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患者男性,65岁,反复心悸10年.心电图提示房性早搏 、阵发性房性心动过速(简称房速)、心房颤动,体表定位为左侧肺静脉起源.术中冷冻球囊消融行肺静脉电隔离后,仍反复发作房速,电生理标测提示左房顶部局灶性房速.应用冷冻球囊行左房顶部冷冻消融后房速终止,不再诱发.

患者男性,59岁,确诊为无休止性右心耳起源的房性心动过速(简称房速),行导管射频消融治疗失败,遂行冷冻球囊导管冷冻隔离右心耳.采用28 m m冷冻球囊,最低冷冻温度-50℃,有效冷冻180 s,冷冻过程中房速终止.再行-50℃,180 s巩固消融1次.术后半年使用华法林抗凝,随访3年,未见房速复发.

先天性房室传导阻滞是临床少见病，多数无特定病因、不可逆，临床可表现为运动耐量受限、生长发育迟缓，甚至导致心力衰竭、阿斯综合征等，需要置入永久性心脏起搏器治疗。然而目前患该疾病的学龄前儿童起搏器类型、置入部位、起搏模式选择并不完全明确。本文报道了1例先天性房室传导阻滞行左束支区域起搏的3岁学龄前儿童，以期为学龄前儿童行生理性起搏治疗提供一定的经验及依据。

患者,女,16岁,反复心悸1年,再发8h.心电图提示室上性心动过速.术中心房程序刺激呈房室结双径路特征,并诱发典型房室结折返性心动过速且排除房性心动过速、房室旁道介导.消融前后及心动过速发作时,HV间期20～30ms,心室最早激动点位于右室中间隔.提示合并His束与心室异常连接,即束室纤维.且无逆传功能,不参与心动过速折返环路,属旁观通道,未进行消融治疗.

Objective The purpose of this study was to evaluate the efficacy of first generation cryoballon ablation therapy in atrial fibrillation.MethodsOne hundred fifty-nine patients were enrolled in succession,received CBA therapy due to atrial fibrillation from May 2014 to March 2015.Patients were divided into PAF and PeAF groups based on the arrhythmia history;and 28 mm groups and 23 mm ballon groups due to cryoballon diameter;initial 50(1-50 th)and subsequent 101(51-159 th)groups in learning curve.The success rates in 3months,6months,12months and beyond 12months were analyzed during follow-ups.Results During 12～22(16.9±2.9)months follow-up,43 cases recurred(atrial fibrillation and atrial tachycardias)after first 3 months blank periods,and 20 patients received repeat RFCA procedures.the success rate of single CBA therapy was 91.2％(145/159),87.4％(139/159),78.5％(117/149)and 72.7％(101/139)in 3 month,6 months,12 months and after 12 months follow-ups;the CBA success rate was difference between 28 mm(n=112)and 23 mm(n=47)ballon group 93.8％vs.85.1％(P=0.052),91.1％vs.78.7％(P=0.03),84.9％vs.65.1％(P=0.006),and 80.0％vs.59.0％(P=0.01)respectively.In the learning curve phase analysis,the initial 50(1-50 th)and subsequent 101(51-159 th)groups,the success rate was 80.0％vs.96.3％(P=0.002),72.0％vs.94.5％(P=0.007)and 66.7％vs.86.5％(P=0.005)respectively in the follow-ups.Conclusion The first generation balloon CBA therapy may be effective,with high middle-term success rates,especially in paraoxymal atrial fibrillation groups,28 mm balloon group and experience could improve the efficacy.

目的 评估一代冷冻球囊消融(the first-generation cryoballoon ablation,CBA-1)治疗70岁以上药物难治性阵发性房颤患者的疗效与安全性.方法 连续入选2015年4月至2016年5月住院期间院接受28 mm一代冷冻球囊消融术隔离肺静脉(pulmonary vein isolation,PVI)的药物难治性阵发性房颤患者126例,依年龄分为2组(≥70岁组,24例,＜ 70岁组,102例).分析房颤冷冻消融术后随访1年成功率及并发症情况.结果 126例患者平均随访(14.3±2.1)个月,两组患者术后3、6、12及1年后成功率分别为:(87.50％v.s 89.20％,P=0.55)、(83.30％ v.s 87.60％,P=0.57)、(80.90％ v.s 84.60％,P=0.68)、(75％v.s 79.30％,P=0.76).最常见并发症为膈神经麻痹(phrenic nerve palsy,PNP),共出现4例(3.17％),年龄≥70岁组1例,年龄＜ 70岁组2例(4.17％ v.s 2.94％,P=0.78).结论 冷冻消融可作为年龄≥70岁组患者的有效治疗手段,与＜ 70岁组人群相比疗效及安全性差异无统计学意义(P＞ 0.05).

>患者女,22岁,因"反复心悸2年,加剧1个月"入福建省立医院。反复发作性心悸2年病史,每次发作持续1～2 h自行缓解,未诊治。入院前1个月,无诱因心悸再发,持续不能终止,当地医院心电图提示"房性心动过速,149次/min",转诊福建省立医院。期间未用药治疗,心动过速呈无休止,数次心电图均提示房性心动过速(房速)。入院后查甲状腺功能正常,X线胸片、超声心动图未发现心脏结构及功能异常。

目的 探讨阿托品对房颤冷冻消融患者术中及术后血管迷走反射的预防作用.方法 回顾性分析2016年1月至2017年1月在我院行经皮心脏冷冻消融术患者240例的临床资料,根据术中有无应用阿托品分为阿托品组(n=153)和非阿托品组(n=87),比较两组迷走反射发生率.结果 阿托品组发生血管迷走反射3例((发生率2%),非阿托品组发生10例(发生率11.4%).两组迷走反射的发生率差异有显著性(χ2=9.839,P<0.05).结论 术中静脉应用阿托品对迷走反射发生有明显的预防作用,能有效减少术中及术后血管迷走反射发生率.

Objective This study was aimed to evaluate electrophysiological characteristics of earliest activation in ventricular arrythmias originating from right ventricular outflow tract ( RVOT) tachycardia( ventricu-lar tachycardia/premature ventricular contraction, VT/PVC ) by noncontact and contact voltage mapping. Methods Fifty-one patients suffered from RVOT-PVC/VT were enrolled in this study( VT group,23 patients, non-sustained VT;PVC group,28 patients).Ensite Array noncontact mapping(St Jude,USA)was applied to find out the earliest activation( EA) and break out( BO) of PVC/VT,then contact voltage mapping of RVOT was cre-ated during sinus rhythm. The distribution of ablation targets were analyzed accordance with voltage mapping. Results The total success rate was 94.1% in all population(48/51).The success rate in VT group(95.7%, 22/23)compared with that in PVC group(92.9%,26/28).The average target voltage of VT group under sinus rhythm was significantly lower than that in PVC group [(1.0±0.9) mV vs. (1.8±1.6) mV,P=0.045].There was no significant difference in the average target voltage of VT/PVC during clinical arrhythmias[(2.4±2.0) mV vs. (2.7±2.1) mV,P=0. 845],neither was the target duration time advanced to VT/PVC QRS [(40.8± 4. 0) ms vs.(39. 2±3. 6) ms,P=0.180].VT group had more preference originating from low-voltage areas than PVC group(82. 6%vs.50%,P=0.031).The first 10 ms dV/dt in VT group was inferior to PVC group [(0. 9±0. 7)vs. (1. 7±1. 1),P=0.010].The EA-BO time of in VT group was significantly longer than PVC group [(14.3±6.0) ms vs. (10.2±4. 3) ms,P=0.044],and more agressive ablation needed(11/23 vs.6/28,P=0. 034).Conclusions VT group had lower initiate dv/dt and longer EA-BO distance,and needsed more aggressive ablations.The majority originating sites of idiopathic RVOT arrhythmias were located in low-voltage zone.VT group showed preferences.Voltage mapping may play an important role inablation of RVOT-concerned arrhythmias.

<正>5新的猪繁殖生产自动化标准IMV技术公司的GTB 1000是猪繁殖生产中自动控制的新标准,能进行精液剂量自动充填、封装以及贴标签(图6)。GTB 1000能够满足需要小型、可靠、高效和全自动精液包装机器的人工授精中心的要求(图7)。GTB的研发是一个非常成功