脑皮层和自主神经活动的因果作用

精神紧张、焦虑等脑活动可以导致心脏疾病,而冥想能够改善心脏功能.采用心率变异性、有向传递函数和校正条件熵的方法研究了不同脑任务引起心脏功能的变化以及皮层脑活动和心脏活动的耦合模式.结果表明,意识活动可以通过抑制交感神经减慢心率,通过抑制副交感神经和激活交感神经加快心率.并且意识活动调节自主神经过程中脑皮层中央后区到前区的信息流增加,心脑间的耦合程度显著增强.有向传递函数和校正条件熵方法有望成为分析脑电信号的功能耦合及脑到心脏信息传递的有力工具.     

心率变异性评估运输应激对Beagle犬自主神经功能的影响

目的 基于心率变异性(heart rate variability,HRV)分析评估运输应激对Beagle犬自主神经功能的影响,并界定其恢复期.方法 16只Beagle犬随机分成两组(每组8只),即对照组和运输应激组,利用大动物无创生理信号遥测技术,分别监测清醒自由活动状态下对照组和运输应激组应激4 h后、恢复1、2、...     

三维标测环肺静脉前庭隔离术后肺静脉狭窄的相关因素

目的：探讨房颤射频消融术后肺静脉狭窄的相关因素,为其预防提供依据。方法：收集113例射频消融房颤患者的临床资料,记录射频术中消融时间、阻抗和温度;术后6个月64层CT左房-肺静脉重建随访,统计肺静脉狭窄的发生率;多元Logistic回归分析肺静脉狭窄的相关因素。结果：依据肺静脉数量计算的肺静脉狭窄率为3．4％,按照患者数量计算的肺静脉狭窄率为7．7％。多元Logistic回归分析,初始50例手术较其后病例的OR为2．167,95％CI=I．038-9．857,P=0．046,消融时间在总消融时间均数之上的患者比在均数之下者OR为2．856,95％CI=1．352-6．043,P=0．021。结论：初始50例手术和消融时间长是房颤射频消融术后肺静脉狭窄的相关因素。     

三维标测环肺静脉前庭隔离术后肺静脉狭窄的相关因素

目的:探讨房颤射频消融术后肺静脉狭窄的相关因素,为其预防提供依据。方法:收集113例射频消融房颤患者的临床资料,记录射频术中消融时间、阻抗和温度;术后6个月64层CT左房-肺静脉重建随访,统计肺静脉狭窄的发生率;多元Logistic回归分析肺静脉狭窄的相关因素。结果:依据肺静脉数量计算的肺静脉狭窄率为3.4%,按照患者数量计算的肺静脉狭窄率为7.7%。多元Logistic回归分析,初始50例手术较其后病例的OR为2.167,95%CI=1.038~9.857,P=0.046,消融时间在总消融时间均数之上的患者比在均数之下者OR为2.856,95%CI=1.352~6.043,P=0.021。结论:初始50例手术和消融时间长是房颤射频消融术后肺静脉狭窄的相关因素。     

双极射频消融改良迷宫术治疗房颤的中远期疗效及其影响因素分析

目的:分析心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的术后中远期疗效及其影响因素。方法:选取2007年7月至2010年12月于我院行心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的72例患者,术后随访3至6年,获得患者术后十二导联心电图、24 h动态心电图和心脏彩超结果,并且记录术后药物应用、相关并发症、心功能恢复情况及生活质量是否改善等情况。根据心电图结果,将患者分为窦性心律组与非窦性心律组,应用统计学方法比较两组患者术前相关因素是否有差异。结果:截止至随访终点,有效随访的68例患者中窦性心律维持率为63.2%。单因素分析显示术前房颤病程、术前左室射血分数、是否合并三尖瓣成形或置换是影响手术效果的影响因素,多因素分析显示术前房颤病程、合并三尖瓣成形或置换是影响手术效果的危险因素。结论:心脏瓣膜置换同期行双极射频消融改良迷宫术治疗房颤的中晚期疗效好,术后并发症少,能够有效防止血栓栓塞,术前房颤病程长、合并三尖瓣成形或置换的患者术后中远期效果相对较差。     

肺静脉口弧形指数与房颤消融术后复发的关系

目的:探讨肺静脉口弧形指数与心房颤动(房颤)导管消融术后复发的关系。方法:选取2008年2月至2011年3月在我院接受导管消融术的房颤患者120例,所有患者于术前3日内利用多排CT行左心房及肺静脉造影,并进行图像的三维重建。测量每条肺静脉前后径及上下径,并计算弧形指数(肺静脉前后径/肺静脉上下径)以描述肺静脉口形态。行射频消融治疗的房颤病人全部达消融终点,术后随访超过3个月,根据患者房性快速性心律失常(房颤、房扑或房速)的发生情况,将其分为治愈组和复发组,进行统计分析。结果:由弧形指数分析,四支肺静脉开口形态存在统计学差异(P0.05);房颤消融术后,53例病人复发。房颤消融术后复发患者的LIPV弧形指数与治愈者不同,差异有显著性(P0.05);两组患者的左上肺静脉(Left Superior Pulmonary Vein,LSPV),右上肺静脉(Right Superior Pulmonary Vein,RSPV),右肺下静脉(Right Inferior Pulmonary Vein,RIPV),的弧形指数比较差异不明显(P0.05)。结论:左下肺静脉形态的不一致性与房颤导管消融术复发有关。     

2型糖尿病患者心率变异性与心率减速力的相关性及其对自主神经功能的评估价值

目的:探讨2型糖尿病(T2DM)患者心率变异性(HRV)与心率减速力(DC)的相关性及其对自主神经功能的评估价值。方法:选取2018年1月～2019年12月期间合肥市第一人民医院收治的120例T2DM患者为研究对象,纳入实验组,其中单纯T2DM患者69例(单纯T2DM组),T2DM伴周围神经病变(DPN)患者51例(DPN组),另选同期在我院进行心功能检查的健康志愿者120例作为对照组。所有受试者均进行24h动态心电图检查,根据检查结果计算HRV值[总标准差(SDNN)、两个相邻RR间期互差(PNN50)、差值均方根(RMSSD)]和DC值,根据各组受试者的DC值,统计对比各组的猝死风险,并分析T2DM患者DC值与HRV各项指标的相关性。结果:对照组、单纯T2DM组、DPN组的SDNN、PNN50、RMSSD、DC值依次降低(均P0.05)。对照组、单纯T2DM组、DPN组各猝死风险等级分布整体比较差异有统计学意义(P0.05),单纯T2DM组、DPN组猝死高危比例显著高于对照组,且DPN组猝死高危比例高于单纯T2DM组(均P0.05)。经Pearson相关分析,T2DM患者的DC值与SDNN、PNN50、RMSSD呈明显的正相关(P0.05)。结论:T2DM患者的DC值、HRV指标均低于正常人群,合并DPN的T2DM患者猝死风险明显提高,DC值与HRV指标间存在明显的正相关,可作为T2DM患者自主神经功能状态评估的重要指标。     

强化间歇训练对慢性心衰患者心肺耐力及自主神经功能的影响

目的：探讨强化间歇训练对慢性心衰患者心肺耐力及自主神经功能的影响。方法：34名稳定期慢性心衰患者随机分成试验组和对照组,每组各17名,两组均采用常规药物治疗,其中试验组同时结合间歇运动训练治疗,训练周期12周,前2周为适应性训练,采用功率自行车和30%~50% HRmax强度进行训练,每周训练3次,每次运动20~30 min;后10周采用强化间歇训练,采用功率自行车和运动靶心率=80%~90% HRmax强度训练,训练时间30~40 min,每周训练3次;采用6 min步行距离和心率变异性指标进行效果评价。结果：与试验前比较,12周治疗后,对照组和试验组6 min步行距离均增加,差异具有统计学意义（P<0.01）,反映自主神经功能的时域指标和频域指标均出现增高,差异具有统计学意义（P<0.01）;试验后,试验组6 min步行距离、时域指标和频域指标改变幅度大于对照组,差异具有统计学意义（P<0.01）。结论：强化间歇训练可以作为慢性心衰患者心肺耐力提高和自主神经功能改善的康复手段,比单一的药物治疗效果更好。     

心肺压力感受器持续卸荷对前臂血流、血管阻力及心率变异性谱的影响

低压值下体负压（ＬＢＮＰ）可仅使心肺压力感受器卸荷。采用－２ｋＰａＬＢＮＰ实验结果表明：ＬＢＮＰ既不引起动脉血压变化,也不引起心率改变,但却引起基础胸阻抗（Ｚ。）从对照的２１．８±０．４升高到２２．５±０．５Ω（Ｐ＜０．０１）,前臂血管阻力（ＦＶＲ）从１２．３±０．９升高到１９．９±１．４Ｕ（Ｐ＜０．０１）,前臂血流（ＦＢＦ）从对照时７．１±０．５降低到４．３±０．３ｍｌ·ｍｉｎ￣（－１）·１００ｍｌ￣（－１）,心率变异性谱（ＨＲＶ）未发生任何变化,即心肺压力感受器卸荷时心脏自主神经活动水平与均衡性不受影响。由于ＦＶＲ和ＦＢＦ的变化可间接反映外周血管交感传出活动水平,上述实验结果提示,心肺压力感受器对外周血管及心脏自主神经活动的调节可能存在机能分化现象。     

P波离散度对房颤消融术后复发的预测价值

目的：探讨P波离散度对心房颤动（房颤）导管消融术后复发的预测价值。方法：连续收集经导管消融的房颤患者120例,根据是否复发分为复发组与对照组,分别测定和比较两组术后心电图最大P波时限（Pmax）及最小P波时限（Pmin）并计算P波离散度（Pd）。结果：房颤消融术后,53例病人复发,复发组最大P波时限（132±23mm VS 102±25mm）及P波离散度（33±9mm VS 29±10mm）均显著高于非复发组,差异有统计学意义（P〈0.05）。结论：P波离散度可用于辅助预测房颤导管消融术后是否复发。     

心房颤动持续时间与肺静脉直径的关系

目的:评价心房颤动持续时间、房颤负荷与肺静脉直径的关系。方法:133例经CT检查的房颤患者,观察肺静脉直径的大小,统计分析房颤持续时间与肺静脉直径的关系。结果:通过统计学处理,对比其肺静脉直径与房颤持续时间及房颤负荷间关系,认为两者间无统计学意义,房颤病史与肺静脉直径无明显相关性。结论:房颤持续时间对肺静脉直径不产生影响。     

Evaluation Of Atrial Fibrillation Burden Before Catheter Ablation Predicts Outcome After Pulmonary Vein Isolation

Background

Paroxysmal atrial fibrillation (PAF) is defined as recurrent AF terminating spontaneously within 7 days. This definition allows the consideration of any AF occurrence lasting < 7 days as paroxysmal, irrespective of the frequency and duration of episodes. The aim of this study was to investigate symptomatic AF burden (AFB) defined as total duration of symptomatic AF episodes within 3 months prior to abalation, for prediction of outcome after pulmonary vein isolation (PVI).

Methods

A total of 320 consecutive patients with symptomatic AF (PAF=244, men=214, age=58 y) were enrolled. AFB in patients with PAF was defined as time spent in AF within 3 months prior to PVI. After the AFB cut-off point was optimized at 500 h, patients with PAF were categorized into 2 groups: Group 1 - patients with AFB< 500 h (n=192), Group 2 - patients with AFB≥ 500 h (n=52). Patients with persistent AF (PersAF, n = 76) comprised control group (Group 3). PVI was performed either with irrigated tip catheter (n=215) or using cryoballoon (n=105). The endpoint of study was first documented recurrence of AF >30 sec.

Results

Symptomatic AFB was found to be appropriate for prediction of outcome after PVI. The freedom from AF within 2 years was observed in 69%, 31%, and 43% patients in Group 1, 2 and 3, respectively (Group 1 vs. Group 2, p < .001; Group 1 vs. Group 3, p< .001; Group 2 vs. Group 3, p = 0.46).

Conclusions

Low AFB < 500 h /3 months was associated with better outcome after PVI. Patients with PAF and high AFB should be treated as patients with PersAF.     

Recent Trends in Imaging for Atrial Fibrillation Ablation

Catheter ablation provides an important treatment option for patients with both paroxysmal and persistent atrial fibrillation. It mainly involves pulmonary vein isolation and additional ablations in the left atrium in persistent cases. There have been significant advancements in this procedure to enhance the safety and effectiveness. One of them is the evolution of various imaging modalities to facilitate better visualization of the complex left atrial anatomy and the pulmonary veins in order to deliver the lesions accurately. In this article, we review the electroanatomic mapping systems including the magnetic-based and impedence-based systems. Each of these mapping systems has its own advantages and disadvantages. In addition, we also discuss the role of intracardiac echocardiography and three dimensional rotational angiography in atrial fibrillation ablation.     

Robotic Ablation of Atrial Fibrillation

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure.     

Usefulness of Contrast Intracardiac Echocardiography in Performing Pulmonary Vein Balloon Occlusion during Cryo-ablation for Atrial Fibrillation

BackgroundCryoballoon ablation (CBA) has been proven to be very effective for pulmonary vein (PV) isolation (PVI) if complete occlusion is achieved and conventionally assessed by angiographic injection of contrast within PV lumen. The aim of our study was to assess the usefulness of saline contrast intracardiac echocardiography in guiding CBA with respect to PV angiography.MethodsThirty consecutive patients with paroxysmal atrial fibrillation were randomly assigned fluoroscopy plus color-flow Doppler (n = 15; group 1: an iodinated medium as both angiographic and echographic contrast) or contrast intracardiac echocardiography plus color-flow Doppler (n = 15; group 2: saline contrast) for guidance of CBA.ResultsWe evaluated 338 occlusions of 107 PVs. The intracardiac echocontrastography-guided assessment of occlusion, defined as loss of echocontrastographic back-flow to the left atrium after saline injection regardless of the visualization of PV antrum, showed a high level of agreement with the angiographic diagnosis of occlusion. PVI rate was similar in both groups and effectively guided by intracardiac echocontrastography (PVI using ≤ 2 double cryofreezes: 89% of PVs in group 1 vs. 91% in group 2; p=n.s.). Group 2 patients had significantly shorter procedure (127 ± 16 vs. 152 ± 19 minutes; p<0.05) and fluoroscopy times (30 ± 12 vs. 43 ± 9 minutes, p<0.05) and used a lower iodinated contrast (88 ± 26 vs. 190 ± 47 mL, p<0.05).ConclusionsPV occlusion and PVI during cryoablation can be effectively predicted by intracardiac saline echocontrastography. This technique reduces procedural time, radiological exposure and iodinated contrast use.