经食道心房程序调搏检测房室结双径路——附23例检查报告

本文通过食道心房程序调搏检测出典型房室结双径路23例,其中12例诱发室上性心动过速(占52%);占17例有心动过速发作史者的70.6%。本文着重分析了房室结双径路与室上性心动过速的关系。     

Temperature-controlled radiofrequency catheter ablation of AV conduction: first clinical experience

A new technique for catheter ablation of atrioventricular (AV)conduction, using temperature-controlled radiofrequency energyand a bipolar asymmetrical electrode configuration, was appliedto 12 patients (mean age, 48 ± 15 years; range, 18–69years) with medically refractory atrioventricular nodal reentranttachycardia (AVNRT) or rapid atrial rhythms. The energy sourcewas a 500 kHz generator with automatic power regulation to apreselected temperature of 80 °C. A specially designed 7F bipolar asymmetric thermo-catheter was used for ablation inall cases. The endpoints of the procedure were: first-degreeAV block in patients with AVN R T and third-degree block inpatients with atrial fibrillation or flutter. Energy was appliedover a range of 1–14 times per patient. After a mean follow-upof 8±4 months, third- or first degree AV block persistedin eight patients. In comparison to constant-power radiofrequencyablation, where impedance rises are commonly observed, no impedancerise or coating of the electrode occurred during any of the97 energy applications in this study. Variable wall contactof the electrode was identified in 20 of 97 applications bya slow temperature rise or a drop in temperature and frequentpower adjustments. Thus, monitoring temperature and automaticpower regulation may help to reduce the total delivered energy.Temperature control during radiofrequency energy avoids coagulumformation and consequently the associated potential hazardsof constant-power application.     

静脉注射维拉帕米或普罗帕酮治疗阵发性室上性心动过速的对比研究

目的观察静脉注射维拉帕米或普罗帕酮治疗阵发性室上性心动过速(PSVT)的疗效.方法静脉注射维拉帕米治疗35例78例次PSVT,并与普罗帕酮治疗31例59例次PSw对比观察.结果维拉帕米组总例次终止率为89.7%,普罗帕酮组总例次终止率为88.7%.两组疗效、终止PSVT发作的心电图形式等无显著性差异(P＞0.05).普罗帕酮组2例较长时间窦性停搏,1例致Ⅲ度房室传导阻滞(AVB),3例中2例死亡.结论房室结折返性心动过速(AVNRT)应用维拉帕米复律优于普罗帕酮(P＜0.05).普罗帕酮副作用较大.     

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     

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.     

Supraventricular arrhythmia: A complication of 5-fluorouracil therapy

5-Fluorouracil is an S-phase-specific, synthetic pyrimidine antimetabolite, which is used as a cytostatic agent for a variety of malignant lesions, either singly or in multidrug regimens. Gastrointestinal toxicity and myelosuppression are the most common adverse reactions, but, of late, clinical cardiotoxicity has been reported in both prospective and retrospective studies. We present our experience of clinical cardiotoxicity in five patients.     

Tratamento de taquicardia supraventricular sincopal durante a gestação sem uso de raios‐X: relato de caso

Arrhythmias during pregnancy pose a dilemma for the treating physician. Most antiarrhythmic drugs are classified as category C in the FDA labeling system during pregnancy. We describe the case of a pregnant woman who presented syncope due to drug‐refractory supraventricular tachycardia who underwent catheter ablation without the use of fluoroscopy.     

Management of gestational supraventricular tachycardia with a ‘modified’ modified Valsalva manoeuvre

A 36 year old woman with chest pain and palpitations at 34 weeks gestation (gravidity 2, parity 1) presented to the emergency department where she was found to be in supraventricular tachycardia (SVT). This patient had an earlier episode of SVT during the same pregnancy that was managed with intravenous adenosine. During both presentations a REVERT trial style ‘modified’ Valsalva manoeuvre (including supine positioning with passive leg raise) was attempted without success. Acknowledging the potential for vena caval compression in pregnant patients while in the Trendelenburg position, the same manoeuvre was attempted with the novel additional of 45 degree left pelvic tilt. This ‘modified’ modified Valsalva was successful in restoring sinus rhythm, suggesting this technique may warrant further investigation as a viable treatment for pregnant patients with hemodynamically stable SVT.