心血管
词汇介绍
拓展阅读
解析
Complex 英 /ˈkɒmpleks/ 美 /ˈkɑmplɛks;kəmˈplɛks/
释 义 adj. 复杂的；合成的
n. 复合体；综合设施
短 语 Complex Question 混合问题；复杂问题；复杂问句
complex fraction 繁分数；复合分数；复分数
activated complex 活化络合物；活化复体；活化配合物；活性络合物
complex velocity 复速度；复速率
complex radiation 复电阻率仪；混合辐射；复合辐射
例 句 If the part element has an element attribute, then you have to step to the element to see whether the type is simple or complex. 如果这个部分元素具有一个元素属性，那么您就不得不进入到元素中去查看类型是简单的或是复杂的。
Fractionate 英 /'frækʃ(ə)neɪt/
释 义 v. 把……分成几部分；分馏，用分馏法取得
短 语 fractionate tower 分馏塔
market fractionate 市场细分
gas fractionate unit 气体分馏装置
同根词 adj.fractional 部分的；[数] 分数的，小数的
n.fraction 分数；部分；小部分；稍微
n.fractionation 分别；分馏法
例 句 Velocity and isopyknic gradient centrifugation was employed to fractionate rat myocardialnuclei. 大鼠心肌细胞核采用差速离心和密度梯度离心分离提纯。
Atrial 英 /'eɪtrɪəl/ 美 /'eɪtriəl/
释 义 adj. 心房的；门廊
短 语 atrial tachycardia 房性心动过速房速
atrial systole 心房收缩；心房收缩期
atrial catheter 心房导管
atrial appendage 心耳
例句 Atrial fibrillation is one of the most common arrhythmias. 心房颤动是最常见的心律失常之一。
Electrogram /ɪ'lektrəɡræm/
释 义 电描记图
短 语 Unipolar electrogram 单极电图
subendocardial electrogram 心内膜下电图
intraventricular electrogram 心室电图
Local electrogram 局部电图
例 句 Conclusions: The changes of local electrogram in ablation electrodes were valuablein evaluating a successful ablation. 结论：局部电图变化对判断消融是否成功具有重要意义。
概述
概述
2004年Nademanee等提出针对房颤基质的改良消融策略是为了提高房颤消融的成功率，首次报道复杂碎裂心房电位(CFAE) 消融成功率高达91%。CFAEs在绝大多数房颤患者的缓慢传导区的心内膜处常可记录到较为复杂的碎裂电位变化，该部位可能是多波折返的重要支点，从而诱发房颤的发生。研究认为CFAEs所在区域是房颤维持的关键区域，是重要的房颤基质，可以作为房颤的消融靶点。CFAEs 电位振幅0.05～0.25mV，双极电图记录滤波30～500 Hz。目前临床研究证实将CFAEs消融作为辅助的消融策略能提高房颤消融成功率，对CFAE区域的消融成为了治疗持续、永久性房颤的新的思路。2006年碎裂电位的定义修订为：由2个或者2个以上在基线上下连续波折组成或者由连续碎裂波组成紊乱基线，心房电图期间非常短(≤120 ms)，伴或不伴多个心房电位。
分布特点
其多分布于肺静脉、左房前壁、间隔部、冠状窦部、左房顶部、左房后间隔、二尖瓣峡部。碎裂电位引起房颤的发生及持续的理论依据为多发性子波折返学说，该电位可能是慢传导、折返、传导阻滞、波阵面碰撞、转子或碎裂波形成颤动样传导的关键部位，其电位分布多与左房迷走神经节分布一致。
评估系统
应用CARTO系统内置的CFAEs 分析软件( CFAE Software Module，CARTO XP or CARTO 3 System，Biosense Webster，Inc．) 进行分析。该软件对CFAEs 的识别和计算应满足：①有多个心房电位且电压为0.05～0.25mV; ②心房电位的周长为50～120 ms。以间期置信水平( interval confidence level，ICL)来评估CFAEs 的特点。ICL定义为在2.5 s的心内膜电图内所具有的电图间期的个数。ICL≥7的区域为高度稳定的CFAEs区域。通过CARTO的面积测量功能，分别测量ICL≥7区域的面积和左房的表面积。CFAEs 指数定义为ICL≥7 区域的面积与左房表面积的比值。将CFAEs 指数作为评价左房房颤基质的主要参数。将左房分为前壁、后壁、顶部、下壁、外侧壁、间隔六个部分，评价CFAEs 在左房不同位置的分布特征。
CFAEs 消融终点
①持续性房颤终止，阵发性房颤不能被诱发；
②CFAEs 电位消失。
治疗前景
心房碎裂电位消融属房颤基质消融，但单纯的碎裂电位房颤的手术效果和成功率饱受争议，有研究显示单纯碎裂电位消融而没有继续进行抗心律失常药物治疗的14个月随访时间内，只有3 % 的患者维持窦性心律，即便进行第2 次消融，其成功率也仅为57 %。也有研究认为对于持续性房颤患者联合碎裂电位消融及环肺静脉电隔离治疗效果是较理想的。目前获得的数据表明碎裂电位消融只能作为环肺静脉电隔离术的一种附加术式，而并不能取代环肺静脉电隔离术。环肺静脉消融联合碎裂电位消融虽不能增加房颤射频消融的成功率，但对于术后窦性心律的维持率能进一步提高。
复制标题线性消融后额外的电图引导消融是否会减少长期持续性房颤导管消融后的复发？一项前瞻性随机研究。
发表时间：2017-02-07
影响指数：4.7
作者： Kim TH
期刊：J Am Heart Assoc
Details of the RFCA technique and strategy used in our center were described in our previous study.17 Briefly, we used an open irrigated-tip catheter (Coolflex, St Jude Medical Inc, Minnetonka, MN; 25-35 W; irrigation rate of 10-15 mL/min) to deliver RF energy for ablation. All patients initially underwent CPVI and cavotricuspid isthmus ablation. Roof line, posterior inferior line, and anterior line6 were added as the standard lesion set, also known as the “Dallas lesion set” (Figure 2B). Adenosine-guided dormant conduction elimination strategy was not applied in PV isolation. To generate the posterior box lesion, linear ablation of the roof line and posterior inferior line was performed by connecting both sides of the CPVI at the top and bottom levels, respectively. The anterior line was generated by ablation from the mitral annulus at the 12 o’clock position toward the LA roof line.6 Operators could opt to perform additional ablation in the superior vena cava or non-PV foci at their discretion. In the CPVI+Line+CFAE group, CFAE ablation procedures were guided by CFAE maps. After generating the protocol-directed lesion set, we restored sinus rhythm by internal cardioversion (10- to 20-J biphasic shocks, Physio-Control Corp, Redmond, WA), except for 6 patients whose AF defragmented during additional CFAE ablation. When bidirectional blocks of linear ablation lines were not achieved, additional ablation was performed to generate bidirectional blocks of these lines. However, if bidirectional blocks could not be achieved after 3 attempts of linear ablation, those lines were kept unblocked to avoid collateral damage. If there were mappable AF triggers or atrial premature beats with isoproterenol infusion (5 lg/ min), we carefully mapped and ablated the non-PV foci as much as possible. All RFCA procedures were conducted according to the protocol specified above by 2 operators with more than 10 years of experience.
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