BACKGROUND Left atrial flutter without prior cardiac interventions is uncommon,especially dual-loop macro-reentry atrial flutter.The critical step to ablate dual-loop macroreentry atrial flutter is to identify the dom...BACKGROUND Left atrial flutter without prior cardiac interventions is uncommon,especially dual-loop macro-reentry atrial flutter.The critical step to ablate dual-loop macroreentry atrial flutter is to identify the dominant loop and key isthmus.Although entrainment mapping could help identify the dominant loop and key isthmus,it may alter or terminate tachycardia.High-density mapping allows the generation of electroanatomic maps without altering or terminating tachycardia.CASE SUMMARY Here,we report a case of symptomatic left atrial flutter without prior intervention.In this case,high-density mapping revealed a dual-loop macro-reentry around the mitral annulus and central scar of the anterior wall.The propagation result showed that the dominant loop was around the mitral annulus,and the key isthmus was between the central scar and mitral annulus.The atrial flutter terminated successfully after ablation was performed.CONCLUSION In this case,we demonstrate that high-density mapping technology may help identify the dominant loop of dual-loop atrial flutter without entrainment,which makes ablation easier.展开更多
A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial fl utter.Endocardial mapping with the carto3 system confi rmed atrial fl utter co...A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial fl utter.Endocardial mapping with the carto3 system confi rmed atrial fl utter counterclockwise reentry around the tricuspid annulus.Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed.However,tachycardia with the same cycle length was induced again.After remapping,the tachycardia was confi rmed to be focal atrial tachycardia located in the crista terminalis.After ablation,the tachycardia was terminated and could not be induced again.展开更多
BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this ma...BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this malignancy.CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgenproducing ACC(21 cm×17 cm×12 cm;2100 g),without metastases,which unusually presented with an acute onset of atrial flutter and congestive heart failure.The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor.Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy,therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC.The atrial flutter was remitted after initiation of drug treatment during admission.The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the firstline treatment to cure the excess of androgen,which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.展开更多
Purpose. To evaluate and compare the effects of heart rate on conduction velocity in the cavotricus-pid isthmus (CTI) and septum in patients with and without typical atrial flutter (AF) using electro-anatomicmapping (...Purpose. To evaluate and compare the effects of heart rate on conduction velocity in the cavotricus-pid isthmus (CTI) and septum in patients with and without typical atrial flutter (AF) using electro-anatomicmapping (EAM) of the right atrium (RA).Methods. Ten patients(age 53±10 yrs,7M/3F)with AF and 13 patients (age 51±11 yrs, 5M/8F) withatrio-ventricular nodal reentrant tachycardia (AVNRT) underwent conventional electrophysionogical study,electro-anatomic mapping and radiofrequency ablation. Using EAMs obtained during coronary sinus pacing at pac-ing cycle length (PCL) 600 ms, 400 ms, and 300 ms, we evaluated conduction velocities in the CTIand septum of RA in 10 patients with AF and compared EAMs to 13 patients with AVNRT to determinewhether the conduction slowing required to maintain AFL was related to changes in volume alone or al-tered RA electrophysiology.Results. Conduction velocities in CTI and septum were significantly slower at all PCL when AF wascompared to AVNRT(*P<0.05). Additionally, in the AF group, septal conduction velocities were slowerat PCL 600 ms and 400 ms, but not at 300 ms compared to CTI (#P<0.05). In AF, during PCL 300.conduction in CTI slowed significantly compared to PCL 600 and 400 ms such that there was no differ-ence between CTI and septum at PCL 300.Conclusionss. There is slower conduction in the septum compared to the CTI in all patients. However,in patients with AF, there is significant slowing of conduction in the CTI and septum as well as decremen-tal rate-dependent slowing of conduction in the CTI. These findings indicate that in addition to RA en-largement, changes in atrial electrophysiology distinguish AF patients from patients with AVNRT.展开更多
BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is ...BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.展开更多
目的:评估无水乙醇注射Marshall静脉(vein of Marshall,VOM)在持续性心房扑动(简称房扑)、心房颤动(简称房颤)二尖瓣峡部线性消融中的有效性和安全性。方法:收集2019年9月—2020年5月上海市胸科医院采用射频消融+无水乙醇注射VOM治疗持...目的:评估无水乙醇注射Marshall静脉(vein of Marshall,VOM)在持续性心房扑动(简称房扑)、心房颤动(简称房颤)二尖瓣峡部线性消融中的有效性和安全性。方法:收集2019年9月—2020年5月上海市胸科医院采用射频消融+无水乙醇注射VOM治疗持续性房扑、房颤患者72例(VOM组)的临床资料,同时选择采用左房线性消融治疗持续性房扑、房颤患者72例作为对照(对照组)。入选患者均行二尖瓣峡部线性消融手术,术中验证二尖瓣峡部线阻断情况,术后随访房性心律失常和心包积液发生情况,均随访12个月以上。结果:VOM组术中验证二尖瓣峡部线阻断63例,其中需要联合心内和心外膜补点消融达到二尖瓣峡部线14例,未能阻断二尖瓣峡部线9例。对照组术中验证二尖瓣峡部线53例,未能阻断19例。随访12~20个月,VOM组房性心律失常复发20例,而对照组房性心律失常复发30例。结论:在持续性房扑、房颤消融治疗中,经VOM行无水乙醇注射能有效阻断二尖瓣峡部线性传导,有助于提高二尖瓣峡部线成功率,减少房颤消融术中二尖瓣峡部相关的房扑发生率,且不增加严重并发症的发生率。展开更多
Hereby we describe a case of LAF developed after a surgical Maze procedure that demonstrates the importance of a systematic approach to mapping and ablating atypical atrial flutter to prevent a recurrence of symptomat...Hereby we describe a case of LAF developed after a surgical Maze procedure that demonstrates the importance of a systematic approach to mapping and ablating atypical atrial flutter to prevent a recurrence of symptomatic arrhythmia. In patients with previous cardiac surgery procedures, and in particular after a surgical maze, there are many different potential LA reentry circuits that involve various pathways. Both activation mapping and entrainment mapping were performed in order to identify the critical isthmus of the circuit and to effectively terminate the arrhythmia.展开更多
Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical...Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical atrial flutter, had been already submitted (three times) to ablation procedures in both left (pulmonary vein insulation) and right atria (cavo-tricuspidal isthmus). During the electrophysiological study, a huge and very fast atrial tachycardia was induced: 230 ms cycle length, 1/1 atrio-ventricular conduction with the ventricular rate of 260 bpm, complete left bundle branch block, and clinically recognized by the patient. Four minutes later, a 2/1 AV conduction without branch block permitted mapping and ablation. A high-density mapping around isthmus and coronary sinus (CS) was performed. The analysis of the chronological activation clearly showed a circuit propagation around the CS ostium with a very slow conduction in the anterior zone enlightened by the tight color progression, and counterclockwise activation of the right atrium lateral wall. In anterior zone of CS ostium diastolic fragmented electrograms were detected. After preventing his position localization, radiofrequency delivering (35 W) was effective to interrupt the arrhythmia in 3 seconds. Energy delivering was continued to anchor the lesion to the inferior vena cava. Confirmation of successful ablation was determined by unsuccessful attempts at reinduction of the arrhythmia, in basal state and during infusion of isoproterenol.展开更多
Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strate...Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strategies. Frequent INR checks associated with warfarin along with several adverse side effects of anti-arrhythmics have propelled investigations into novel treatments for atrial fibrillation. Research is focused not only on pioneering new pharmacological antico- agulation and anti-arrhythmic agents but also on improving surgical techniques in hopes of treating the arrhythmia. Here, we first briefly discuss the current treatment options, both pharmacological and non-pharmacological, for atrial fibrillation. We then present a focused review of recent animal and human investigations that examine the use of novel an-ticoagulation agents, mechanisms of new anti-arrhythmics, analyze potential triggers of atrial fibrillation, and highlight the role of genetics in atrial fibrillation.展开更多
In this paper,electrophysiologic study and RFCA were attempted in 3 patientswho had clinical episodes of atrial arrhythmias with multiple ECG recordings.Diagnoses were automatic atrial tachycardia in one,reentrant atr...In this paper,electrophysiologic study and RFCA were attempted in 3 patientswho had clinical episodes of atrial arrhythmias with multiple ECG recordings.Diagnoses were automatic atrial tachycardia in one,reentrant atrialtachycardia in one,and typical atrial flutter in one.Site for atrial flutterablation was based on anatomic barriers in the floor of the right atrinm.Forautomatic atrial tachycardia,the site of earliest activation before the pwave was sought and for reentrant atrial tachycardia,our goal was to identifya site of early activation in a zone of slow conduction.At target sites,20 to40w of radiofrequency energy were delivered during tachycardia.Procedureend point was inability to reinduce tachycardia by atrial pacing and infusionof isoproterenol,Acute success was achieved in all of three patients.Fortachycardia involves reentry(reentrant atrial tachycardia and atrial flutter),successful ablation required severing an isthmus of slow conduction.Foratrial flutter,this was between the tricuspid annulus and the coronary sinus osor between the inferior vena cava and the tricuspid annulus.Abla-tioo ofautomatic and reentrant atrial tachycardia and atrial flutter had a highsuccess rate and caused no complications.Repeat procedures may be requiredfor long-term success,especially in patient with atrial flutter.展开更多
目的通过术中测量三尖瓣-下腔静脉峡部(CTI)依赖心房扑动(房扑)消融前后峡部传导间期百分比,探讨峡部传导间期百分比在CTI线性阻滞消融终点评估的临床价值。方法本研究入组2021年2月至2023年2月诊断CTI依赖房扑并行射频消融治疗患者共37...目的通过术中测量三尖瓣-下腔静脉峡部(CTI)依赖心房扑动(房扑)消融前后峡部传导间期百分比,探讨峡部传导间期百分比在CTI线性阻滞消融终点评估的临床价值。方法本研究入组2021年2月至2023年2月诊断CTI依赖房扑并行射频消融治疗患者共37例(首都医科大学附属北京安贞医院35例,河北省儿童医院2例),术中均诱发CTI依赖房扑,并采用解剖消融方法沿三尖瓣环至下腔静脉行线性消融,术后经右心房激动标测验证CTI呈线性阻滞。分别统计入组患者心动过速周长(TCL)、冠状窦起搏下消融前局部传导间期(P-ABL1)、冠状窦起搏下消融后局部传导间期(P-ABL2),计算局部传导期间百分比(P-ABL2/TCL)。评估P-A BL 2/T C L对诊断C T I双向传导阻滞的价值,并通过消融后激动顺序验证其有效性。结果所有入组患者均采用解剖方法行射频消融,并行激动标测验证CT I呈线性阻滞。术中诱发TCL为(310.00±46.32)ms。术前测定P-ABL1为(92.16±27.65)ms,术后测量P-ABL2为(173.65±16.35)m s,两组数据差异有统计学意义(P<0.001)。术后P-A B L 2/T C L为(0.81±0.12)。P-A B L 2/T C L越接近1,评估C T I双向传导阻滞的特异性及有效性越高。结论采用术前局部传导间期可预估CTI阻滞终点,并结合术后P-ABL2/TCL的方法可提高CTI阻滞线完整性,减少反复消融,提高手术成功率。展开更多
BACKGROUND Atrial arrhythmias such as paroxysmal supraventricular tachycardia(PSVT)and atrial flutter(AF)are common in the perioperative setting.They commonly resolve spontaneously.However,occasionally,they may contin...BACKGROUND Atrial arrhythmias such as paroxysmal supraventricular tachycardia(PSVT)and atrial flutter(AF)are common in the perioperative setting.They commonly resolve spontaneously.However,occasionally,they may continually progress to fatal arrhythmias or cause complications.Therefore,prompt and appropriate management is important.CASE SUMMARY A 46-year-old female patient diagnosed with cervical C6-7 radiculopathy characterized by decreased sensation in the right third,fourth and fifth fingers underwent C6-7 anterior cervical disc fusion surgery.Electrocardiography showed PSVT and ventricular tachycardia during C6-7 disc retraction.However,the patient remained stable.Initial treatment with esmolol and lidocaine for ventricular tachycardia was ineffective.Carotid massage and Valsalva maneuver were attempted but PSVT did not resolve.The surgery was paused,and the patient’s fraction of inspired oxygen was set to 100%.Adenosine was administered for pharmacological management of PSVT.The arrhythmia temporarily resolved.However,it then transformed into AF.Diltiazem was administered,which briefly decreased blood pressure,which immediately recovered.Surgery resumed while the patient was in normal sinus rhythm.She was discharged safely on postoperative day 6 without complications or abnormalities.Currently,she is living a healthy life without arrhythmia recurrence.CONCLUSION Ganglia associated with cardiac arrhythmias in the surgical site should be identified during cervical spine surgery.展开更多
基金the National Science Foundation of China,No.81800292.
文摘BACKGROUND Left atrial flutter without prior cardiac interventions is uncommon,especially dual-loop macro-reentry atrial flutter.The critical step to ablate dual-loop macroreentry atrial flutter is to identify the dominant loop and key isthmus.Although entrainment mapping could help identify the dominant loop and key isthmus,it may alter or terminate tachycardia.High-density mapping allows the generation of electroanatomic maps without altering or terminating tachycardia.CASE SUMMARY Here,we report a case of symptomatic left atrial flutter without prior intervention.In this case,high-density mapping revealed a dual-loop macro-reentry around the mitral annulus and central scar of the anterior wall.The propagation result showed that the dominant loop was around the mitral annulus,and the key isthmus was between the central scar and mitral annulus.The atrial flutter terminated successfully after ablation was performed.CONCLUSION In this case,we demonstrate that high-density mapping technology may help identify the dominant loop of dual-loop atrial flutter without entrainment,which makes ablation easier.
文摘A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial fl utter.Endocardial mapping with the carto3 system confi rmed atrial fl utter counterclockwise reentry around the tricuspid annulus.Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed.However,tachycardia with the same cycle length was induced again.After remapping,the tachycardia was confi rmed to be focal atrial tachycardia located in the crista terminalis.After ablation,the tachycardia was terminated and could not be induced again.
文摘BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this malignancy.CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgenproducing ACC(21 cm×17 cm×12 cm;2100 g),without metastases,which unusually presented with an acute onset of atrial flutter and congestive heart failure.The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor.Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy,therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC.The atrial flutter was remitted after initiation of drug treatment during admission.The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the firstline treatment to cure the excess of androgen,which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.
文摘Purpose. To evaluate and compare the effects of heart rate on conduction velocity in the cavotricus-pid isthmus (CTI) and septum in patients with and without typical atrial flutter (AF) using electro-anatomicmapping (EAM) of the right atrium (RA).Methods. Ten patients(age 53±10 yrs,7M/3F)with AF and 13 patients (age 51±11 yrs, 5M/8F) withatrio-ventricular nodal reentrant tachycardia (AVNRT) underwent conventional electrophysionogical study,electro-anatomic mapping and radiofrequency ablation. Using EAMs obtained during coronary sinus pacing at pac-ing cycle length (PCL) 600 ms, 400 ms, and 300 ms, we evaluated conduction velocities in the CTIand septum of RA in 10 patients with AF and compared EAMs to 13 patients with AVNRT to determinewhether the conduction slowing required to maintain AFL was related to changes in volume alone or al-tered RA electrophysiology.Results. Conduction velocities in CTI and septum were significantly slower at all PCL when AF wascompared to AVNRT(*P<0.05). Additionally, in the AF group, septal conduction velocities were slowerat PCL 600 ms and 400 ms, but not at 300 ms compared to CTI (#P<0.05). In AF, during PCL 300.conduction in CTI slowed significantly compared to PCL 600 and 400 ms such that there was no differ-ence between CTI and septum at PCL 300.Conclusionss. There is slower conduction in the septum compared to the CTI in all patients. However,in patients with AF, there is significant slowing of conduction in the CTI and septum as well as decremen-tal rate-dependent slowing of conduction in the CTI. These findings indicate that in addition to RA en-largement, changes in atrial electrophysiology distinguish AF patients from patients with AVNRT.
基金Anhui University of Chinese Medicine,No.2022LAY012.
文摘BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.
文摘目的:评估无水乙醇注射Marshall静脉(vein of Marshall,VOM)在持续性心房扑动(简称房扑)、心房颤动(简称房颤)二尖瓣峡部线性消融中的有效性和安全性。方法:收集2019年9月—2020年5月上海市胸科医院采用射频消融+无水乙醇注射VOM治疗持续性房扑、房颤患者72例(VOM组)的临床资料,同时选择采用左房线性消融治疗持续性房扑、房颤患者72例作为对照(对照组)。入选患者均行二尖瓣峡部线性消融手术,术中验证二尖瓣峡部线阻断情况,术后随访房性心律失常和心包积液发生情况,均随访12个月以上。结果:VOM组术中验证二尖瓣峡部线阻断63例,其中需要联合心内和心外膜补点消融达到二尖瓣峡部线14例,未能阻断二尖瓣峡部线9例。对照组术中验证二尖瓣峡部线53例,未能阻断19例。随访12~20个月,VOM组房性心律失常复发20例,而对照组房性心律失常复发30例。结论:在持续性房扑、房颤消融治疗中,经VOM行无水乙醇注射能有效阻断二尖瓣峡部线性传导,有助于提高二尖瓣峡部线成功率,减少房颤消融术中二尖瓣峡部相关的房扑发生率,且不增加严重并发症的发生率。
文摘Hereby we describe a case of LAF developed after a surgical Maze procedure that demonstrates the importance of a systematic approach to mapping and ablating atypical atrial flutter to prevent a recurrence of symptomatic arrhythmia. In patients with previous cardiac surgery procedures, and in particular after a surgical maze, there are many different potential LA reentry circuits that involve various pathways. Both activation mapping and entrainment mapping were performed in order to identify the critical isthmus of the circuit and to effectively terminate the arrhythmia.
文摘Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical atrial flutter, had been already submitted (three times) to ablation procedures in both left (pulmonary vein insulation) and right atria (cavo-tricuspidal isthmus). During the electrophysiological study, a huge and very fast atrial tachycardia was induced: 230 ms cycle length, 1/1 atrio-ventricular conduction with the ventricular rate of 260 bpm, complete left bundle branch block, and clinically recognized by the patient. Four minutes later, a 2/1 AV conduction without branch block permitted mapping and ablation. A high-density mapping around isthmus and coronary sinus (CS) was performed. The analysis of the chronological activation clearly showed a circuit propagation around the CS ostium with a very slow conduction in the anterior zone enlightened by the tight color progression, and counterclockwise activation of the right atrium lateral wall. In anterior zone of CS ostium diastolic fragmented electrograms were detected. After preventing his position localization, radiofrequency delivering (35 W) was effective to interrupt the arrhythmia in 3 seconds. Energy delivering was continued to anchor the lesion to the inferior vena cava. Confirmation of successful ablation was determined by unsuccessful attempts at reinduction of the arrhythmia, in basal state and during infusion of isoproterenol.
文摘Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strategies. Frequent INR checks associated with warfarin along with several adverse side effects of anti-arrhythmics have propelled investigations into novel treatments for atrial fibrillation. Research is focused not only on pioneering new pharmacological antico- agulation and anti-arrhythmic agents but also on improving surgical techniques in hopes of treating the arrhythmia. Here, we first briefly discuss the current treatment options, both pharmacological and non-pharmacological, for atrial fibrillation. We then present a focused review of recent animal and human investigations that examine the use of novel an-ticoagulation agents, mechanisms of new anti-arrhythmics, analyze potential triggers of atrial fibrillation, and highlight the role of genetics in atrial fibrillation.
文摘In this paper,electrophysiologic study and RFCA were attempted in 3 patientswho had clinical episodes of atrial arrhythmias with multiple ECG recordings.Diagnoses were automatic atrial tachycardia in one,reentrant atrialtachycardia in one,and typical atrial flutter in one.Site for atrial flutterablation was based on anatomic barriers in the floor of the right atrinm.Forautomatic atrial tachycardia,the site of earliest activation before the pwave was sought and for reentrant atrial tachycardia,our goal was to identifya site of early activation in a zone of slow conduction.At target sites,20 to40w of radiofrequency energy were delivered during tachycardia.Procedureend point was inability to reinduce tachycardia by atrial pacing and infusionof isoproterenol,Acute success was achieved in all of three patients.Fortachycardia involves reentry(reentrant atrial tachycardia and atrial flutter),successful ablation required severing an isthmus of slow conduction.Foratrial flutter,this was between the tricuspid annulus and the coronary sinus osor between the inferior vena cava and the tricuspid annulus.Abla-tioo ofautomatic and reentrant atrial tachycardia and atrial flutter had a highsuccess rate and caused no complications.Repeat procedures may be requiredfor long-term success,especially in patient with atrial flutter.
文摘目的通过术中测量三尖瓣-下腔静脉峡部(CTI)依赖心房扑动(房扑)消融前后峡部传导间期百分比,探讨峡部传导间期百分比在CTI线性阻滞消融终点评估的临床价值。方法本研究入组2021年2月至2023年2月诊断CTI依赖房扑并行射频消融治疗患者共37例(首都医科大学附属北京安贞医院35例,河北省儿童医院2例),术中均诱发CTI依赖房扑,并采用解剖消融方法沿三尖瓣环至下腔静脉行线性消融,术后经右心房激动标测验证CTI呈线性阻滞。分别统计入组患者心动过速周长(TCL)、冠状窦起搏下消融前局部传导间期(P-ABL1)、冠状窦起搏下消融后局部传导间期(P-ABL2),计算局部传导期间百分比(P-ABL2/TCL)。评估P-A BL 2/T C L对诊断C T I双向传导阻滞的价值,并通过消融后激动顺序验证其有效性。结果所有入组患者均采用解剖方法行射频消融,并行激动标测验证CT I呈线性阻滞。术中诱发TCL为(310.00±46.32)ms。术前测定P-ABL1为(92.16±27.65)ms,术后测量P-ABL2为(173.65±16.35)m s,两组数据差异有统计学意义(P<0.001)。术后P-A B L 2/T C L为(0.81±0.12)。P-A B L 2/T C L越接近1,评估C T I双向传导阻滞的特异性及有效性越高。结论采用术前局部传导间期可预估CTI阻滞终点,并结合术后P-ABL2/TCL的方法可提高CTI阻滞线完整性,减少反复消融,提高手术成功率。
基金Supported by The Research fund from Chosun University Hospital.
文摘BACKGROUND Atrial arrhythmias such as paroxysmal supraventricular tachycardia(PSVT)and atrial flutter(AF)are common in the perioperative setting.They commonly resolve spontaneously.However,occasionally,they may continually progress to fatal arrhythmias or cause complications.Therefore,prompt and appropriate management is important.CASE SUMMARY A 46-year-old female patient diagnosed with cervical C6-7 radiculopathy characterized by decreased sensation in the right third,fourth and fifth fingers underwent C6-7 anterior cervical disc fusion surgery.Electrocardiography showed PSVT and ventricular tachycardia during C6-7 disc retraction.However,the patient remained stable.Initial treatment with esmolol and lidocaine for ventricular tachycardia was ineffective.Carotid massage and Valsalva maneuver were attempted but PSVT did not resolve.The surgery was paused,and the patient’s fraction of inspired oxygen was set to 100%.Adenosine was administered for pharmacological management of PSVT.The arrhythmia temporarily resolved.However,it then transformed into AF.Diltiazem was administered,which briefly decreased blood pressure,which immediately recovered.Surgery resumed while the patient was in normal sinus rhythm.She was discharged safely on postoperative day 6 without complications or abnormalities.Currently,she is living a healthy life without arrhythmia recurrence.CONCLUSION Ganglia associated with cardiac arrhythmias in the surgical site should be identified during cervical spine surgery.