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中国循环杂志 1999年第S1期14卷 129-130页

作者：姚焰王方正张奎俊王崇慧田瑞国孙瑞龙陈新中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective : Ultrasound is considered as an alternative enedrgy for post myocardial infarction ventricular tachycardia due to its good penetration through tissues- This study was designed to observe the effects of acoustic power, duration , repetitive ablations , tissue transducer interface temperature and different sites ofthe ultrasound ablation in vitro- The histological and electrical damages of ultrasound ablation and the feasibility of using ultrasound energy for chronic myocardial infarction scar ablation were also evaluated in vivo- Methods : At 1-8 MHz frequency , Ultrasound ablation were conducted with : ①Different acoustic powers (3-0 ～9-67 W/cm 2) , duration (20 ～90 sec) and repetitive times (1 ～4) ; ②Lesion volume and depth were compared between right and left ventricular muscles ; ③Two different types oftransducers with (model A) and without (model B) direct tissue contact were used in vitro and ①Ultrasound ablation was applied on the epicardium to compare the histological and electrophysiological damages in ten canines ; ②After chronic myocardial infarction , ultrasound ablation was applied on the scar regions in 5 canines in vivo- Results : In vivo : ①While the acoustic powerincreased from 3-0 W/cm 2to 9-67 W/cm 2 ,the lesion depth and volume increased from 1-96 ± 0-18 m m and 64 ±11-40 m m 3to 6-31 ±0-58 m m and 538-51 ±82-63 m m 3, respectively , and there were also significant differences between different powere levels ;Similarly , while the ablation time was prolonged from 30 s to 90 s at fixed acoustic powere levels , the lesion depth and volume significantly increased from 1-93 ±0-22 m m and 58-79 ±13-94 m m 3to 5-75 ±0-45 m m and 445-78 ±82-46 m m 3,respectively ; Repetitive ablations resulted in larger lesion size but such increase was not significant after the fourth time ablation ; Tissue transducerinterface temperature did not displayed a close relationship with thelesion size as acoustic power and ablation time did ; ②Both the lesion dept

关键词：中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理北京阜外医院超声消融心肌实验研究摘要

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射频导管消融右心房后位峡部和间隔峡部治疗典型心房扑动方法的对比研究(摘要)

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中国循环杂志 1999年第S1期14卷 114-115页

作者：马坚王方正余培桢王锦志张奎俊华伟楚建民张澍陈新孙瑞龙中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective : To compare posterior isthmus (inferior vena cava tricuspid annulus isthmus) ablation technique and septal isthmus (tricuspid annulus Eustachian ridge isthmus) ablation technique for typical atrialflutter- Methods :Thirty five patients ( mean age 53 ±15 years) with typical atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with posterior isthmus ablation technique (PIgroup ,15 patients) or septal isthmus ablation technique (SIgroup ,20 patients)- Radiofrequency energy was used to create linear lesion from tricuspid ring to inferior vena cava in the PIgroup and from tricuspid ring to Eustachian ridge in the SIgroup- The ablation technique was changed to the other,if one of the ablation techniques failed to block the isthmus after eight applications of radiofrequency energy- The endpoint of successful ablation included a complete bidirectional conduction block atisthmus and inability to induce atrial flutter- Results : Atrialflutter was present atthe onset of ablation in 10 patients of the PIgroup and in 15 patients of the SIgroup , however the cycle lengths of atrialflutter between the two groups were 240 ±30 ms and 220 ±23 ms ( p < 0-05) ,respectively- The endpoint of successful ablation was achieved in all of the patients without any complication- The ablation technique was changed for two patientsin both groups afterthe primary ablation technique was unsuccessful- The times ofradiofrequency application and proceduretime were notsignificantly differentin both groups- During a mean follow up of 15-4 ±3-8 months ,one patient (PIgroup) experienced atrialflutter recurrence- Conclusion : Radiofrequency ablation oftypical atrialflutteris safe and effective with eitherthe posterioristhmus ablation technique orthe septal isthmus ablation technique- The ablation success rate can be increased when these two techniques are used alternatively-

关键词：中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理北京阜外医院典型心房扑动峡部射频导管消融右心房对比研究摘要

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射频导管消融治疗伴发于Ebstein畸形的房室折返性心动过速

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中国循环杂志 1999年第2期14卷 94-95页

作者：姚焰王方正张奎俊马坚华伟田瑞国朱克平鲁志民孙瑞龙陈新中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室

目的：为治疗伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速，我们对４例患者进行了射频导管消融。方法：４例伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速患者，年龄２５～３４岁，药物治疗效果不佳或不能耐受，遂进行电生理检... 详细信息

目的：为治疗伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速，我们对４例患者进行了射频导管消融。方法：４例伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速患者，年龄２５～３４岁，药物治疗效果不佳或不能耐受，遂进行电生理检查和射频导管消融。结果：４例患者经心内电生理检查均证实为右侧旁路房室折返性心动过速。理想的消融靶点位于房室环、心内ＡＶ波大致相等处，其ＡＶ波间距较长。全部患者的射频导管消融均获成功。结论：射频导管消融通过阻断右侧旁路而治愈伴发于Ｅｂｓｔｅｉｎ畸形的室上性心动过速。正确认识其解剖和电生理特点，是消融成功的关键。附图射频导管消融治疗Ｅｂｓｔｅｉｎ畸形的旁路心内电生理图。图ａ：射频导管消融靶点图，消融导管远端（ＬＡＢｄ）所描记到的ＡＶ波振幅基本相等并有距离，在此进行消融。图ｂ：射频导管消融成功后ＡＶ间距明显增大。ＨＢＥ：希氏束电图ＲＶＡ１～２：右心室心尖部ＣＳ１～１０：冠状静脉窦ＣＳ９～１０：冠状静脉窦近端ＣＳ１～２：冠状静脉窦远端ＬＡＢｐ：消融电极近端３讨论Ｅｂｓｔｅｉｎ畸形是最常伴有预激综合征的先天性心脏病（可达１６．１％），且有１２．９％的患者有阵发性室上性心动过速［１］；与心动过速有关的晕厥及?

关键词： Ebstein畸形室上性心动过速射频导管消融

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中国心脏起搏与电生理发展现状概况

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中国循环杂志 1999年第S1期14卷 132-133页

作者：陈新王方正华伟中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理研究室!100037

The Chinese society of cardiac pacing and electrophysiology organized nationalsurvey on cardiac pacinginthe period from January 1 ,1995 to December31 ,1997- There are 182 hospitals alloverthe country participated inthe survey- Followingisthe result ofthe survey- There were atotal number of5 000 new implanted pacemakersin Chinain 1997- It wasincreased rapidly ( > 15% ) annually compared with thatin 1994 (3 000)- There were about700 pacemakers replacement- Itis estimated there were about6 000 pacemakersimplanted in 1998- The single chamber ventricular(VVI) pacing accountedfor79-6 % oftotalpacemakerimplantation- However,the percentage of Dual chamberand rate responsive pacingisincreasing in 1997 (20-4 % ) ,compared with thatin 1996 (16-1% ) and in 1995 (14-5 % )- The indication for pacemaker implantation wassicksinussyndromein 50% ～53 % patientsand atrialventricular blockin41% ～44 % patients,othersin5 % ～7 % patientsfrom 1995 to 1997- coronary heart disease wasfoundin 50 % ～57 % patients- 66-8 % patients were over60 years old and male was 71-4 % in patientsreceived pacingtherapy- The new pacing technique,including automatic mode switch ,auto capture, mutisite pacing to treat atrialfibrillation and congestive heartfailure ,have been usedin China- SincetransvenousImplantable Cardioverter Defibrillators (ICD) were applied in China in 1996 ,there are a total of 71 ICDimplanted before 1998- Allthe devices werethethird generationICDincluded MedtronicJewel,CPIVantak seriesand Pacesetter Angstrom- The mean age ofpatients was48-7 years,61 males and 10 females- Most ofthem suffered from coronary heart disease and dilated cardiomyopathy- Allthe patients had syncope outof hospital and ventricular fibrillation was found in 27 patients and ventricular tachycardia was found in other 44 patients- Allthe implantation were performed inthe catheterlaboratory without complication- There are total about 20 000 cases were undertaken catheter ablation in China- The arrhythmias for ablation i

关键词：心脏起搏电生理恶性室性心律失常射频导管消融起搏器置入中国医学科学院中国协和医科大学心血管病研究所现状概况

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心肌梗塞细胞L型钙通道、钙运作(Ca^(2+)handling)及钠/钙交换功能研究

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中国循环杂志 1999年第A09期14卷 24-26页

作者：浦介麟 BoydenPA 中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室北京市100037 美国纽约哥伦比亚大学药理系

目的：研究心肌梗塞细胞钙通道、钙运作及钠／钙交换功能变化。方法：运用膜片钳全细胞记录法测细胞膜钙电流，荧光技术测细胞内钙浓度。结果：心肌梗塞细胞钙离子密度明显下降（正常细胞：９－８ ±１－４ｐＡ／ｐＦ，心肌梗塞... 详细信息

目的：研究心肌梗塞细胞钙通道、钙运作及钠／钙交换功能变化。方法：运用膜片钳全细胞记录法测细胞膜钙电流，荧光技术测细胞内钙浓度。结果：心肌梗塞细胞钙离子密度明显下降（正常细胞：９－８ ±１－４ｐＡ／ｐＦ，心肌梗塞细胞：３－７ ±０－６ｐＡ／ｐＦ，Ｐ＜０．０１），肌浆网钙诱发钙释放功能下降，钙回落缓慢而钠／钙交换功能无变化。结论：钙通道及钙运作功能异常可能与心肌梗塞后心力衰竭。

关键词：心肌梗塞钙通道钙运作钠/钙交换

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风湿性心脏病心力衰竭患者抗心脏β_1和M_2受体自身抗体的研究

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临床心血管病杂志 1999年第11期15卷 499-501页

作者：孟宪敏张麟李莉赵荣瑞刘力生中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院分子医学中心北京100037 山西医科大学生理教研室

目的：探讨抗心脏Ｇ－蛋白偶联型β１和Ｍ２受体的自身抗体是否与风湿性心脏病（ＲＶＨＤ）心力衰竭有关。方法：以心脏Ｇ－蛋白偶联受体β１和Ｍ２细胞外第二环表位肽段序列的合成肽作为抗原，应用酶联免疫吸附测定（ＥＬＩＳＡ）... 详细信息

目的：探讨抗心脏Ｇ－蛋白偶联型β１和Ｍ２受体的自身抗体是否与风湿性心脏病（ＲＶＨＤ）心力衰竭有关。方法：以心脏Ｇ－蛋白偶联受体β１和Ｍ２细胞外第二环表位肽段序列的合成肽作为抗原，应用酶联免疫吸附测定（ＥＬＩＳＡ）技术检测５０例ＲＶＨＤ患者和４１例正常人血清中抗心脏β１和Ｍ２受体的自身抗体。结果：５０例ＲＶＨＤ心力衰竭患者中有２０例存在抗心脏β１受体自身抗体（４０．０％），正常组仅５例（１２．２％）；前组又有２４例存在抗心脏Ｍ２受体自身抗体（４８．０％），正常组仅４例（９．８％）。ＲＶＨＤ组β１和Ｍ２自身抗体的滴度分别为１∶１０４与１∶１１７，正常组为１∶４０与１∶２４（Ｐ＜０．０５）；心功能Ⅱ～Ⅲ级的阳性率及抗体滴度也明显高于心功能Ⅳ级。结论：抗心脏β１和Ｍ２受体的自身抗体与ＲＶＨＤ有关，这两种自身抗体可能参与ＲＶＨＤ心力衰竭的病理改变。

关键词： β1肾上腺素能风湿性心脏病心力衰竭自身抗体

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隐匿性后间隔慢传导旁道参与的房室折返性心动过速一例

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中国心脏起搏与心电生理杂志 1999年第1期13卷 62-63页

作者：马坚王方正孙瑞龙楚建民余培桢王锦志张奎俊李一石华伟中国医学科学院心血管病研究所中国协和医科大学阜外心血管病医院临床电生理研究室

由于隐匿性后间隔慢传导旁道的特殊电生理表现，其参与的房室折返性心动过速（ＡＶＲＴ）需与非典型房室结折返性心动过速（ＡＶＮＲＴ）鉴别［１～３］。本文报告１例心中静脉处逆向递减性传导旁道的电生理检查和射频消融过程。１病例... 详细信息

由于隐匿性后间隔慢传导旁道的特殊电生理表现，其参与的房室折返性心动过速（ＡＶＲＴ）需与非典型房室结折返性心动过速（ＡＶＮＲＴ）鉴别［１～３］。本文报告１例心中静脉处逆向递减性传导旁道的电生理检查和射频消融过程。１病例资料及消融过程患者男性，１６岁，阵...

关键词：心动过速 AVRT 电生理检查射频消融心电图

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经皮冠状动脉腔内成形术对心率变异性的影响

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临床心电学杂志 1999年第1期8卷 26-28页

作者：陈柯萍尹彦琳吴永健王方正陈新中国医学科学院阜外心血管病医院电生理研究室中国协和医科大学心血管病研究所

目的本文对２２例行经皮冠状动脉腔内成形术（ＰＴＣＡ）的患者进行２４小时心率变异性（ＨＲＶ）检查，以了解ＰＴＣＡ对心率变异性的影响。方法所有患者均于ＰＴＣＡ术前进行２４小时Ｈｏｌｔｅｒ记录，并于术后１周及３个月重复检查... 详细信息

目的本文对２２例行经皮冠状动脉腔内成形术（ＰＴＣＡ）的患者进行２４小时心率变异性（ＨＲＶ）检查，以了解ＰＴＣＡ对心率变异性的影响。方法所有患者均于ＰＴＣＡ术前进行２４小时Ｈｏｌｔｅｒ记录，并于术后１周及３个月重复检查，ＨＲＶ检查方法包括时域分析（ＳＤＮＮ、ＳＤＡＮＮ和ＳＤＮＮ指数）和频域分析（ＴＦ、ＬＦ和ＨＦ）。结果ＰＴＣＡ术后１周ＨＲＶ值较术前降低。其中时域指标：ＳＤＮＮ、ＳＤＡＮＮ和ＳＤＮＮ指数明显降低（Ｐ＜０．０５）。频域指标：ＴＦ、ＬＦ和ＨＦ亦明显降低（Ｐ＜０．０５）。术后３个月复查，ＨＲＶ恢复至术前水平。结论ＰＴＣＡ术后１周ＨＲＶ明显下降，但这种早期的自主神经功能损伤是暂时的。

关键词： PTCA 心率变异性自主神经功能冠心病

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快速房性心律失常的电生理研究和射频导管消融治疗(摘要)

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中国循环杂志 1999年第S1期14卷 121-121页

作者：马坚王方正楚建民余培桢王锦志张奎俊华伟张澍中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective :To report the results of electrophysiologic study and radiofrequency ablation for patients with atrial tachycardia and patients with typical atrialflutter- Methods : There were fifty six patients ,including thirty two with atrialtachycardia ( AT, mean age 37 ±17 years , paroxysmal ATin 30 cases and chronic ATin 2 cases) and twenty four patients with atrialflutter ( AFL, mean age 55 ±14 years ,paroxysmal AFLin 8 cases and persistent AFL in 16 cases)- AT was induced by atrial stimuli,and intravenous adenosine triphosphate ( ATP) 20 ～30 mg was given during AT- The mapping and ablating catheter is positioned in the right or left atrium to locate the ablation target site with earliest atrial activation of AT- Radiofrequency ablation at the inferior vena cava tricuspid annulus or the tricuspid annulus Eustachian ridge isthmus was performed in 24 patients with AFL- Successful ablation endpoints : ATnot induced for AT patients ; and bidirectional conduction block atisthmus for AFL patients- Results :The suspected mechanism of paroxysmal AT in 30 patients was related to reentry , and in the other 2 cases with chronic AT was probably due to abnormal automaticity- ATPwas effective in terminating 87 % ofthe paroxysmal AT- ATwas successfully ablated in 31 patients- The mean local endocardial electrogram timing relative to P wave onset was 38 ±11 ms at successful ablation sites , which was significantly longer than that at unsuccessful ablation sites (26 ±7 ms , p < 0-05)- Radiofrequency ablation was performed during atrial flutter in 16 patients or during sinus rhythm in the other 8 patients ;complete ischmus bidirectional block was achieved in all 24 patients- During a follow up of 15 months ,tachycardia recurred in 2 patients with ATand in 1 with AFL- However ,second ablation was successful in these three patients- Conclusion : Radiofrequency ablation had shown to be an effective method to treat ATand AFL- Itis suggested thatthe major mechanism of AT in adult patien

关键词：快速房性心律失常心房激动右心房阵发性心房刺激房速房扑生理研究

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埋藏式心脏复律除颤器治疗快速室性心律失常随访观察(摘要)

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中国循环杂志 1999年第S1期14卷 125-125页

作者：华伟王方正陈新中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective : To observe the efficacy of implantable cardioverter defibrillator to treat ventricular tachyarrhythmias- Methods : Twenty six patients ,23 males and 3 females , mean age of 48-08 years were implanted nonthoracotomy ICDsystems- The indications for implantation were VFin 18 patients and refractory VTin 8- All patients had syncope out of hospital- The device is the third generation ICD with multitherapies including antitachycardia pacing (ATP) , cardiovertion and defibrillation and data storing functions- All patients were followed up at least once after ICDimplantation- Results :In the follow up of 9-4 (2 ～26) months ,13 out of 26 patients (50 % ) received ICD therapy- The data stored in ICD showed that totally 187 episodes were detected by the devices- 54 of them were nonsustained VT which spontaneously terminated- 133 VT/ VF episodes were treated by ICD- 110 ofthem were VT,42 were terminated by ATPand 61 by low energy cardiovertion- 2 episodes were sinus tachycardia- Another 5 VT were accelerated to VFand terminated by high energy shocks- There were 23 VFepisodes diagnosed by the devices , however 4 of them were confirmed VT with rate over VFdetection criterion by reviewing the stored electrocardiogram- Allthe episodes were terminated by shocks- 2 patients died of heartfailure during the follow up- Conclusion : The third generation ICD with multitherapy function has high efficacy in the termination of ventricular tachyarrhythmias- It is importantto follow up the patients and set appropriate parameters for diagnosis and therapy by ICD-

关键词：室性心律失常埋藏式心脏复律除颤器随访观察中国医学科学院中国协和医科大学心血管病研究所心动过速心搏过速心律失常心律转复除颤器摘要

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