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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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先天性心脏憩室临床特点分析(摘要)

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中国循环杂志 1999年第S1期14卷 113-113页

作者：尤士杰姚民李琳杨跃进高润霖乔树宾秦学文姚康宝陈纪林徐义枢陈在嘉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冠心病研究室!100037

Objective:Toelucidatethe differentclinicalfeaturesbetween adultsand children with congenitalcardiac diverticulum- Methods:The clinicalcharacteristicofpatients with congenitalcardiacdiverticulum confirmed by ventriculograpyhyorsurgicaloperationin nine casesinourhospitalwereanalyzedretrospectively-Fourcaseswereadultswith a mean ageof59-3±7-6 years(50～68 years);and5 were children ofage6-5±4-4years(2-5～14 years)- Results: ①Four adults with the left ventricular diverticulum were allincidentally discovered and confirmed by left ventriculography for differential diagnosis- Five children were confirmedin corrected operationforotherseverecongenitalheart malformation- ②The averagediameterof the diverticulum were36-3±11-8 mm (20～48 mm) andthe neck of diverticulum were14-0 ±2-9 mm (10～17 mm) in 4 adults;while the average diameterofthediverticulum were42-0 ±22-0 mm (25 ～80 mm) and the neck ofdiverticulum were 8-6 ±3-9 mm (4 ～12 mm) in 5 children- ③Alladult patients had isolated left ventricular muscular diverticulum with no related complications thus did not been operated- All children,1 with isolateralleft ventricular muscular diverticulum , with bioverticular muscular diverticulum ,2 with right ventricular muscular diverticulum ,and 1 withleftatrialfibrous diverticulum ,underwentsurgicaloperationsuch assuturationofthediverticulum andrepairing ofatrialor verticularseptum ,valvuloplastyoftricuspid valve,replacementof mitralvalve orligation ofartery duct,accordingtothetypes of congenital heart anomales- Conclusion:There are many differentclinicalfeaturesbetweenadults (olderand middle) and children with congenitalcardiacdiverticulum-

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冠心病冠状动脉病憩室北京阜外医院阜外心血管病医院临床特点分析心脏摘要

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双心腔起搏治疗肥厚性梗阻型心肌病血液动力学观察(摘要)

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中国循环杂志 1999年第S1期14卷 117-117页

作者：华伟王方正杨跃进张奎俊余培贞王锦志李一石马坚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:We report our clinical use of dual chamber pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM) and its hemodynamiceffects- Methods:Twenty three patients,16 males and 7 females, mean age of 39 years, with HOCM, were implanted permanent dual chamber pacemaker- Allpatients had clinicalsymptomsrefractoryto medicaltherapy (βblockersand/orCa2 + blockers) and12 ofthem hadsyncope- Mean thickenessoftheventricularseptum was2-1 cm- Results:Thesymptoms weresignificantlyimprovedin20 patientsafter pacing withshort A Vdelay comparedtothose before pacing- Theleft ventricularoutfolwtract(LVOT) pressure gradients werereducedfrom 51-05to 19-07 mmHgafterpacing(p<0-05)-In afollow up of9 months (5～23 months),no patients had syncope- Conclusion:Dual chamberpacingisan effective new methodtotreatpatients with HOCM

关键词：双心腔起搏阜外心血管病医院电生理北京阜外医院肥厚性梗阻型心肌病中国医学科学院中国协和医科大学心血管病研究所循环生理学血液动力学摘要

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下壁导联ST段压低/T波倒置对窄QRS波心动过速的鉴别作用(摘要)

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中国循环杂志 1999年第S1期14卷 119-119页

作者：姚焰邓旭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!100037

Objective : To explore the diagnostic value of STsegment depression Twave inversion on inferior leads during narrow QRScomplex tachycardia- Methods : We analyzed 12 lead electrocardiograms of 205 patients (112 males) during narrow QRS complex supraventricular tachycardia to evaluate the significance of STsegment depression/T wave inversion- All patients underwent complete electrophysiologic evaluation and successful radiofrequency catheter ablation- None ofthem had pre excitation in sinus rhythm- Results : There were 99 atrioventricular node reentrant tachycardias (AVNRT) and 116 AV reciprocating tachycardias (AVRT)- STsegment depression or T wave inversion > 1-5 m V on inferior lead was present more often in AVRTthan in AVNRT, and the sensitivity were 62-5 % vs- 6-7 % ,70-2 % vs- 16-3 % and 64-4 % vs- 6-7 % on lead Ⅱ, Ⅲand aVF,respectively- The mean magnitude of Tinversion of AVRTon lead Ⅱ, Ⅲand aVF1-7 ±0-8 m V,1-6 ±0-8 m Vand 1-5 ±0-8 m V- For AVRT,the specificity of STdepression/Twave inversion were 93 % ,90 % and 93 % on lead Ⅱ, Ⅲand aVF- The percentages of STsegment/T wave inversion on lead Ⅱ, Ⅲand aVFin AVRT with right side accessory pathway were significantly higherthan those with left side accessory pathway (84 % vs- 48 % ,86 % vs- 53 % and 82 % vs- 50 % ,respectively ,all p < 0-001)- Conclusion : The presence of STsegment depression/T wave inversion > 1-5 m V on inferior leads during narrow QRS complex tachycardia , strongly suggests arioventricular reciprocating tachycardia- This finding is helpful for the promptly distinguisgment of orthodromic AVRT using a concealed accessory pathway-

关键词：心动过速阜外心血管病医院电生理心搏过速心律失常北京阜外医院中国医学科学院中国协和医科大学心血管病研究所下壁导联 QRS 鉴别作用 ST 摘要

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