论文标题:体内心房除颤治疗心房颤动的临床应用研究
Clinical Study of Internal Atrial Defibrillation in the Treatment of Patients with Atrial Fibrillation
论文作者
论文导师 贾国良,论文学位 博士,论文专业 内科学
论文单位 第四军医大学,点击次数 172,论文页数 156页File Size8045K
2000-06-01论文网 http://www.lw23.com/lunwen_66639637/
atrial fibrillation (AF); transvenous atrial defibrillation(TAD); cardioversion; atrial defibrillation threshold (ADFT); implantable atrial defibrillator (IAD); sick sinus syndrome (SSS); DDD(R) pacing; indication; predictor; atrial stunning; left ventricle; right ventricle; tissue Doppler echocardiography
心房颤动(AF)是最常见的心律失常，会增加死亡率和患病率，恢复窦性心律是治疗房颤的主要目的。体外除颤常常使用很大的除颤能量，需要深层麻醉，而使用抗心律失常药物复律的成功率较低，且有致心律失常的副作用，经静脉心房除颤转复房颤心律为窦性心律的有效性很高。有钙离子超负荷介导的心房重构是“房颤促发房颤”解剖和电生理学基础，这种现象强烈提示我们应该尽早复律。植入型心房除颤器(IAD)及其与其它植入装置的结合，将在治疗不同类型的房颤患者中发挥重要作用。本研究的目的是评估经静脉体内心房除颤治疗急性房颤和慢性房颤的有效性，介绍植入型心房除颤器的临床应用，评估钙通道拮抗剂维拉帕米对IAD患者的心房颤动负荷的影响，进一步探讨具有心房除颤功能的双腔起搏器在病态窦房结综合征患者中临床应用的必要性和可行性。比较心室除颤电极结合冠状静脉窦电极转复房颤的临床效果，最后深入探讨评估早期复律后心房和心室功能的系列改变。 方法和结果 第一部分：76例慢性房颤患者和37例急性房颤患者进行了经静脉体内心房除颤，由右房和冠状经脉窦之间发放R波同步化的双相低能量电流，急性成功率分别为90.1％和100％。15.9％的房颤患者于成功复律后出现了早期复发的房颤，只有1例患者因发放了非R波同步的电流而引起了室颤。平均心房除颤阈值(ADFT)为2.8±1.65J，急性房颤组的ADFT显著低于慢性房颤组。体内除颤的ADFT重复性好，急性房颤组的ADFT重复性较慢性房颤组高(27％vs7.2％P＜0.005)。
BackgroundAtrial fibrillation (AF) is one of the most common arrhythmia and increases the morbidity and mortality. Restoring sinus rhythm is the main aim of the treatment. External cardioversion associated with higher defibrillation energy and deep sedation. Antiarrhythmic drugs had lower conversion rate and proarrhythmic side effects. Transvenous atrial defibrillation is highly effective in converting AF to sinus rhythm. The fact that AF begets AF due to atrial remodeling, which paristly involved by Ca~+ overload strongly implicates early cardioversion of AF. Implantable atrial defibrillator (IAD) and its combination with implantable devices may play an important role in the treatment of different subset patients with AF. The aims of this study are to assess the clinical efficacy of transvenous atrial defibrillation with low energy biphasic shocks between right atrium and coronary sinus in the treatment of patients with acute and chronic AF, to introduce the initial usage of the stand-alone IAD in patients with recurrent AF, to evaluate the effect of Calcium-channel blocker, verapamil on AF burden in patients with an IAD, and to investigate the implication of combining atrial defibrillation mode into a dual chamber pacemaker for patients with sick sinus syndrome, and to compare the efficacy of ventricular defibrillation lead system for atrial defibrillation with or without a CS defibrillation lead, and finally, to assess the serial changes of both atrial and ventricular function after prompt cardioversion.
|
