左心耳封堵术后房颤患者生活质量评价及其影响因素研究

摘要 目的：探讨左心耳封堵术（LAAC）术后对房颤（AF）患者的生活质量的影响,并分析其影响因素。方法：回顾性分析兰州大学第二医院2019年3月至2022年3月期间接受LAAC治疗的213例AF患者的临床资料。根据简明健康调查量表（SF-36）将213例LAAC术后AF患者分为低生活质量组（总分≤50分,n=107）和高生活质量组（总分＞50分,n=106）。收集并比较AF患者术前基线资料、实验室资料和影像学资料。采用多因素Logistic回归模型分析LAAC术后AF患者生活质量的影响因素。结果：低生活质量组心房颤动血栓发生危险度（CHA2DS2-VASc）评分高于高生活质量组（P<0.05）。低生活质量组的凝血酶原时间百分比高于高生活质量组（P<0.05）。高生活质量组红细胞水平高于低生活质量组（P<0.05）。高生活质量组的左心室射血分数（LVEF）高于低生活质量组（P<0.05）。多因素Logistic回归分析结果显示：CHA2DS2-VASc评分偏高、LVEF偏低是影响LAAC术后AF患者生活质量的危险因素（P<0.05）。结论：CHA2DS2-VASc评分偏高、LVEF偏低是影响LAAC术后AF患者生活质量的危险因素,可降低LAAC术后AF患者的生活质量。     

三维斑点追踪技术联合左心腔声学造影评价CABG后左心室扭动

摘要 目的：应用三维斑点追踪技术联合左心腔声学造影评价冠状动脉搭桥术后左心室扭动的变化,探讨其评价治疗效果的临床应用价值。方法：(1)选择本院心脏外科接受择期冠状动脉搭桥术的患者30例,男19例,女11例,左室射血分数≥50%。排除急性及陈旧性心肌梗死病史、其他器质性心脏疾病。另外选择30名行冠状动脉造影或冠状动脉CT成像结果正常的人做为对照组,血生化、心电图检查结果正常。同时排除其它器质性疾病。(2)分别于搭桥术前1-3天、术后早期（7-15）天及术后3个月进行超声心动图检查,同时进行左心腔超声造影。开启4D模式,获取左室扭动参数,并进行手术前后对比分析。结果：左心腔造影可以提高设备自动描记的准确性。术前病例组的左室整体扭动幅度明显减低,与正常对照组相比差异具有显著性（P＜0.05）。术后早期左室扭动角度略高于术前,仅中间段增高幅度与术前相比有显著性差异（P＜0.05）。而手术后三个月左室扭动逐渐增强,接近正常对照组,与术后早期相比差异有显著性(P<0.05)。结论：三维斑点追踪显像联合左心腔造影可以准确检测冠状动脉搭桥手术前、后左心室扭动的变化。左室扭动可以敏感地反映术后左室心肌收缩功能的变化。     

经食道超声心动图评估特发性房颤左心房左心耳的价值

目的:研究经食道超声心动图(TEE)评估特发性房颤左心房左心耳的临床价值。方法:选择自2015年1月到2016年8月在医院接受诊治的特发性房颤患者100例纳入本次研究,阵发性房颤92例,记为阵发性房颤组;持续性房颤8例,记为持续性房颤组。另选同期在医院进行健康体检的心功能正常志愿者90例作为对照组。利用TEE对受试者进行检查,对比房颤组与对照组的左心房及左心耳参数,是否含有自发性显影(LASEC)的房颤患者的左心房及左心耳参数,利用TEE分析对房颤患者的预后情况。结果:阵发性房颤组左心房的前后径和左右径,左心耳血流最大的排空速度(Lev)均明显小于对照组,左心耳的面积变化率及最大的充盈速度(Lfv)均明显大于对照组,差异有统计学意义(P0.05)。持续性房颤组左心房的前后径和左右径均明显大于对照组,左心耳的面积变化率、Lev及Lfv均明显小于对照组,差异有统计学意义(P0.05)。阵发性房颤组左心房的前后径和左右径均明显小于持续性房颤组,左心耳的面积变化率、Lev及Lfv均明显大于持续性房颤组,差异有统计学意义(P0.05)。有LASEC者左心房的前后径和左右径均明显大于无LASEC者,左心耳的面积变化率、Lev及Lfv均明显小于无LASEC者,差异有统计学意义(P0.05)。100例房颤患者中发现34例LASEC,占34.00%,其中有18例患者合并有左心耳血栓,占18.00%。总计有66例患者接受导管射频消融疗法,占66.00%,均未在术中及术后7d内出现血栓及栓塞并发症。结论:利用TEE对特发性房颤的患者左心房及左心耳进行评估,有利于更好的辅助患者的临床治疗,值得重视。     

耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效比较及术后短期内听力恢复效果的影响因素分析

摘要 目的：比较耳内镜与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎的疗效,并分析术后短期内听力恢复效果的影响因素。方法：选取2019年3月~2022年2月期间我院收治的158例慢性化脓性中耳炎患者,均接受Ⅰ型鼓室成形术治疗,根据手术方式不同分为耳内镜组（81例）和显微镜组（77例）,比较两组临床疗效及术后6个月的听力恢复不良发生率。收集相关资料,采用多因素Logistic回归分析术后短期内听力恢复效果的影响因素。结果：两组鼓膜穿孔发生例数组间对比无统计学差异（P>0.05）。耳内镜组的手术时间、住院时间短于显微镜组,术中出血量、医疗费用、干耳时间>1个月例数、耳廓麻木发生例数少于显微镜组（P<0.05）。耳内镜组、显微镜组术后6个月的听力恢复不良发生率组间对比无统计学差异（P>0.05）。单因素分析结果显示,慢性化脓性中耳炎患者术后6个月听力恢复效果与鼓室黏膜、鼓膜张肌腱、咽鼓管情况、是否鼓室硬化、听小骨周围是否肉芽包裹、术前鼓室内是否有脓性分泌物有关（P<0.05）。多因素Logistic回归分析显示,鼓膜张肌腱缺损、咽鼓管不通、鼓室硬化、听小骨周围肉芽包裹、术前鼓室内有脓性分泌物是慢性化脓性中耳炎患者术后短期内听力恢复不良的危险因素（P<0.05）。结论：与显微镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎相比,耳内镜下进行手术可缩短手术时间、住院时间,减少术中出血量和住院费用,降低并发症发生率。此外,患者术后短期内听力恢复效果受到鼓膜张肌腱、咽鼓管、鼓室硬化、听小骨周围肉芽包裹、术前鼓室内脓性分泌物等多种因素的影响。     

胶原生物膜在耳内镜下中耳胆脂瘤乳突根治术中的应用效果分析

摘要 目的：探讨胶原生物膜在耳内镜下乳突根治术中的应用效果。方法：选取徐州医科大学附属医院2021年4月至2022年 2月收治的51例中耳胆脂瘤患者进行回顾性分析,其中研究组27例患者予以胶原生物膜修复皮肤缺损,对照组予以颞肌筋膜修复术腔皮肤缺损,观察两组患者术后临床症状,手术时长,术腔完全上皮化时间、干耳时间及术前术后听力改变。结果：研究组术后患者因外耳道进水,存在感染及肉芽生长者1例,予以清理后未再次生长;对照组术后发生1例外耳道口狭窄的情况,予以橡胶扩张管进行扩张并后并定期清理术腔肉芽、脱落痂皮,患者外耳道恢复良好。两组术前耳闷、耳痛、耳鸣及术后耳痛VAS评分无明显差异（P>0.05）;研究组术后耳闷及耳鸣VAS评分较对照组降低（P<0.05）。研究组平均手术时长、术后术腔完全上皮化时间及平均干耳时间短于对照组（P<0.05）。两组术前术后气骨导差（ABG）、平均气导听阈（AC）比较差异均无统计学意义（P＞0.05）。结论：作为术区移植物,胶原生物膜应用于耳内镜下中耳胆脂瘤乳突根治术可加快创面术腔的修复,减少局部创伤与操作步骤,改善临床症状,缩短手术时间、术后术腔完全上皮化时间及获得干耳时间,可作为临床上有效的修复材料。     

鼻内镜下低温等离子刀鼻后神经切断术与鼻内镜下鼻后神经切断术对中重度变应性鼻炎的近远期疗效及安全性分析

摘要 目的：探讨鼻内镜下低温等离子刀鼻后神经切断术与鼻内镜下鼻后神经切断术对中重度变应性鼻炎的近远期疗效及安全性。方法：选择2019年3月到2021年3月来我院诊治的变应性鼻炎患者90例,将其随机分为对照组与观察组,对照组中48例,观察组42例,对照组给予鼻内镜下鼻后神经切断术治疗,观察组给予鼻内镜下低温等离子刀鼻后神经切断术治疗。对比两组患者术前、术后3个月及术后1年的喷嚏、鼻塞、鼻痒、流涕临床症状评分、临床疗效、生活质量评分、血清血管活性肠肽5水平,对比两组并发症发生率。结果：术后3个月及术后1年,两组临床症状评分降低,且观察组较对照组低（P<0.05）;术后3个月,两组的临床症状评分低于同组间术后1年,但对比无差异（P>0.05）。术后3个月及术后1年,观察组的治疗有效率均较高（P<0.05）。术后3个月及术后1年,两组生活质量评分降低,且观察组较对照组低（P<0.05）;术后3个月,两组的生活质量评分高于同组间术后1年,但对比无差异（P>0.05）。术后3个月及术后1年,两组血清血管活性肠肽5水平降低,且观察组较对照组低（P<0.05）;术后3个月,两组的血清血管活性肠肽5水平低于同组间术后1年,但对比无差异（P>0.05）。观察组的并发症发生率较对照组低（P<0.05）。结论：与鼻内镜下鼻后神经切断术相比,鼻内镜下低温等离子刀鼻后神经切断术可提高中重度变应性鼻炎的近远期疗效,且安全性较好。     

腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗子宫肌瘤的回顾性研究

摘要 目的：回顾性分析子宫肌瘤剜除术联合腹腔镜下子宫血管阻断术治疗子宫肌瘤的临床疗效。方法：分析2017年6月~2019年7月期间我院收治的子宫肌瘤患者的临床资料（n=150）。根据手术方法的不同将患者分为A组（腹腔镜下子宫肌瘤剜除术治疗,73例）和B组（腹腔镜下子宫血管阻断术联合子宫肌瘤剜除术治疗,77例）,对比两组术中、内分泌激素、术后恢复指标、妊娠情况、并发症发生率及复发率。结果：两组患者手术时间对比无统计学差异（P>0.05）,B组的术中出血量少于A组,术后排气时间、住院天数、下床活动时间短于A组（P<0.05）。A组术前、术后3个月、术后6个月黄体生成素(LH) 、卵泡刺激素(FSH) 、雌二醇(E₂) 水平组内对比无统计学差异（P>0.05）。B组术前、术后3个月、术后6个月E₂水平呈降低后升高趋势,LH、FSH水平呈升高后降低趋势（P<0.05）。B组术后3个月LH、FSH水平高于A组,E2水平低于A组（P<0.05）。与A组相比,B组的并发症发生率明显下降,组间对比有差异（P<0.05）。B组的妊娠率高于A组,子宫肌瘤复发率低于A组（P<0.05）。两组流产率组间对比无统计学差异（P>0.05）。结论：与单纯子宫肌瘤剜除术相比,结合腹腔镜下子宫血管阻断术治疗子宫肌瘤患者可减少术中出血量,促进患者术后恢复,降低并发症发生率及复发率,虽然其对卵巢功能有轻微、短暂性影响,但可逐步恢复,且有利于提高妊娠率。     

A型肉毒毒素耳后注射治疗帕金森病合并神经性耳鸣患者的疗效探讨

摘要 目的：探讨A型肉毒毒素耳后注射治疗帕金森病合并神经性耳鸣患者的疗效。方法：收集2016年3月至2021年6月苏州大学附属第二医院耳鼻喉科或神经内科门诊就诊或住院的帕金森病患者,追问病史,发现部分患者有单侧或双侧耳鸣症状,并进行电测听+声导抗检查回报,其中有73 %患者有神经性听力下降,根据治疗方法将其分为A型肉毒毒素耳后注射组（实验组,22例）和地塞米松耳后注射组（对照组,22例）,A型肉毒毒素注射组予以100U A型肉毒毒素耳垂后方自上而下3个点注射,地塞米松注射组予以5 mg地塞米松耳垂后方自上而下3个点注射,对比两组鸣残疾评估量表（THI）评分、耳鸣评价量表（TEQ）评分、治疗总有效率、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分、匹兹堡睡眠质量指数（PSQI）评分。结果：两组治疗前THI和TEQ评分比较无差异（P>0.05）,两组治疗后THI和TEQ评分均有所降低,且实验组均低于对照组（P<0.05）;实验组治疗后1周、治疗后4周、治疗后14周治疗总有效率为63.64 %、81.82 %、90.91 %,对照组治疗总有效率分别为63.64 %、63.64 %、72.73 %,两组治疗总有效率比较无差异（P>0.05）,但实验组略高于对照组;两组治疗前HAMA、HAMD评分比较无差异（P>0.05）,两组治疗后14周HAMA、HAMD评分均有多下降,且实验组均低于对照组（P<0.05）;两组治疗前入睡时间、睡眠时间、睡眠质量、睡眠效率、睡眠障碍、日间功能障碍、安眠药物评分以及总分比较无差异（P>0.05）,两组治疗后14周上述各项评分均有所降低,且实验组均低于对照组（P<0.05）。结论：A型肉毒毒素耳后注射治疗帕金森病合并神经性耳鸣患者,可改善耳鸣症状,提高临床治疗效果,缓解焦虑抑郁情绪,改善睡眠质量,值得临床不断深入研究。     

EarWell耳矫治器对新生儿耳廓畸形的效果及其预后不良影响因素分析

摘要 目的：探讨EarWell耳矫治器对新生儿耳廓畸形的效果及其预后不良影响因素。方法：选取我院2019年3月到2022年3月收治的60例（共78耳）耳廓畸形新生儿作为研究对象,依照患儿年龄进行分组,将年龄≤7 d的16例（21耳）患儿分为A组,8-14 d的21例（26耳）分为B组,15-28 d的23（31耳）分为C组,对所有患儿采取EarWell耳矫治器治疗,对比不同组别患儿新生儿耳廓畸形的治疗总有效率,并发症和矫治时间。通过复查随访评价患儿预后情况,将48例（60耳）预后良好的患儿分为预后良好组,将12例（18耳）预后不良的患儿分为预后不良组,对比两组患儿临床相关资料。最后,采用logistic回归分析分析EarWell耳矫治器对新生儿耳廓畸形治疗预后不良的影响因素。结果：三组患儿治疗总有效率差异显著,A组（100.00 %）高于B组（88.46 %）与C组（64.52 %）（P＜0.05）;A组患儿并发症发生率为14.29 %,B组为15.38 %,C组为19.35 %,组间对比有差异（P＞0.05）;预后良好组与预后不良组患儿性别、畸形部位对比无差异（P＞0.05）,预后良好组与预后不良组患儿年龄、耳廓畸形Max分型、外耳道闭锁分级以及容貌耳长差值对比差异显著（P＜0.05）;logistic回归分析结果显示,年龄、耳廓畸形Max分型为新生儿耳廓畸形治疗预后不良的独立影响因素（P＜0.05）。结论：EarWell耳矫治器对于新生儿耳廓畸形矫治效果显著,并发症发生率较低,且年龄越小矫治效果越好。年龄、耳廓畸形Max分型为耳廓畸形新生儿的预后不良的独立影响因素,临床上针对此类患儿需采取一定预防措施,预防预后不良现象的发生。     

重组牛碱性成纤维细胞生长因子外用凝胶联合耳内镜下软骨-软骨膜修补术治疗鼓膜大穿孔的临床研究

摘要 目的：探讨重组牛碱性成纤维细胞生长因子（bFGF）外用凝胶联合耳内镜下软骨-软骨膜修补术治疗鼓膜大穿孔的临床疗效。方法：选择2021年1月-2022年11月在中国人民解放军联勤保障部队第九八一医院接受诊治的鼓膜大穿孔患者120例。将患者根据随机数字表法分为对照组和研究组,各60例。对照组接受耳内镜下软骨-软骨膜修补术,研究组接受重组牛bFGF外用凝胶联合耳内镜下软骨-软骨膜修补术。对比两组愈合情况、听力情况[骨导听阈、气导听阈、气骨导差（A-B gap）]、炎症因子[肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）]和并发症发生情况。结果：研究组的愈合例数高于对照组,平均愈合天数短于对照组（P<0.05）。研究组术后6个月骨导听阈、气导听阈、A-B gap低于对照组（P<0.05）。研究组术后3dTNF-α、IL-1β、IL-6低于对照组（P<0.05）。研究组的并发症发生率低于对照组（P<0.05）。结论：重组牛bFGF外用凝胶联合耳内镜下软骨-软骨膜修补术治疗鼓膜大穿孔,可缩短鼓膜愈合时间,改善患者听力,减轻炎症反应,安全性较好。     

Evaluating the novel parameters for assessing the LAA function and thrombus formation with nonvalvular atrial fibrillation

The dysfunction of left atrial appendage (LAA) is prone to form thrombus when atrial fibrillation (AF) sustained more than 48 h. Traditional 2D-TEE (transesophageal echocardiography) can not accurate evaluate the function of LAA. The purpose of this study is to analyze the relationship of LAA function parameters and thrombus formation in patients with non-valvular atrial fibrillation (NVAF) by real-time three-dimensional transesophageal echocardiography (RT-3D-TEE). High risk patients can be identified according to the characteristics of ultrasonic index in patients with left atrial appendage thrombosis, which has important clinical value and significance in the risk assessment, guiding treatment and judging prognosis. We examined the relationship between the echocardiographic parameters of LAA function and the incidence of thrombus in 102 NVAF patients. They underwent RT-3D-TEE and left atrial appendage thrombus (LAAT)/severe spontaneous echocardiographic contrast (SSEC) was found in 67 patients (thrombus group) but absent in the remaining 35 patients (non-thrombus group). After measured by QLAB software, the LAA functional parameters were significantly associated with LAAT/SEC formation. Univariate analysis indicated that AF time, LAD, LVEF, LAA-OAmax, LAAVmax, LAAVI and LAAEF demonstrated a positive association (P < 0.05). However, logistic regression analysis identified that AF time (OR:1.73, P < 0.05)、LAAEF (OR:4.09, P < 0.01)and LAAVI (OR:3.28, P < 0.01) were independent predictors of LAAT/SSEC. In patients with nonvalvular atrial fibrillation, echocardiographic parameters of LAA function are significantly associated with LAAT/SSEC.     

Variability of the Left Atrial Appendage in Human Hearts

Atrial fibrillation increases the risk of thrombus formation. It is commonly responsible for cerebral stroke whereas less frequently for pulmonary embolism. The aim of the study was to describe the morphology of the left atrial appendage in the human heart with respect to sex, age and weight. Macroscopic examination was carried out on 100 left appendages taken from the hearts of the patients aged 18–77, both sexes. All hearts preserved in 4% water solution of formaldehyde carried neither marks of coronary artery disease nor congenital abnormalities. Three axes of appendage orientation were performed. After the appendage had been cut off, morphological examination was performed in long and perpendicular axes. Measurements of the appendages were taken from anatomical specimens and their silicone casts. We classified the left atrial appendage into 4 morphological groups according to the number of lobes. Most left atrial appendages in female population were composed of 2 lobes. In the male group typically 2 or 3-lobed appendages were observed. The mean left atrial appendage orifice ranged from 12.0 to 16.0 mm and the most significant difference in the orifices between males and females was observed in LAA type 2 (about 3.3 mm). A smaller orifice and narrower, tubular shape of the LAA lobes could explain a higher risk of thrombus formation during nonvalvular atrial fibrillation in women. Knowledge of anatomical variability of the LAA helps diagnose some undefined echoes in the appendage during transesophageal echocardiographic examination.     

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States ¹. Since AF affects primarily elderly people, its prevalence increases parallel with age. As such, it is expected that 15.9 million Americans will be affected by the year 2050 ². Ischemic stroke occurs in 5% of non-anticoagulated AF patients each year. Current treatments for AF include rate control, rhythm control and prevention of stroke ³.The American College of Cardiology, American Heart Association, and European Society of Cardiology currently recommended rate control as the first course of therapy for AF ³. Rate control is achieved by administration of pharmacological agents, such as β-blockers, that lower the heart rate until it reaches a less symptomatic state ³. Rhythm control aims to return the heart to its normal sinus rhythm and is typically achieved through administration of antiarrhythmic drugs such as amiodarone, electrical cardioversion or ablation therapy. Rhythm control methods, however, have not been demonstrated to be superior to rate-control methods ^4-6. In fact, certain antiarrhythmic drugs have been shown to be associated with higher hospitalization rates, serious adverse effects ³, or even increases in mortality in patients with structural heart defects ⁷. Thus, treatment with antiarrhythmics is more often used when rate-control drugs are ineffective or contraindicated. Rate-control and antiarrhythmic agents relieve the symptoms of AF, including palpitations, shortness of breath, and fatigue ⁸, but don''t reliably prevent thromboembolic events ⁶.Treatment with the anticoagulant drug warfarin significantly reduces the rate of stroke or embolism ^9,10. However, because of problems associated with its use, fewer than 50% of patients are treated with it. The therapeutic dose is affected by drug, dietary, and metabolic interactions, and thus requires detailed monitoring. In addition, warfarin has the potential to cause severe, sometimes lethal, bleeding ². As an alternative, aspirin is commonly prescribed. While aspirin is typically well tolerated, it is far less effective at preventing stroke ¹⁰. Other alternatives to warfarin, such as dabigatran ¹¹ or rivaroxaban ¹² demonstrate non-inferiority to warfarin with respect to thromboembolic events (in fact, dabigatran given as a high dose of 150 mg twice a day has shown superiority). While these drugs have the advantage of eliminating dietary concerns and eliminating the need for regular blood monitoring, major bleeding and associated complications, while somewhat less so than with warfarin, remain an issue ^13-15.Since 90% of AF-associated strokes result from emboli that arise from the left atrial appendage (LAA) ², one alternative approach to warfarin therapy has been to exclude the LAA using an implanted device to trap blood clots before they exit. Here, we demonstrate a procedure for implanting the WATCHMAN Left Atrial Appendage Closure Device. A transseptal cannula is inserted through the femoral vein, and under fluoroscopic guidance, inter-atrial septum is crossed. Once access to the left atrium has been achieved, a guidewire is placed in the upper pulmonary vein and the WATCHMAN Access Sheath and dilator are advanced over the wire into the left atrium. The guidewire is removed, and the access sheath is carefully advanced into the distal portion of the LAA over a pigtail catheter. The WATCHMAN Delivery System is prepped, inserted into the access sheath, and slowly advanced. The WATCHMAN device is then deployed into the LAA. The device release criteria are confirmed via fluoroscopy and transesophageal echocardiography (TEE) and the device is released.     

Digitalis Does not Improve Left Atrial Mechanical Dysfunction After Successful Electrical Cardioversion of Chronic Atrial Fibrillation

This study was designed to investigate whether administration of digitalis could improve mechanical function of left atrial appendage (LAA) and left atrium prospectively in patients with atrial stunning. Fifty-four consecutive patients in whom atrial stunning was observed immediately after cardioversion of chronic atrial fibrillation (AF) were randomized into digitalis or control group for 1 week following cardioversion. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed prior to, immediately following, 1 day after and 1 week after cardioversion to measure transmitral flow velocity and LAA flow velocity. Electrical cardioversion of AF elicited significantly slower left atrial appendage peak emptying velocity (LAA-PEV) and peak filling velocity (LAA-PFV) immediately following cardioversion in both groups. 1 day post cardioversion, there were no significant differences in transmitral E wave, A wave, E/A ratio, LAA-PEV, LAA-PFV or left atrial appendage ejection fraction (LAA-EF) between digitalis and control groups. 1 week post cardioversion, no significant differences were found in transmitral E wave, A wave, E/A ratio, LAA-PEV, LAA-PFV or LAA-EF between the two groups. The occurrence rates of spontaneous echo contrast were not significantly different between digitalis and control groups one day and one week post cardioversion. In conclusion, digitalis did not improve left atrial and appendage mechanical dysfunction following cardioversion of chronic AF. Digitalis did not prevent the development of spontaneous echo contrast in left atrial chamber and appendage. This may be due to the fact that digitalis aggravates intracellular calcium overload induced by chronic AF and has a negative effect on ventricular rate.     

Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure

Aims

To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure.

Methods and Results

In this open-label single-center study LAA closure (Amplatzer^TM Cardiac Plug) was performed in 34 consecutive patients (8 women; 73.1±8.5 years) with (n = 17, EN+) or without (n = 17, EN-) integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator^® [EN]; Philips Healthcare). There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm²; p = 0.01). Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035). These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96) or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53). During short-term follow-up of at least 3 months (mean: 8.1±5.9 months) no device-related events occurred.

Conclusions

Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure.

Trial Registration

ClinicalTrials.gov NCT01262508     

Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.     

瓣膜手术同期射频消融改良迷宫术治疗心脏瓣膜病并发房颤患者的疗效及对血清细胞因子的影响

目的:分析瓣膜手术同期射频消融改良迷宫术治疗心脏瓣膜病并发房颤患者的疗效及对血清细胞因子的影响。方法:将80例心脏瓣膜病并发房颤患者依据简单随机法分为对照组和观察组,每组40例。对照组采用心脏瓣膜置换术治疗,观察组采用心脏瓣膜置换术同期射频消融改良迷宫术治疗,比较两组窦性心律转复情况,手术情况,手术前后心功能、血清金属蛋白酶组织抑制因子-1(TIMP-1)、基质金属蛋白酶-1(MMP-1)和基质金属蛋白酶-9(MMP-9)水平的变化以及术后并发症的发生情况。结果:观察组术后当天、术后1月、术后3月及术后6月的窦性心律转复率均显著高于对照组(P0.05),体外循环时间、主动脉阻断时间及术后24 h引流量均明显多于对照组(P0.05)。两组呼吸机使用时间和监护室时间比较差异无统计学意义(P0.05)。术后6个月,两组左室舒张末期内径、左室收缩末期内径、血清MMP-1和MMP-9水平均较术前显著下降,且观察组以上指标明显低于对照组;两组LVEF及血清TIMP-1水平较术前显著上升,且观察组以上指标均显著高于对照组(P0.05)。两组术后均无严重并发症发生。结论:瓣膜手术同期射频消融改良迷宫术治疗心脏瓣膜病并发房颤安全有效,早期窦性心律的转复率高,且可改善患者血清TIMP-1、MMP-1、MMP-9水平。     

The Effects Of Short Time Right Ventricular Pacing On Left Atrial Mechanical Functions

Objectives

Left atrium (LA) plays an important role in left ventricular filling. It is well known that right ventricular apical pacing has unfavorable effects on ventricular systolic and diastolic performance. The aim of this study is to evaluate the LA mechanical functions with 2D echocardiography in patients with a permanent pacemaker after short time ventricular pacing.

Design

Echocardiographic examination was performed in 38 patients (mean age 63.0± 10.9, 18 female) with dual chamber pacemakers or defibrillators (< 20% ventricular pacing within previous 6 months, all of them on sinus rhythm) before and after 4 hours > 90% ventricular pacing at 70 beats per minute in DDD mode with an optimal AV interval. Left atrial volumes (LAV) including at the time of mitral valve opening (Vmax), at closure (Vmin), and at the onset of atrial systole (Volp) were measured. The passive emptying, conduit, active emptying and total emptying volume, stroke volumes were also calculated.

Results

No significant differences were noted at baseline and after pacing for absolute Vmax, Volp, passive emptying, conduit, active emptying, total emptying volumes as well as the volumes indexed to body surface area (p >0.05).

Conclusions

Short - time RV pacing seems to have no acute effects on left atrial mechanical functions.