房顫相關(guān)緩慢心律失常精美醫(yī)學(xué)

房顫及房顫射頻消融術(shù)相關(guān)緩慢型心律失常Summary病竇綜合征房顫與病竇關(guān)系消融術(shù)能否替代起搏器治療消融術(shù)相關(guān)緩慢心律失常展望病竇綜合征竇性心動過緩竇房結(jié)變時性功能障礙快-慢綜合征慢-快綜合征SicksinussyndromePathologyMachanismSss中af發(fā)生率？Discoveryofsinusnode1907年structureofsinusnodeThree-dimensionalsinusnodePositionofleadingpacemakersite(identifiedbyarrows)inhumans:Sicksinussyndrome平均發(fā)病年齡68歲,但可發(fā)生于任何年齡,新生兒中亦有發(fā)病,年齡大于65歲人群中患病率1/600,占美國植入起搏器病人中的50%病因推測可能為纖維化或缺血,但未能得到充分證實病竇綜合征對心房影響房顫與病竇的關(guān)系房顫對心房及竇房結(jié)電重構(gòu)作用快-慢綜合征房顫治療可逆轉(zhuǎn)電重構(gòu)作用病竇合并房顫發(fā)生率?慢-快綜合征以心率慢為主，合并房顫、房撲，用藥存在矛盾是否可行消融治療？JCardiovascElectrophysiol.2004Jul;15(7):784-9.

Pulmonaryveinisolationforatrialfibrillationinpatientswithsymptomaticsinusbradycardiaorpauses.

KhaykinY,NataleA.

CenterforAtrialFibrillation,DepartmentofCardiovascularMedicine,TheClevelandClinicFoundation,Cleveland,Ohio44195,USA.

INTRODUCTION:Sicksinussyndromeiscommonlyassociatedwithtachyarrhythmiasandbradyarrhythmiasthatoftenaresymptomatic.Theaimofthisstudywastoassesstheeffectofpulmonaryveinisolationinpatientswithsicksinussyndromeandatrialfibrillation(AF).METHODSANDRESULTS:ThreehundredfourteenconsecutivepatientswhounderwentpulmonaryveinisolationbetweenDecember2000andJanuary2002wereincludedinthestudy.Thirty-onepatientshadsicksinussyndrome,whichwasdefinedasapreproceduralhistoryofsymptomaticsinusbradycardiaorpauses.EndpointsincludedAFrecurrence,changeinthefrequencyofsinuspauses,andsymptomsofpresyncopeorsyncope,aswellasmeanheartrateandpercentageofatrialpacinginpatientswithpacemakersimplantedpriortothepulmonaryveinisolation.PatientshadAFforanaverageof6+/-3years.Patientswere58+/-8yearsoldandhadejectionfractionsof55+/-4%.Sixty-onepercenthadimplantedpacemakers.AFrecurredwithin6monthsin4patients.Twohadasuccessfulsecondpulmonaryveinisolationprocedure.Therewerenorecurrencesofpresyncopalevents(P<0.05)ordocumentedsinuspauses(P<0.05)aftersuccessfulpulmonaryveinisolationinthepatientswithoutpermanentpacemakers.Patientswithpacemakershada13-foldreductioninthepercentageofatrialpacing(P<0.05).Bothgroupsshowedasignificantincreaseinaverageheartratesat6-monthfollow-up.CONCLUSION:CureofAFbypulmonaryveinisolationhelpedresolvetheclinicalmanifestationsofsicksinussyndrome,suggestingthattheoccurrenceofAFand/ortheassociatedtreatmentcouldbepartiallyresponsibleforsicksinussyndrome.

快-慢綜合征房顫終止后長間歇，消融是否有效？房顫可導(dǎo)致竇房結(jié)功能障礙房撲\房顫終止后,竇房結(jié)功能可恢復(fù)Electrophysiologicalpropertiesinchronicloneatrialfibrillation.KKumagai,KArakawa.

Circulation1991;84;1662-1668

Patients.Thestudygroupconsistedof12patientswithchronic(morethan1year)loneAFwhowerereferredforexternaldirectcurrentcardioversion.AdiagnosisofchronicloneAFinthepresentstudywasmadebyexcludingthefollowingdiseases:coronaryThecontrolgroupconsistedof12patientswithassociatedarrhythmiasexceptforatrialflutterorfibrillation,sicksinussyndrome,andorganicheartdisease.Sinusnodalfunction.Correctedsinusrecoverytimewasover525msecinninepatientswithAFandsignificantlylonger(p<0.01)thanthatinthecontrolgroup.Sinoatrialconductiontimewasover150msecin11patientsandsignificantlylonger(p<0.01)thanthatinthecontrolgroup.ElectricalRemodelingoftheAtriaAssociatedWithParoxysmalandChronicAtrialFlutter.

PaulB.Sparks,JonathanM.Kalman.Circulation2000;102;1807-1813

ERPsatLRA,Septum,andCSandcSNRTs(600ms/450ms)at15Minutes,30Minutes,and3WeeksAfterTerminationofChronicAFLReverseRemodelingofSinusNodeFunctionAfterCatheter

AblationofAtrialFibrillationinPatientsWithProlonged

SinusPauses

(Circulation.2003;108:1172-1175.)

MélèzeHocini,MichelHaissaguerre20例,(14men;age56.0±12.1years)陣發(fā)性房顫(房顫史100±80month),并房顫轉(zhuǎn)律后RR大于3秒(4.8±2.2秒),暈厥6例,近似暈厥11例,2例術(shù)前有行起搏器術(shù),5例器質(zhì)性心臟病或高血壓排除無房顫時有竇性停搏者.術(shù)式:環(huán)肺靜脈隔離,左房附加線(左下肺靜脈至二尖瓣瓣環(huán),左房頂部線,左房前壁線),三尖瓣峽部線隔離竇房結(jié)功能評估CSNRT:大于基礎(chǔ)心動周長+400-600ms,起搏60秒,術(shù)后6月評估平均心率與心率范圍,Holter評估,術(shù)后1周\1,3,6月最高心率:最大運(yùn)動負(fù)荷心率,術(shù)后1周\1,3,6月消融情況共進(jìn)行33次消融,1次10人,2次7人,3次3人.暴光時間54±28,手術(shù)時間165±11minutes臨床結(jié)果隨訪26.0±17.6months,3例病人房顫復(fù)發(fā),1例應(yīng)用藥物,房顫不再發(fā)作;2例房顫發(fā)作減少,其中一例仍有房顫終止時竇性停搏,植入起搏器.17例病人(85%)沒有房顫發(fā)作,也沒有應(yīng)用藥物,均無心動過緩癥狀.竇房結(jié)功能Nosinuspauses≥3secondswereobservedbyambulatorymonitoringduringthefirstweekafterablationorat1,3,and6monthsin19patients.Meanheartrate.conclusionAlthoughthemechanismsresultingintheassociationbetweensinusnodedysfunctionandatrialarrhythmiasremainunknown,thepresentstudydemonstratesthatparoxysmsofAFmayproducedepressionofsinusnodefunctionresultinginprolongedsinuspauses.ThisphenomenonisreversiblebycurativeablationofAF,thusavoidingtheneedforpacemakerimpla