房颤相关缓慢心律失常精美医学课件

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1、厦门大学附属中山医院厦门心脏中心心内科黄卫斌房颤及房颤射频消融术相关缓慢型心律失常www.xmheart.comSummary病窦综合征房颤与病窦关系消融术能否替代起搏器治疗消融术相关缓慢心律失常展望病窦综合征窦性心动过缓窦房结变时性功能障碍快-慢综合征慢-快综合征SicksinussyndromePathologyMachanismSss中af发生率？Discoveryofsinusnode1907年structureofsinusnodeThree-dimensionalsinusnodePositionofleadingpacemakersite(iden

2、tifiedbyarrows)inhumans:Sicksinussyndrome平均发病年龄68岁,但可发生于任何年龄,新生儿中亦有发病,年龄大于65岁人群中患病率1/600,占美国植入起搏器病人中的50%病因推测可能为纤维化或缺血,但未能得到充分证实病窦综合征对心房影响房颤与病窦的关系房颤对心房及窦房结电重构作用快-慢综合征房颤治疗可逆转电重构作用病窦合并房颤发生率?慢-快综合征以心率慢为主，合并房颤、房扑，用药存在矛盾是否可行消融治疗？JCardiovascElectrophysiol.2004Jul;15(7):784-9.Pulmonaryveinis

3、olationforatrialfibrillationinpatientswithsymptomaticsinusbradycardiaorpauses.KhaykinY,NataleA.CenterforAtrialFibrillation,DepartmentofCardiovascularMedicine,TheClevelandClinicFoundation,Cleveland,Ohio44195,USA.INTRODUCTION:Sicksinussyndromeiscommonlyassociatedwithtachyarrhythmiasan

4、dbradyarrhythmiasthatoftenaresymptomatic.Theaimofthisstudywastoassesstheeffectofpulmonaryveinisolationinpatientswithsicksinussyndromeandatrialfibrillation(AF).METHODSANDRESULTS:ThreehundredfourteenconsecutivepatientswhounderwentpulmonaryveinisolationbetweenDecember2000andJanuary2002w

5、ereincludedinthestudy.Thirty-onepatientshadsicksinussyndrome,whichwasdefinedasapreproceduralhistoryofsymptomaticsinusbradycardiaorpauses.EndpointsincludedAFrecurrence,changeinthefrequencyofsinuspauses,andsymptomsofpresyncopeorsyncope,aswellasmeanheartrateandpercentageofatrialpacingin

6、patientswithpacemakersimplantedpriortothepulmonaryveinisolation.PatientshadAFforanaverageof6+/-3years.Patientswere58+/-8yearsoldandhadejectionfractionsof55+/-4%.Sixty-onepercenthadimplantedpacemakers.AFrecurredwithin6monthsin4patients.Twohadasuccessfulsecondpulmonaryveinisolationproc

7、edure.Therewerenorecurrencesofpresyncopalevents(P<0.05)ordocumentedsinuspauses(P<0.05)aftersuccessfulpulmonaryveinisolationinthepatientswithoutpermanentpacemakers.Patientswithpacemakershada13-foldreductioninthepercentageofatrialpacing(P<0.05).Bothgroupsshowedasignificantincreaseinave

8、rageheartrat