慢性心房颤动的导管消融治疗

慢性心房颤动(房颤)的发生和维持机制远较阵发性房颤复杂,导管消融治疗方法还在不断完善和优化,消融策略应包括针对房颤触发灶和维持基质的更广泛的消融方法,包括肺静脉前庭消融隔离、复杂碎裂电位消融和线性消融的阶梯式复合消融方法,可提高慢性房颤治疗的有效性.在目前的认识和技术条件下,慢性房颤的导管消融治疗应在有经验的中心完成.     

如何提高慢性房颤导管消融的成功率

慢性心房颤动（房颤）的基本导管消融方法包括环肺静脉消融隔离、复杂碎裂心房电位消融和线性消融,肺静脉外异位兴奋灶的消融和基质改良是提高慢性房颤消融成功率的有效方法,复合式或个体化消融方案是治疗慢性房颤的趋势,但是如何针对不同患者选择个体化的消融策略进一步提高慢性房颤消融的有效性仍是一大挑战。     

如何提高慢性房颤导管消融的成功率

慢性心房颤动(房颤)的基本导管消融方法包括环肺静脉消融隔离、复杂碎裂心房电位消融和线性消融,肺静脉外异位兴奋灶的消融和基质改良是提高慢性房颤消融成功率的有效方法,复合式或个体化消融方案是治疗慢性房颤的趋势,但是如何针对不同患者选择个体化的消融策略进一步提高慢性房颤消融的有效性仍是一大挑战.     

阵发性心房颤动导管消融策略

导管消融是目前治疗阵发性心房颤动（房颤）的重要手段。消融策略包括阻断房颤的触发病灶和清除房颤的维持机制。消融方法主要为肺静脉隔离、碎裂电位消融、心房去迷走神经、线性消融及上述方法的联合应用。     

阵发性心房颤动导管消融策略

导管消融是目前治疗阵发性心房颤动(房颤)的重要手段.消融策略包括阻断房颤的触发病灶和清除房颤的维持机制.消融方法主要为肺静脉隔离、碎裂电位消融、心房去迷走神经、线性消融及上述方法的联合应用.     

慢性房颤导管消融：挑战与展望

随着对慢性房颤机制认识的深入以及消融方法不断探索,经导管消融在慢性房颤治疗的地位逐渐提高。尽管在适应证、消融策略、获益风险比及远期疗效等还存在一定争议,随着经验的积累和技术的进步,导管消融根治慢性房颤充满希望。     

慢性房颤的导管消融：时机已经成熟

心房解剖及电重构基础上的多发子波折返是慢性房颤的维持机制,支持线性消融策略;导管消融有关的操作逐渐标准化;盐水灌注导管和三维标测系统等新器械不断进展;慢性房颤消融策略的争议逐渐减少,采用肺静脉隔离加线性消融者越来越多;消融终点更多的以肺静脉隔离和线性阻滞为主,以直接终止心动过速为终点者减少。慢性房颤的导管消融时机已经成...     

慢性房颤的导管消融:时机已经成熟

心房解剖及电重构基础上的多发子波折返是慢性房颤的维持机制,支持线性消融策略;导管消融有关的操作逐渐标准化;盐水灌注导管和三维标测系统等新器械不断进展;慢性房颤消融策略的争议逐渐减少,采用肺静脉隔离加线性消融者越来越多;消融终点更多的以肺静脉隔离和线性阻滞为主,以直接终止心动过速为终点者减少.慢性房颤的导管消融时机已经成熟.     

高密度标测技术在心房颤动导管消融中的价值

随着经导管射频消融技术的日趋成熟和三维标测系统的应用普及,导管射频消融术已成为心房颤动(简称房颤),尤其是阵发性房颤的首选治疗方式。高密度标测技术对于有复杂基质的房颤消融有着显著意义。本文主要介绍高密度标测技术在心房颤动导管消融中的价值。     

中国房颤导管消融现状

心房颤动(简称房颤)是临床上最为常见的持续性心律失常。据估计,目前中国房颤患者数量已超过800万。房颤显著增加致死率和致残率,降低生活质量。转复窦律可消除房颤症状,恢复心房功能,降低血栓栓塞风险,改善预后。因此,房颤的治疗以恢复并维持窦性心律为最佳治疗目标。自1998年国内开展房颤导管消融以来,导管消融在房颤治疗中的地位不断提高。     

慢性心房颤动导管消融的若干争议

随着房颤消融技术的迅速发展和提高,阵发性房颤射频消融已列入I类推荐,慢性房颤射频消融也列入Ⅱa类适应证。肺静脉电隔离仍是慢性房颤消融的基石。但由于慢性房颤病因不一,机制更加复杂,除了肺静脉电隔离外,还需进行心房基质改良,其消融策略、术式、终点还存在若干争议。     

心房颤动的外科治疗策略

阵发性心房颤动（房颤）需要“局灶触发”,其触发灶一般位于肺静脉开口附近,持续或永久性房颤同时需要“局灶触发”和心房的“异常基质”两个因素。也有人认为持续或永久性房颤根本不需要触发灶。因此,可靠的肺静脉隔离可以治愈绝大部分阵发性房颤的患者,而持续或永久性房颤则需要进行迷宫手术或与其相似的肺静脉隔离基础上的心房附加隔离线。近年来外科消融发展很快,其原因是该方法可达到与迷宫手术相似的高成功率,而并发症低以及手术时间短则明显优于迷宫手术。外科消融可采用的能量很多,有射频、微波、冷冻等。因为外科一般为永久性房颤的患者,肺静脉开口加左房后壁消融是其基本的消融线。考虑到没有心脏器质性疾病的房颤本身是一种良性心律失常,同时外科消融可能出现的某些重并发症,例如左房食管漏、冠状动脉损伤等,不推荐广泛应用外科消融来治疗孤立的房颤。但对需要进行心脏外科手术的患者合并房颤,无论是永久或阵发性房颤,均应常规进行外科治疗。     

无序的心律有序的认知——心房颤动电生理机制认识过程的回顾与治疗决策的选择

心房颤动（房颤）病因谱广,病理基础呈多样性,电生理机制复杂。本文回顾了房颤电生理机制认识过程的百年历史。提出去除或控制病因是治疗房颤的基础和前提。经外科或导管消融治疗应依据房颤的不同临床背蒂和电生理特征而采用不同的治疗策略。     

Attentional flexibility and perseveration: developmental aspects in young children.

Whereas a growing interest in the development of attentional flexibility (AF) and in perseverative behavior, being one marker of this component, exists in neuropsychological studies and in the domain of developmental psychopathology (e.g., PKU, infantile schizophrenia, autism and Parkinson's disease) (Pennington & Ozonoff, 1996; Stahl & Pry, 2002), only a few studies have concerned themselves with this subject in normal children. It is thus of interest to add more empirical data to the existing literature in this domain. Therefore, the aim of our study was to explore the development of AF and of perseverative errors in young preschool children with normal development, aged 1.5 to 6 years. Using set-shifting tasks of increasing difficulty level, three age groups were compared with respect to their AF skills.Results show a developmental factor underlying AF, with different levels of this form becoming more and more complex with age, ranging from a rudimentary visual form to a complex representational form of flexibility. Overall, few perseverative errors occurred and they decreased with age. Results are discussed from a developmental and neuropsychological perspective.     

Perceptions of Hospitalization by Children with Chronic Illnesses and Siblings

Understanding children’s perceptions of their illnesses and functioning when they are undergoing medical procedures remains an important area for research. Further research about siblings’ perceptions will also provide knowledge about how they are coping with a brother or sister’s chronic illness. The current study examined the perceptions of children with illnesses and their siblings using a play interview. Themes in the data indicated resilience in child functioning for both patients and siblings. Children with chronic illnesses could experience pain, which often related to fears and other negative feelings about hospitalization and potentially doctors or nurses, if they were administering painful procedures. Distraction and prayer were coping tools for patients. However, most patients believed their illness and recovery would be a “long journey.” Brothers and sisters of children with chronic illnesses could experience loneliness. A more common report was a strong desire to help and be a support for a brother or sister with an illness. Support from parents was critical for both patients and siblings and both typically enjoyed child life activities. A member-checking process, with a different group of children with illnesses and siblings, was used to audit themes discovered after reviewing play interviews. The audit process supported the positive and negative themes in the data. In the future, examining the impact of magical thinking on outcomes and conducting studies after the children have gained distance from medical trauma will be important. Moreover, increasing a focus on resilience as a hallmark of children’s functioning remains another area for further research.     

Health anxiety moderates the effects of distraction versus attention to pain

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.