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导管消融治疗心房颤动的新策略与新趋势
心房颤动(atrial fibrillation)简称房颤,是临床常见的快速性心律失常之一,人群发病率达2‰~6‰,随着年龄增加,房颤有逐渐增加的趋势,据统计,65岁以上老年人中发病率达到5%~8%,在75岁以上人群可达10%.
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心房纤颤案
患者,男,73岁.初诊日期:2010年4月2日.主诉:心慌1天.病史:有不稳定性心绞痛病史7年,每因劳累及情绪激动而发作心前区疼痛,休患或口服硝酸甘油可缓解.后渐出现心慌、气短,于某医院行H0lter检查,提示偶发室性及室上性期前收缩,偶发房颤伴差传,ST-T改变.
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脑内微出血增加房颤相关卒中患者死亡率
近年有关脑内微出血(cerebral microbleeds,CMBs)的研究认为 CMBs 与颅内出血的发生相关。此外, CMBs 也是心脑血管疾病相关死亡率的独立预测因素。然而,尚不明确 CMBs 与非瓣膜性房颤(nonvalvular atrial fibrillation,NVAF)患者长期预后的相关性,因这部分患者常需服用抗凝药物治疗,CMBs 对这部分患者意义更为重大。
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瑜伽与心房颤动:Yoga My Heart研究的启示
为了评估瑜伽对阵发性心房颤动(paroxysmal atrial fibrillation,PAF)患者的发作次数、情绪状态(焦虑、抑郁)及生活质量的影响,美国堪萨斯大学医疗中心的Lakkireddy博士等人进行了一项名为"The Yoga My Heart"的研究,即单中心、前瞻性、自身前后对照的队列研究,研究结果[1]发表在2013年3月份的<美国心脏病学会杂志>(Journal of American College of Cardiology , JACC).
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老年非瓣膜病心房纤颤患者脑栓死的临床分析及防治
心房纤颤简称房颤(AF),房颤患者心房内容易形成血栓,因而具有较高发生脑栓死(CE)的危险.随着社会的老年化发展趋势,非瓣膜病房颤(Nonvalvular Atrial Fibrillation,NVAF)患者日益增多,作为其重要合并症之一的栓死性卒中的发生率也呈增高趋势,栓死性卒中已经成为影响老年房颤预后的重要原因之一.抗凝治疗是预防卒中的有效手段.本文拟对我院31例NVAF致CE患者的临床表现及转归进行分析,以探讨其临床特点,及早预防治疗.
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心房颤动患者的低剂量、大螺距双源CT冠状动脉成像的可行性研究
Objective The objective was to attempt to rule out whether high-pitch spiral acquisition dual-source computed tomography coronary angiography (CTCA) can be performed in patients with atrial fi-brillation at low dose. Methods Ten patients with atrial fibrillation who were admitted for a first diagnostic coronary angiogram were screened for participation. All patients underwent dual-source CT. Patients were per-formed CTCA using the prospectively ECG-gated high-pitch mode and retrospective ECG gating spiral acqui-sition respectively with their permissions. The start phase for image acquisition of the most cranial slice was selected at 20% -30% of the R-R interval in all patients. Results Image qualities of prospectively ECG-ga-ted high-pitch mode were rated as being excellent in 7 cases of all the patients and only 3 cases' image quali-ties were graded score 2. By using retrospective ECG gating spiral acquisition mode, non-diagnostic image quality (score 3) occurred in 4 patients which were observed in RCA and 1 patient in LCX. The estimated radiation dose ranges from 0. 68 to 1. 887 mSv in flash mode and the radiation dose of spiral mode were very high ranging from 14. 92 to 29. 308 mSv. Conclusions Our case series suggest that patients with atrial fibril-lation rhythm can be performed CTCA with high-pitch spiral acquisition mode. 20% -30% of the RR interval window for data acquisition for high-pitch dual-source CTCA may probably obtain good image quality with low doses.
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Objective To perform a systematic review and meta-analysis of the predictive abilities of CHADS2 and CHA2DS2-VASc in stroke and thromboembolism risk stratification of atrial fibrillation (AF) patients. Methods We searched PubMed and EMBASE for Eng-lish-language literature on comparisons of the diagnostic performance between CHADS2 and CHA2DS2-VASc in predicting stroke, or sys-temic embolism, in AF. We then assessed the quality of the included studies and pooled the C-statistics and 95%confidence intervals (95%CI). Results Eight studies were included. It was unsuitable to perform a direct meta-analysis because of high heterogeneity. When analyzed as a continuous variable, the C-statistic ranged from 0.60 to 0.80 (median 0.683) for CHADS2 and 0.64-0.79 (median 0.673) for CHA2DS2-VASc. When analyzed as a continuous variable in anticoagulation patients, the subgroup analysis showed that the pooled C-statistic (95%CI) was 0.660 (0.655-0.665) for CHADS2 and 0.667 (0.651-0.683) for CHA2DS2-VASc (no significant difference). For non-anticoagulation patients, the pooled C-statistic (95%CI) was 0.685 (0.666-0.705) for CHADS2 and 0.675 (0.656-0.694) for CHA2DS2-VASc (no significant differ-ence). The average ratio of endpoint events in the low-risk group of CHA2DS2-VASc was less than CHADS2 (0.41%vs. 0.94%, P<0.05). The average proportion of the moderate-risk group of CHA2DS2-VASc was lower than CHADS2 (11.12%vs. 30.75%, P<0.05). Conclu-sions The C-statistic suggests a similar clinical utility of the CHADS2 and CHA2DS2-VASc scores in predicting stroke and thromboem-bolism, but CHA2DS2-VASc has the important advantage of identifying extremely low-risk patients with atrial fibrillation, as well as classi-fying a lower proportion of patients as moderate risk.
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导管射频消融肺静脉治疗心房颤动的现状与评价
近年来对心房颤动(房颤)机制的突破性认识在于发现大多数阵发性房颤的发作是由某一局灶的异位激动所触发,局灶异位激动可以来自上腔静脉、终末嵴、冠状静脉窦、Marshall静脉(或韧带)、房间隔或左房后壁,但80%~95%以上的异位激动在肺静脉内这一观点已获公认,因此有人将这种房颤称之为肺静脉触发性房颤(pulmonary vein triggering atrial fibrillation).1998年以来,尤其是2002年以来,国内外有关资料均显示,针对触发病灶的肺静脉消融,可以使60%~80%的阵发性房颤患者获得令人满意的治疗[1-3].
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冠状动脉造影对心房颤动患者的冠心病诊断价值
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心脏瓣膜病慢性心房颤动迷宫手术的八年随访
关键词: 心脏瓣膜病 慢性心房颤动 迷宫手术 随访 Atrial Fibrillation -
中国人非瓣膜病心房颤动患者脑卒中发生率及影响因素的回顾性前瞻研究(摘要)
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慢性心力衰竭伴慢性心房颤动房室结消融及双心室同步起搏治疗半年疗效观察
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心力衰竭患者心房颤动的节律控制与心率控制
心力衰竭合并心房颤动(房颤)患者通常的处理是恢复并维持窦性心律.这种做法部分是基于有数据表明房颤是心力衰竭患者死亡的预测因子,提示抑制房颤可能改善患者的预后.然而,这样做的益处和风险并没有被充分研究.
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心房颤动药物治疗的热点问题
心房颤动(房颤)是临床常见的心律失常之一,其在一般人群中发生率0.4%,在心血管病患者的发生率4%,而严重的心血管病患者房颤的发生率高达40%.因此,有效地治疗房颤是内科医生的基本功.下面重点讨论房颤药物治疗的几个热点问题.
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心房颤动复律对血浆脑利钠肽的影响
血浆脑利钠肽(brain natriuretic peptide,BNP)一直是左心室功能障碍的一个指标[1],其在左心室功能正常的心房颤动(atrial fibrillation,Af)患者中的作用报道不多,且有争论[2~5].本文前瞻性地研究了左心室功能正常的Af患者复律前后血浆BNP的变化.
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非瓣膜病性房颤抗凝治疗--华法林PK新型口服抗凝药物
心房颤动(房颤)是临床常见的持续性心律失常,电生理表现为规则有序的心房电活动丧失而代之以快速无序的房颤波。房颤也是严重的心房电活动紊乱,心房附壁血栓形成是房颤患者的主要病理生理特点之一。非瓣膜病性房颤(nonvalvular atrial fibrillation,NVAF)是由高血压、缺血性心脏病等引起而非瓣膜病引起的房颤,其发病率随年龄增加而增长,75岁以上房颤患者约占房颤患者总数的一半[1]。近年来,由瓣膜病引起的房颤发病率逐渐降低,而非瓣膜病性房颤却随着人口老龄化而逐渐增加。在临床上,房颤严重的后果是因卒中事件而导致的死亡及残疾,非瓣膜病房颤患者发生卒中的风险是正常人的5~6倍,卒中给社会和家庭带来沉重的负担,因此对房颤患者进行抗栓治疗是其治疗的重要内容。本文对目前临床上房颤抗凝治疗的现状及两类口服抗凝药物优势及缺陷进行了讨论,希望能为临床医生合理选择抗凝药物提供帮助。
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心房颤动导管消融的终点问题
阵发性、持续性、持久性或永久性心房颤动(房颤)等概念上的递进关系,在一定程度上体现了房颤的触发和维持机制呈不同比例融合的发展过程.阵发性房颤主要决定于触发机制,持续性房颤主要决定于维持机制.触发机制与维持机制的相互作用导致了临床房颤特征的千变万化.
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预防心房颤动患者脑卒中的药物治疗新进展
心房颤动(房颤)是常见的心律失常,有较高的发病率和病死率.患病率随增龄而增加,年龄<60岁的患者有1%受累,而年龄>80岁的患者为10%\[1-2].房颤可使栓塞或脑卒中风险增加5倍,每年的绝对风险为1%~20%,取决于患者的年龄和是否存在危险因素,如充血性心力衰竭、高血压、糖尿病和既往栓塞事件[3].
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对侵入性治疗手段治疗心房颤动的思考
进入21世纪以来,国内外介入专家们非常重视并赞扬经皮经腔心脏导管射频消融心房颤动(房颤)的技术.而媒体的连篇累牍热情重复报道则推动了"根治性房颤"就在眼前的前景.在没有"规范准入"制的情况下,国内房颤射频消融术已经进入大城市的二甲医院,以至于有统计2006年突破年度3000例,2008年将成倍增加.有的专家认为房颤射频消融术可提升到Ⅰ级适应证的治疗方法.
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碎裂电位消融对心房颤动患者自主神经功能和预后的影响
在经典的环肺静脉隔离术(PVI)的基础上配合心房碎裂电位(CFAE)消融可明显提高消融治疗的成功率,降低心房颤动(房颤)的复发.本研究利用无创手段--心率变异性分析(HRV)探索单纯PVI和PVI结合CFAE消融两种术式对自主神经活性的影响.