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Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation

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Chinese Medical Journal 2006年第24期119卷 2036-2041页

作者： LI Yi-gang Gerian Gronefeld Carsten Israel LU Shang-biao WANG Qun-shan stefan h hohnloser Department of Cardiology Xinhua Hospital Shanghai Jiaotong University Shanghai 200092 China Department of Medicine Division of Cardiology J.-W.Goethe-University Frankfurt Germany

Background Atrial tachycardia or flutter is common in patients after orthotopic heart transplantation. Radiofrequency catheter ablation to treat this arrhythmia has not been well defined in this setting. This study was conducted to assess the incidence of various symptomatic atrial arrhythmias and the efficacy and safety of radiofrequency catheter ablation in these patients. Methods Electrophysiological study and catheter ablation were performed in patients with symptomatic tachyarrhythmia. One halo catheter with 20 poles was positioned around the tricuspid annulus of the donor right atrium, or positioned around the surgical anastomosis when it is necessary. Three quadripolar electrode catheters were inserted via the right or left femoral vein and positioned in the recipient atrium, the bundle of his position, the coronary sinus. Programmed atrial stimulation and burst pacing were performed to prove electrical conduction between the recipient and the donor atria and to induce atrial arrhythmias. Results Out of 55 consecutive heart transplantation patients, 6 males [（58±12） years] developed symptomatic tachycardias at a mean of （5±4） years after heart transplantation. Electrical propagation through the suture line between the recipient and the donor atrium was demonstrated during atrial flutter or during recipient atrium and donor atrium pacing in 2 patients. By mapping around the suture line, the earliest fragmented electrogram of donor atrium was assessed. This electrical connection was successfully ablated in the anterior lateral atrium in both patients. There was no electrical propagation through the suture line in the other 4 patients. Two had typical atrial flutter in the donor atrium which was successfully ablated by completing a linear ablation between the tricuspid annulus and the inferior vena cava. Two patients had atrial tachycardia which was ablated in the anterior septal and lateral donor atrium. There were no procedure-related complications. Patients w

关键词： atrial flutter atrial tachycardia heart transplantation ablation

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Stepwise approach to substrate modification of ventricular tachycardia after myocardial infarction

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Chinese Medical Journal 2006年第14期119卷 1182-1189页

作者： LI Yi-gang Gerian Groenefeld Carsten Israel LU Shang-biao WANG Qun-shan MENG Shu stefan h hohnloser Department of Cardiology Xinhua Hospital Shanghai Jiao Tong University Shanghai 200092 China Department of Medicine Division of Cardiology J. W. Goethe- University Frankfurt Germany

Background Recently, substrate mapping （SM） has been described to facilitate catheter ablation of stable and unstable ventricular tachycardia （VT） after myocardial infarction. however, SM is time consuming with potential disadvantages of multiple ablation lines such as impairment of ventricular function or proarrhythmia. The aim of the present study was to delineate a stepwise approach to SM to shorten procedure time and limit the possibility of complications. Methods SM was performed in 14 infarct survivors referred for VT ablation using an electroanatomical mapping system （CARTO） to define infarct regions. A new stepwise approach for SM was designed as follows. The initial ablation site was identified by pace- and entrainment mapping in case of stable VT and by pace mapping only in case of unstable VT. Based on the CARTO voltage mapping, linear ablation was done from this site to the center of the scar and perpendicular to the boundary of the scar or to the mitral annulus. Additional lines were performed only when VT remained inducible. A maximum of 3 ablation lines were created during one procedure. Results A total of 57 VTs （21 stable, 36 unstable） were induced during the procedures. VT was no longer inducible after the first linear ablation in 2 patients, after the second linear ablation in 6 patients and after the third linear ablation in 3 patients. Either VT or ventricular fibrillation was still inducible at the end of the procedure in 3 patients. Procedure time averaged （291 ±85） minutes, fluoroscopy time （10±7） minutes. VT recurred in 3 patients. Following a second procedure in 2 patients, there were no further VT recurrences. Overall, there was a significant reduction in VT episodes 3 months after [median： 0, interquartile ranges （IQR）： 0-1] compared with 3 months before ablation （median： 25, IQR： 16-105, P〈0.01）. Conclusions This stepwise approach to SM is effective in facilitating ablation of stable and unstable VT. It reduces procedure and fluoro

关键词： ventricular tachycardia mapping ablation substrate modification

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Refinement of CARTO-guided substrate modification in patients with ventricular tachycardia after myocardial infarction

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Chinese Medical Journal 2008年第2期121卷 122-127页

作者： LI Yi-gang WANG Qun-shan Gerian Gronefeld Carsten Israel LU Shang-biao ShAO Yun Joachim R. Ehrlich stefan h. hohnloser Department of Cardiology Xinhua Hospital School of Medicine Shanghai Jiaotong University Shanghai 200092 China Department of Medicine Division of Cardiology J. W. Goethe-University Frankfurt Germany

Background Substrate modification guided by CARTO system has been introduced to facilitate linear ablation of ventricular tachycardia （VT） after myocardial infarction （MI）. however, there is no commonly accepted standard approach available for drawing these ablation lines. Therefore, the aim of the present study was to practically refine this time consuming procedure.Methods Substrate modification was performed in 23 consecutive patients with frequent VTs after MI using the CARTO system. The initial target site （ITS） for ablation was identified by pace mapping （PM） during sinus rhythm and/or entrainment pacing （EM） during VT. According to the initial target site, two approaches were used. The initial target site in approach one has a similar QRS morphology as VT and an interval from the stimulus to the onset of QRS cmplex （S-QRS） of ≥50 ms during PM in sinus rhythm or a difference of the post pacing interval and VT cycle length ≤30 ms during concealed entrainment pacing of VT; The initial target site in approach two has an similar QRS morphology as VT and an S-QRS of 〈50 ms during PM in sinus rhythm.Results Overall, 50 lines were performed with a length of （35±11） mm. Procedure time averaged （232±56） minutes, fluoroscopy time （10±8） minutes. Sixteen patients were initially involved into approach one. After completion of 3±1 ablation lines, no further VT was inducible in 13 patients. The remaining 3 patients were switched to use the alternative approach. however, in none of them the alternative approaches were successful. Approach two was initially used in 7 patients. After completion of 3±1 ablation lines, no further VT was inducible in only 2 patients. The remaining 5 patients were switched to approach one, which resulted in noninducibility of VT in 4 of them. The initial successful rate was significantly higher in the group of approach one compared to that in the group of approach two （13/16 patients vs 2/7 patients, P=-0.026）.Conclusions The approach for su

关键词： ventricular tachycardia mapping ablation substrate modification

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压力感受器功能的研究

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德国医学 2000年第1期17卷 29-30页

作者： stefan h.hohnloser 卢青 Medizinische Klinik IV Kardiologie/Nephrologie Johann Wolfgang GoetheUniversitt Theodor-Stern-Kai7 60590 Frankfurt 同济医科大学附属同济医院

压力反射在血液循环调节中占重要地位。可根据血压波动引起的窦房结频率的改变对压力反射敏感性(BRS)进行定量分析。BRS 主要反映迷走反射活性的大小。鉴于心性猝死与自主神经系统的关系,BRS 测定有助于评价自主神经张力,因此 BRS 用评... 详细信息

压力反射在血液循环调节中占重要地位。可根据血压波动引起的窦房结频率的改变对压力反射敏感性(BRS)进行定量分析。BRS 主要反映迷走反射活性的大小。鉴于心性猝死与自主神经系统的关系,BRS 测定有助于评价自主神经张力,因此 BRS 用评价心脏患者猝死的危险性。血压发生变化时,压力感受器通过植物神经介导窦性心率改变,称之为压力反射。

关键词：压力反射压力感受器心肌梗塞 BRS

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心肌梗死后室性心动过速的消融治疗

心肌梗死后室性心动过速的消融治疗

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中华医学会心血管病学分会第八次全国心血管病学术会议

作者：李毅刚 Gerian Grnefeld Carsten Israel 陆尚彪王群山孟舒 stefan h．hohnloser 上海交通大学医学院附属新华医院心内科德国Frankfurt J．W．Goethe大学

目的探讨一种心室基质改良的新方法,以缩短心肌梗死后室性心动过速(室速)消融的手术时间,减少可能的并发症。方法对21例心肌梗死后室速并进行导管消融的患者进行了研究。先用电解剖标测系统(CARTO)确定梗死区,然后进行基质改良。基质改...

目的探讨一种心室基质改良的新方法,以缩短心肌梗死后室性心动过速(室速)消融的手术时间,减少可能的并发症。方法对21例心肌梗死后室速并进行导管消融的患者进行了研究。先用电解剖标测系统(CARTO)确定梗死区,然后进行基质改良。基质改良采用的是一种顺序法,设计如下:首先确定起始消融靶点。对稳定性室速通过起搏标测和拖带标测识别始消融靶点,而对不稳定性室速则只通过起搏标测识别。根据CARTO电压标测,从该起始消融靶点一边向瘢痕中心消融,一边垂直于瘢痕边缘或二尖瓣环进行

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Assessment of slow pathway function after successful radiofrequency modification in patients with typical AV nodal reentry tachycardia by the use of the maximal Ah interval

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Chinese Medical Journal 1997年第12期 28-28页

作者： Yi Gang Li, Frank Bogun, Gerian Grnefeld, stefan h.hohnloser and J.W.Goethe

Background Persistence of slow pathway (SP) function after SP modification is not uncommon after successful rediofrequency (RF) ablation of typical AV nodal reentry tachycardia (AVNRT). Methods and results We compared two methods (maximal Ah interval during decremental atrial stimlation vs occurrence of AV nodal echos or dual AV nodal physiology (DAVNP): ≥50 msec increment in Ah interval with a 10 msec decrement in A1A2) for the assessment of SP function immediately and 40 minutes after successful RF modification of SP. In 31 consecutive patients (age: 51±16 years, 18 women, 13 men) with typical AVNRT, SP modification was performed using a combined anatomic and electrogram guided approach. Immediately after successful SP modification, AV nodal function was assessed. This was repeated 40 minutes later. RF modification of SP was successful in all 31 patients. There was no recurrance during a 5±3 month follow up period. There was no significant difference between the electrophysiological parameters immediately and University of Frankfurt, Germany (Li YG, Bogun F, Grnefeld G, hohnloser Sh and Goethe JW)40 min after successful SP modification. There was evidence of SP function in 14 patients (6 with DAVNP+AV nodal echoes, 8 with either DAVNP or AV nodal echos) immehiately after SP modification. These patients could be differentiated from the patients without remaining SP function by maximal Ah interval (298±102 msec vs 198±72 msec, P=0.004). 40 minutes after the suucessful SP modification, 11 patients displayed SP function (4 patients with DAVNP+AV nodal echos, 7 patients with either DAVNP or AV nodal echos). These patients could also be differentiated from the remaining patients with the use of the maximal Ah interval (294±89 msec vs 189±50 msec, PhDFG3,WK9ZQ,WK6,WK10*2,WK5W]Befroe SP modificationImmediately after RF40 min after RF[BhDZG1*2,WK9ZQ,WK6,WK10*2,WK5W]AVNERP (msec)258±44310±116316±114AVBCL (msec)330±55384±113376±110VABCL (msec)306±6

关键词： Assessment of slow pathway function after successful radiofrequency modification in patients with typical AV nodal reentry tachycardia by the use of the maximal Ah interval AV

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器质性心脏病室性心动过速的消融

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上海医学 2007年第S1期30卷 25-25页

作者：李毅刚王群山陆尚彪邵芸 stefan h.hohnloser Carsten W.Israel Gerian Grnefeld 俞洁霏谢起裕舒红上海交通大学医学院附属新华医院心内科 200092 Department of Medicine Division of CardiologyJ.W.Goethe-UniversityFrankfurtGermany

目的探讨器质性心脏病室性心动过速的发病谱、发生机制和导管消融的方法学,使器质性心脏病室性心动过速得到更有效的控制。方法106例器质性心脏病室性心动过速进行电生理检查和消融治疗的患者,男72例,女34例,平均年龄为(61±13)岁。冠心... 详细信息

目的探讨器质性心脏病室性心动过速的发病谱、发生机制和导管消融的方法学,使器质性心脏病室性心动过速得到更有效的控制。方法106例器质性心脏病室性心动过速进行电生理检查和消融治疗的患者,男72例,女34例,平均年龄为(61±13)岁。冠心病72例(包括心肌梗死后患者67例和冠状动脉外科搭桥术后16例),扩张性心肌病17例,右室发育不良性心肌病室性心动过速4例,心肌炎后3例,高血压性心脏病6例,除冠状动脉搭桥术外其他心脏外科术后4例。常规植入3根标测导管,分别放置在高右房、希氏束和右心室。行常规电生理检查,包括心室程序刺激。所有患者均有自发或诱发的持续性室性心动过速。然后行右心室和(或)左心室标测,必要时行冠状动脉窦标测．理想消融耙点确定后,行消融治疗。结果67例心肌梗死后室性心动过速患者,除2例成功的消融靶点在右心室近原起搏器植入部位和右心室心尖部外,其余瘢痕相关的折返性室性心动过速成功消融部位均在左心室。接受常规方法消融42例,消融成功率为86％(36例,以不能诱发临床室性心动过速为终点);接受心室三维基质标测和线性消融25例,消融成功率为84％(20例,以不能诱发任何室性心动过速为终点)。5例冠心病无心肌梗死史的室性心动过速患者,2例患者的发生机制为折返,3例为触发机制,均消融成功。17例扩张性心肌病室性心动过速的发生机制均为折返,其中2例消融成功的部位在冠状动脉窦; 9例束支折返性心动过速,右束支消融成功;其余6例中4例常规和(或)三维标测、消融后不能诱发室性心动过速。4例右室发育不良性心肌病室性心动过速、4例心脏外科术后室性心动过速和3例心肌炎后室性心动过速的发生机制均为折返,分别有2例、3例和2例消融成功。6例高血压性心脏病室性心动过速,1例的发生机制为折返,5例为触发机制,均消融成功。结论折返是器质性心脏病室性心动过速的主要发生机制,触发激动也是其发生机制之一。常规标测方法是器质性心脏病室性心动过速消融的基础,三维基质标测和线性消融有利于该类室性心动过速消融成功。

关键词：标测右心室心尖部线性消融电生理检查右束支触发激动消融靶点希氏束右室发育不良导管消融

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隐源性卒中的心电监测策略：2015年卒中诊断和监测专题组的报告

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国际脑血管病杂志 2017年第7期25卷 592-600页

作者： Gregory W. Albers Richard A. Bernstein Johannes Brachmann John Camm J. Donald Easton Peter Fromm Shinya Goto Christopher B. Granger stefan h. hohnloser Elaine hylek Amir K. Jaffer Derk W. Krieger Rod Passman Jesse M. Pines Shelby D. Reed Peter M. Rothwell Peter R. Kowey 地力木拉提·阿米提朱沂李红燕牛晓珊 Department of Neurology and Neurological Sciences Stanford University Stanford CA Davee Department of Neurology Feinberg School of Medicine of Northwestern University Chicago IL hospital Klinikum Coburg Teaching Hospital of the University of Wurzburg Coburg Germany Cardiovascular and Cell Sciences Research Institute St. George's University of London and Imperial College London LK Department of Neurology University of California San Francisco Sandier Neurosciences Center San Francisco CA Center for Cardiovascular health South Nassau Communities hospital Oeeanside NY Department of Medicine Tokai University School of Medicine Isehara Japan Cardiac Care Unit Duke University Medical Center Durham NC Division of Clinical Electrophysiology Department of Cardiology J.W. Goethe University Frankfurt Germany Boston University School of Medicine Boston MA Department of Medicine Rush Lhiversity Medical Center Chicago IL Faculty of health and Medical Science University of Copenhagen Denmark German Neuroscience Center Dubal Healthcare City Dubai UAE Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine Chicago IL Office for Clinical Practice Innovation George Washington Lhiversity Washington DC Duke Clinical Research Institute Duke University Durham NC Stroke Prevention Research Unit Nuffield Department of Clinical Neurosciences University of Oxford UK Division of Cardiovascular Diseases Lankenau Heart Institute Wyrmewood PA Department of Medicine Jefferson Medical College Philadelphia PA 新疆维吾尔自治区人民医院神经内科乌鲁木齐830001

卒中是一个重要的全球性公共卫生问题。2010年全世界总共发生3300万例卒中，其中1690万为首发卒中。卒中是仅次于心脏病的第二大全球人口死亡原因，占全部死亡的10％以上。卒中是一类异质性疾病，其病因可以是血管破裂（出血性）或血管... 详细信息

卒中是一个重要的全球性公共卫生问题。2010年全世界总共发生3300万例卒中，其中1690万为首发卒中。卒中是仅次于心脏病的第二大全球人口死亡原因，占全部死亡的10％以上。卒中是一类异质性疾病，其病因可以是血管破裂（出血性）或血管闭塞（缺血性）。缺血性卒中约占全部卒中的85％，可根据发病机制进行分类。

关键词：缺血性卒中心电监测隐源性专题诊断公共卫生问题死亡原因异质性疾病

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