房颤相关缓慢心律失常精美医学4讲义教材.ppt

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 Summary 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 Discovery of sinus node 1907年 structure of sinus node Three-dimensional sinus node Position of leading pacemaker site (identified by arrows) in humans: Sick sinus syndrome 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？ J Cardiovasc Electrophysiol. 2004 Jul;15(7):784-9. Pulmonary vein isolation for atrial fibrillation in patients with symptomatic sinus bradycardia or pauses. Khaykin Y, Natale A.Center for Atrial Fibrillation, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. INTRODUCTION: Sick sinus syndrome is commonly associated with tachyarrhythmias and bradyarrhythmias that often are symptomatic. The aim of this study was to assess the effect of pulmonary vein isolation in patients with sick sinus syndrome and atrial fibrillation (AF). METHODS AND RESULTS: Three hundred fourteen consecutive patients who underwent pulmonary vein isolation between December 2000 and January 2002 were included in the study. Thirty-one patients had sick sinus syndrome, which was defined as a preprocedural history of symptomatic sinus bradycardia or pauses. Endpoints included AF recurrence, change in the frequency of sinus pauses, and symptoms of presyncope or syncope, as well as mean heart rate and percentage of atrial pacing in patients with pacemakers implanted prior to the pulmonary vein isolation. Patients had AF for an average of 6 +/- 3 years. Patients were 58 +/-8 years old and had ejection fractions of 55 +/- 4%. Sixty-one percent had implanted pacemakers. AF recurred within 6 months in 4 patients. Two had a successful second pulmonary vein isolation procedure. There were no recurrences of presyncopal eve