶点图只见V波,6例有峰电位。随访2～12个月,1例PVC复发。结论在长鞘辅助下,经右锁骨下静脉途径能够安全、有效地消融治疗三尖瓣环下PVC/VT,是经股静脉途径消融失败的有效补充。     

CartoXP Guided Catheter Ablation for Paroxysmal Atrial Fibrillation Without Three-dimensional Modeling of Left Atrium and Pulmonary Veins

Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. 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 tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.     

Ionic Remodeling and Direct Effects of Valsartan on Ionic Currentsin Human Atrial Myocytes with Atrial Fibrillation

Objectives Previous studies demonstrated that angiotensin receptor antagonists had effects on some potassium channels in guinea pig myocytes and cloned channels that expressed in human cardiac myocytes. This study determined the direct effects of Valsartan on I caL, INa, IKur, IK1 and Ito1 in isolated human atrial myocytes. Methods and Results Specimens of right atrial appendage tissue were obtained from 39 patients with coronary artery and valvular heart diseases during cardiopulmonary bypass procedure. Pre- operation cardiac rhythm was sinus (SR)in 19 patients and was atrial fibrillation (AF) in the others. Single atrial myocyte was isolated by enzymatic dissociation with the chunk method. The ionic currents were recorded using the whole cell coffiguration of the voltage clamp technique. ICaL and Ito1 densities in AF patients were significantly lower than those in SR patients by 74% and 60%, respectively, while IK1density was significantly higher by 34% at command potential of - 120 mV. With 10 μmol/L Valsartan, INa density was significantly decreased by 59% in SR patients and by 66% in AF patients. IKur and IKl density were significantly decreased in only AF patients by 31% and23%, respectively. Conclusions Conclusions Decreased IcaL and Itol and increased IKl at hyperpolarizing potentials in AF patients‘ atrial myocytes may result from the electrophysiological remodeling by AF. Valsartan significantly decreases INa, IK1 and IKur current densities in AF patients‘ myocyte, but decreases only INa in SR patients‘ myocyte, suggesting that Valsartan may be beneficial to the recovering of remolded atria.