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1.
MICHAEL SCHLÜTER PH.D. RICCARDO CAPPATO M.D. FEIFAN OUYANG M.D. MATTHIAS ANTZ M.D. CATARINA A. SCHLÜTER M.D. KARL-HEINZ KUCK M.D. 《Journal of cardiovascular electrophysiology》1997,8(12):1366-1372
Dormant Accessory Pathways. Introduction : Recurrence of clinical symptoms after radiofrequency catheter ablation of an accessory atrioventricular pathway (AP) may be due to the late manifestation of an additional AP that was not detected during the initial ablation session. It was the purpose of this study to elucidate the phenomenon of these "dormant" APs.
Methods and Results : Of 1280 consecutive patients who underwent radiofrequency catheter ablation of an AP, 54 patients (4.2 %) developed clinical symptoms postablation, necessitating a repeat ablation session. Recurrence of conduction over the AP targeted al the initial ablation session was found in 45 patients, whereas in the other 9 patients (0.7%) the manifestation of a previously unnoticed AP had caused symptom recurrence. Retrospective analysis of the data from these patients' ablation sessions revealed that the late manifesting AP was ablated at a site clearly different from that of the initially targeted AP, and that the manifestation of conduction over a previously "dormant" AP occurred significantly later than the recovery of a presumably ablated AP. Seven (78%) of the 9 "dormant" APs were concealed, and none exhibited decremental conduction properties.
Conclusion : The incidence of clinical recurrences mediated by the late manifestation of conduction over a previously "dormant" AP is low. The lack of an anatomic vicinity of these predominantly concealed APs with the initially targeted AP and the lack of evidence for their presence during the initial ablation session suggest intermittent conduction as the most likely explanation for their late manifestation. 相似文献
Methods and Results : Of 1280 consecutive patients who underwent radiofrequency catheter ablation of an AP, 54 patients (4.2 %) developed clinical symptoms postablation, necessitating a repeat ablation session. Recurrence of conduction over the AP targeted al the initial ablation session was found in 45 patients, whereas in the other 9 patients (0.7%) the manifestation of a previously unnoticed AP had caused symptom recurrence. Retrospective analysis of the data from these patients' ablation sessions revealed that the late manifesting AP was ablated at a site clearly different from that of the initially targeted AP, and that the manifestation of conduction over a previously "dormant" AP occurred significantly later than the recovery of a presumably ablated AP. Seven (78%) of the 9 "dormant" APs were concealed, and none exhibited decremental conduction properties.
Conclusion : The incidence of clinical recurrences mediated by the late manifestation of conduction over a previously "dormant" AP is low. The lack of an anatomic vicinity of these predominantly concealed APs with the initially targeted AP and the lack of evidence for their presence during the initial ablation session suggest intermittent conduction as the most likely explanation for their late manifestation. 相似文献
2.
PAOLO ALBONI NELLY PAPARELLA RICCARDO CAPPATO PAOLO PEDRONI GIAN CARLO CANDINI GIAN ENRICO ANTONIOLI 《Pacing and clinical electrophysiology : PACE》1989,12(2):294-300
The purpose of this study was to find out whether transesophageal pacing could be utilized for assessment of sinus node function in patients with sick sinus syndrome (SSS). In 17 patients with SSS (study group) we compared the results of sinus node tests obtained both in the basal state and after pharmacological autonomic blockade by endocavitary stimulation and, 24 hours later, by transesophageal pacing. In another group of 17 patients with SSS (control group), we compared the results obtained by two endocavitary studies. In "study group", sinus cycle length (SCL) and corrected sinus node recovery time (CSRT) did not show significant differences between the two studies both in the basal state and after autonomic blockade, whereas sinoatrial conduction time (SACT) was more prolonged during esophageal pacing (P less than 0.01). In "control group", sinus node measures did not show significant differences between the two studies. In the "study group," the following coefficients of correlation were obtained in the basal state; SCL, r = 0.65, CSRT, r = 0.57, SACT, r = 0.52 and after autonomic blockade: SCL, r = 0.95, CSRT, r = 0.62 and SACT, r = 0.53. In the basal state, the correlation for SCL and CSRT between the two studies was lower in the "study group" than in the "control group" (P less than 0.05), whereas after autonomic blockade the correlation for sinus node measures did not show significant differences between the two groups of patients. These data suggest that transesophageal study influences the autonomic tone regulating the sinus node; however, it is not responsible for important variations in sinus node measures.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
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RICCARDO FENICI KATJA PESOLA † PETRI KORHONEN †‡ MARKKU MÄKIJÄRVI †‡ JUKKA NENONEN † LAURIE TOIVONEN †‡ PETER FENICI TOIVO KATILA‡ 《Pacing and clinical electrophysiology : PACE》1998,21(11):2492-2499
The purpose of the study was to validate, in patients, the accuracy of magnetocardiography (MCG) for three-dimensional localization of an amagnetic catheter (AC) for multiple monophasic action potential (MAP) with a spatial resolution of 4 mm2. The AC was inserted in five patients after routine electrophysiological study. Four MAPs were simultaneously recorded to monitor the stability of endocardial contact of the AC during the MCG localization. MAP signals were band-pass filtered DC-500 Hz and digitized at 2 KHz. The position of the AC was also imaged by biplane fluoroscopy (XR), along with lead markers. MCG studies were performed with a multichannel SQUID system in the Helsinki BioMag shielded room. Current dipoles (5mm; 10mA), activated at the tip of the AC, were localized using the equivalent current dipole (ECD) model in patient-specific boundary element torso. The accuracy of the MCG localizations was evaluated by: (1) anatomic location of ECD in the MRI, (2) mismatch with XR. The AC was correctly localized in the right ventricle of all patients using MRI. The mean three-dimensional mismatch between XR and MCG localizations was 6 ± 2 mm (beat-to-beat analysis). The coefficient of variation of three-dimensional localization of the AC was 1.37% and the coefficient of reproducibility was 2.6 mm. In patients, in the absence of arrhythmias, average local variation coefficients of right ventricular MAP duration at 50% and 90% ofrepolarization, were 7.4% and 3.1%, respectively. This study demonstrates that with adequate signal-to-noise ratio, MCG three-dimensional localizations are accurate and reproducible enough to provide nonfluoroscopy dependant multimodal imaging for high resolution endocardial mapping of monophasic action potentials. 相似文献
5.
GIUSEPPE CRITELLI M.D. CESARE GRECO M.D. MARIA AMBROSINI M.D. RICCARDO SINATRA M.D. BENEDETTO MARINO M.D. ATTILIO REALE M.D. 《Journal of cardiovascular electrophysiology》1990,1(4):330-333
The occurrence of inappropriate discharge from an implanted cardioverter-defibrillator is reported. The device was triggered by an episode of induced nonsustained ventricular tachycardia, and the shock was delivered 10 sec after spontaneous termination of the arrhythmia.
This observation demonstrates that unexpected discharges from an implanted cardiaverter/defibrillator can occur while the patient is asymptomatic. In order to avoid such an adverse effect, improvement of the detection system of the device is advisable. 相似文献
This observation demonstrates that unexpected discharges from an implanted cardiaverter/defibrillator can occur while the patient is asymptomatic. In order to avoid such an adverse effect, improvement of the detection system of the device is advisable. 相似文献
6.
DONATELLA BRISINDA M.D. Ph.D. RICCARDO FENICI M.D. 《Pacing and clinical electrophysiology : PACE》2007,30(S1):S151-S155
Background: Ventricular preexcitation (VPx) is usually localized noninvasively by means of electrocardiogram (ECG) algorithms, which vary in their concordance levels. Contactless magnetocardiography (MCG) has been used as an alternate 3-dimensional (3D) method of accessory pathways (AP) localization. The sensitivity of MCG can be increased for preoperative evaluations and planning of ablation procedures by combining it with transesophageal pacing (TEP) and electrophysiological (EP) studies. This study compared the accuracy of VPx localization with MCG with ECG algorithms, and examined the increment in diagnostic accuracy achievable with TEP.
Methods: Multisite mapping from the anterior chest wall was performed with a 36-channel MCG system. TEP allowed the evaluation of anterograde conduction properties and inducibility of arrhythmias. The reproducibility of the test and follow-up was examined in 88 patients with Wolff–Parkinson–White (WPW) syndrome. The accuracy of MCG localization was reevaluated during pacing-induced maximal VPx in 36 patients in whom, during MCG, the degree of VPx was highest during TEP. The gold standard for validation was effective ablation of the AP.
Results: The MCG classification of VPx was accurate in 94% of AP, versus 64% and 67% with ECG, during sinus rhythm and during pacing-induced maximal VPx, respectively. In 4.5% of cases with unclear ECG localization, MCG suggested a complex septal VPx. In all patients with successful ablations, the 3D MCG localization of the AP corresponded to the ablation site.
Conclusions: MCG was more accurate than ECG for the classification of VPx and provided additional information in the non-invasive EP assessment of patients with WPW syndrome. 相似文献
Methods: Multisite mapping from the anterior chest wall was performed with a 36-channel MCG system. TEP allowed the evaluation of anterograde conduction properties and inducibility of arrhythmias. The reproducibility of the test and follow-up was examined in 88 patients with Wolff–Parkinson–White (WPW) syndrome. The accuracy of MCG localization was reevaluated during pacing-induced maximal VPx in 36 patients in whom, during MCG, the degree of VPx was highest during TEP. The gold standard for validation was effective ablation of the AP.
Results: The MCG classification of VPx was accurate in 94% of AP, versus 64% and 67% with ECG, during sinus rhythm and during pacing-induced maximal VPx, respectively. In 4.5% of cases with unclear ECG localization, MCG suggested a complex septal VPx. In all patients with successful ablations, the 3D MCG localization of the AP corresponded to the ablation site.
Conclusions: MCG was more accurate than ECG for the classification of VPx and provided additional information in the non-invasive EP assessment of patients with WPW syndrome. 相似文献
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9.
ALBONI P.; PIRANI R.; PAPARELLA N.; CAPPATO R.; PREZIOSI S.; TOMASI A. M. 《European heart journal》1986,7(11):952-960
Thirty-four patients with a prolonged A-H interval (group I)and 26 with A-V nodal Wenckebach block (group II) were studiedin the basal state and after autonomic blockade (propranolol0.2mg kg1 and atropine 0.04 mg kg1 in order toassess the role of autonomic system in A-V nodal conductiondisturbances. In group I, the A-H intervals did not change significantlyafter autonomic blockade, whereas pacing cycle length for Wenckebachblock, effective and functional refractory periods of the A-Vnode decreased significantly (P<005). In the 22 patientswith organic heart disease these variables did not change significantlyafter autonomic blockade, whereas in the 12 without underlyingheart disease, they decreased in all cases (P< 0001). Inthe former, the variables of intrinsic A-V nodal conductionwere normal in only 6% of patients, whereas in the latter theywere normal in 66%. Also in group II, the intrinsic A-H intervalswere normal in only 6% of patients with cardiac disease butwere normal in 63% without underlying heart disease. These datasuggest that in the patients with first and second degree A-Vnodal block and organic heart disease, the conduction disturbanceis predominantly related to intrinsic involvement of A-V node,whereas in the subjects without underlying heart disease theA-V nodal blocks appear mainly related to autonomic alterations. 相似文献
10.
ALBONI P.; SCARFO S.; BAGGIONI G. F.; PAPARELLA N.; CAPPATO R.; CAVALLESCO G. 《European heart journal》1989,10(10):887-891
A precise localization of the most proximal His bundle (HB)is useful both for diagnostic and for therapeutic purposes,allowing the modification of atrioventricular (AV) nodal conduction.For selective diagnosis a bipolar lead is utilized; for therapy,a unipolar lead. The aim of the present study was to determinethe relationship between the most proximal HB and the morphologyof intracavitary pressure curves. In 15 patients (aged 64 ± 10 years), both bipolar andunipolar H-V intervals were continuously recorded while graduallywithdrawing the catheter, which detected the pressure at itstip, from the right ventricle to the atrium. The longest bipolarHV was 55.5±13 ms and the shortest 44.5±11ms (P<0.001); the longest unipolar HV was 56.5 ±14 ms and the shortest 46.2±11 ms (P<0.001). During unipolar recording, H deflection was present in all patientsat the same time as ventricular, transvalvular and atrial pressurecurves; during bipolar recording, the H electrogram was notpresent in only one patient concomitantly with the atrial curve.During bipolar recording, the atrial HV interval wasgreater than transvalvular HV in nine patients (meandifferences: 6 ± 2 ms) and they were equal in five; withunipolar recording the atrial HV interval was greaterthan transvalvular HV in 13 patients (mean difference:8 ± 6 ms) and they were equal in two. In all patients,the H wave amplitude diminished from the transvalvular areato the atrial one. These data suggest that the values of the HV intervalrecorded in the past have been underestimated. Furthermore,in order to modify AV nodal conduction selectively without damagingthe HB it might be useful to record, in addition to the H deflection,the intracavitary pressure curves so as to deliver energy onlywhen the tip of the catheter picks up an atrial curve. 相似文献