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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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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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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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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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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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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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25例房性心动过速的电生理检查和射频消融结果

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中华心血管病杂志 1998年第4期26卷 286-288页

作者：马坚王方正余培桢王锦志许斐张奎俊李一石华伟楚建民方丕华陈柯平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

目的探讨房性心动过速（房速）的发生机制和射频消融结果。方法对２５例房速患者进行心内电生理检查、药物试验和射频消融治疗。结果（１）２４例阵发性房速为折返机制，并且静脉注射三磷酸腺苷的终止率达８７％；而另１例慢性房速则是... 详细信息

目的探讨房性心动过速（房速）的发生机制和射频消融结果。方法对２５例房速患者进行心内电生理检查、药物试验和射频消融治疗。结果（１）２４例阵发性房速为折返机制，并且静脉注射三磷酸腺苷的终止率达８７％；而另１例慢性房速则是异常自律性增加。（２）２４例（９６％）房速消融成功。成功靶点的Ａ波较体表心电图Ｐ′波（Ａ－Ｐ′间期）提前３８±１１ｍｓ，明显长于非成功靶点（２６±７ｍｓ，Ｐ＜０．０５）。消融成功部位主要位于房内特殊的解剖区域。结论成年人阵发性房速的主要发病机制是折返性，并对三磷酸腺苷敏感。

关键词：心动过速房性心动过速电生理学导管消融术

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