Atrial fibrillation (AF) is estimated that by 2010, approximately 2.6 million people will be affected in USA;by 2050, that number may increase to 10 million patients. Generally, rate control alone is reasonable in som...Atrial fibrillation (AF) is estimated that by 2010, approximately 2.6 million people will be affected in USA;by 2050, that number may increase to 10 million patients. Generally, rate control alone is reasonable in some AF patients, especially asymptomatic patients. Restoration and maintenance of sinus rhythm (SR) may be achieved by means of cardioversion, drugs or/ and catheter ablation. Pharmacological therapy can be useful to maintain SR and prevent tachycardia-induced cardiomyopathy. All patients with AF regardless of whether a rhythm or rate control strategy recommend anticoagulant, antiplatelet or both combined therapy for prevention of thromboembolism, except those with lone AF or contraindications. Drug selection should be based upon the absolute risk of stroke, bleeding, the relative risk and benefit for a given patient. Biventricular pacing may overcome many of the adverse hemodynamic effects associated with RV pacing alone. A target individual ectopic foci ablation within the pulmonary vein (PV) has evolved to circumferential electrical isolation of the entire PV musculature. Cavotricuspid isthmus should be considered as first-line therapy for patients with typical atrial flutter. Completely non-fluoroscopic ablation guided by Real-Time Magnetic Resonance Imaging (RTMRI) using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology.展开更多
Background:The coronary venous system is increasingly targeted for pacing in patients with severe heart failure. The recent advancement of Multi-Detector Computed Tomography (MDCT) allows accurate analysis of the coro...Background:The coronary venous system is increasingly targeted for pacing in patients with severe heart failure. The recent advancement of Multi-Detector Computed Tomography (MDCT) allows accurate analysis of the coronary arteries, but little data exist on its role in assessing cardiac venous anatomy. The aim of the present study was to investigate the feasibility of using MDCT in evaluating the cardiac venous anatomy in patients with heart disease;Methods and Results: One hundred and eighteen subjects (59 ± 11 years, 100 males) were studied by contrast enhanced 16-slice CT with retrospective ECG-reconstructions. The diameter, length, and angulations of coronary veins were measured from both volume rendered 3-dimensional images and curved multi-planar images. The coronary sinus vein was visualized in all of patients. However, the posterior, postero-lateral, lateral, antero-lateral and anterior veins were found in 71.2%, 50.0%, 65.3%, 9.3% and 96% patients, respectively. Twenty-three (19.5%) subjects had neither postero-lateral nor lateral cardiac veins. The ostial diameter angle of take-off and total length of the postero-lateral and lateral veins ranged from 1.7 - 7.0 mm, 38 - 160 degrees and 2.6 - 10.6 mm, respectively;Conclusions: This study confirms the feasibility of assessing diameter, length, and angulations of coronary veins by MDCT. This non-invasive information should be useful for pre-operative lead placement planning for patients scheduled to have cardiac resynchronization therapy.展开更多
文摘Atrial fibrillation (AF) is estimated that by 2010, approximately 2.6 million people will be affected in USA;by 2050, that number may increase to 10 million patients. Generally, rate control alone is reasonable in some AF patients, especially asymptomatic patients. Restoration and maintenance of sinus rhythm (SR) may be achieved by means of cardioversion, drugs or/ and catheter ablation. Pharmacological therapy can be useful to maintain SR and prevent tachycardia-induced cardiomyopathy. All patients with AF regardless of whether a rhythm or rate control strategy recommend anticoagulant, antiplatelet or both combined therapy for prevention of thromboembolism, except those with lone AF or contraindications. Drug selection should be based upon the absolute risk of stroke, bleeding, the relative risk and benefit for a given patient. Biventricular pacing may overcome many of the adverse hemodynamic effects associated with RV pacing alone. A target individual ectopic foci ablation within the pulmonary vein (PV) has evolved to circumferential electrical isolation of the entire PV musculature. Cavotricuspid isthmus should be considered as first-line therapy for patients with typical atrial flutter. Completely non-fluoroscopic ablation guided by Real-Time Magnetic Resonance Imaging (RTMRI) using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology.
文摘Background:The coronary venous system is increasingly targeted for pacing in patients with severe heart failure. The recent advancement of Multi-Detector Computed Tomography (MDCT) allows accurate analysis of the coronary arteries, but little data exist on its role in assessing cardiac venous anatomy. The aim of the present study was to investigate the feasibility of using MDCT in evaluating the cardiac venous anatomy in patients with heart disease;Methods and Results: One hundred and eighteen subjects (59 ± 11 years, 100 males) were studied by contrast enhanced 16-slice CT with retrospective ECG-reconstructions. The diameter, length, and angulations of coronary veins were measured from both volume rendered 3-dimensional images and curved multi-planar images. The coronary sinus vein was visualized in all of patients. However, the posterior, postero-lateral, lateral, antero-lateral and anterior veins were found in 71.2%, 50.0%, 65.3%, 9.3% and 96% patients, respectively. Twenty-three (19.5%) subjects had neither postero-lateral nor lateral cardiac veins. The ostial diameter angle of take-off and total length of the postero-lateral and lateral veins ranged from 1.7 - 7.0 mm, 38 - 160 degrees and 2.6 - 10.6 mm, respectively;Conclusions: This study confirms the feasibility of assessing diameter, length, and angulations of coronary veins by MDCT. This non-invasive information should be useful for pre-operative lead placement planning for patients scheduled to have cardiac resynchronization therapy.
