房颤相关缓慢心律失常精美医学

房颤及房颤射频消融术相关缓慢型心律失常Summary病窦综合征房颤与病窦关系消融术能否替代起搏器治疗消融术相关缓慢心律失常展望病窦综合征窦性心动过缓窦房结变时性功能障碍快-慢综合征慢-快综合征SicksinussyndromePathologyMachanismSss中af发生率？Discoveryofsinusnode1907年structureofsinusnodeThree-dimensionalsinusnodePositionofleadingpacemakersite(identifiedbyarrows)inhumans:Sicksinussyndrome平均发病年龄68岁,但可发生于任何年龄,新生儿中亦有发病,年龄大于65岁人群中患病率1/600,占美国植入起搏器病人中的50%病因推测可能为纤维化或缺血,但未能得到充分证实病窦综合征对心房影响房颤与病窦的关系房颤对心房及窦房结电重构作用快-慢综合征房颤治疗可逆转电重构作用病窦合并房颤发生率?慢-快综合征以心率慢为主，合并房颤、房扑，用药存在矛盾是否可行消融治疗？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-慢综合征房颤终止后长间歇，消融是否有效？房颤可导致窦房结功能障碍房扑\房颤终止后,窦房结功能可恢复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)阵发性房颤(房颤史100±80month),并房颤转律后RR大于3秒(4.8±2.2秒),晕厥6例,近似晕厥11例,2例术前有行起搏器术,5例器质性心脏病或高血压排除无房颤时有窦性停搏者.术式:环肺静脉隔离,左房附加线(左下肺静脉至二尖瓣瓣环,左房顶部线,左房前壁线),三尖瓣峡部线隔离窦房结功能评估CSNRT:大于基础心动周长+400-600ms,起搏60秒,术后6月评估平均心率与心率范围,Holter评估,术后1周\1,3,6月最高心率:最大运动负荷心率,术后1周\1,3,6月消融情况共进行33次消融,1次10人,2次7人,3次3人.暴光时间54±28,手术时间165±11minutes临床结果随访26.0±17.6months,3例病人房颤复发,1例应用药物,房颤不再发作;2例房颤发作减少,其中一例仍有房颤终止时窦性停搏,植入起搏器.17例病人(85%)没有房颤发作,也没有应用药物,均无心动过缓症状.窦房结功能Nosinuspauses≥3secondswereobservedbyambulatorymonitoringduringthefirstweekafterablationorat1,3,and6monthsin19patients.Meanheartrate.conclusionAlthoughthemechanismsresultingintheassociationbetweensinusnodedysfunctionandatrialarrhythmiasremainunknown,thepresentstudydemonstratesthatparoxysmsofAFmayproducedepressionofsinusnodefunctionresultinginprolongedsinuspauses.ThisphenomenonisreversiblebycurativeablationofAF,thusavoidingtheneedforpacemakerimpla