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评价左房顶部线性阻滞的一种新方法:可靠吗?不会影响起搏吗?
A new method to evaluate linear block at the left atrial roof: Is it reliable without pacing?
Sang C, Jiang C, Dong J, Liu X, Yu R, Long D, Tang R, Gao L, Ning M, Chen G, Li W, Ma C  2010/7/22 10:12:00 
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Journal of Cardiovascular Electrophysiology, 2010, Volume 21, Issue 7 
 

A New Method to Evaluate Linear Block at the Left Atrial Roof. Objective: The present study aimed to evaluate a new method for validation of complete linear block at the left atrial (LA) roof. Background: Linear lesions at the LA roof have been reported to improve the success rate of catheter ablation of atrial fibrillation (AF). Methods: Complete linear block at the LA roof was evaluated in 31 patients after complete isolation of pulmonary vein antrum (PVA) using a simple method. We hypothesized that complete linear block of the LA roof could be confirmed during sinus rhythm if (1) a continuous line of double potentials could be recorded at the LA roof, and (2) the activation sequence along the posterior wall changed to caudocranial. The results of this method were compared with standard pacing techniques. Results: Thirty-nine lines were assessed using this method: 8 before and 31 after achievement of complete conduction block. After validation of complete linear block at the LA roof, double potentials with a mean interpotential interval of 60 ± 13 ms were recorded in 25 patients and electroanatomical mapping of the left atrium showed the activation sequence of posterior wall changed to caudocranial in all 31 patients during sinus rhythm. The sensitivity, specificity, positive and negative predictive values of this method for validating complete linear block were 100%, 88.9%, 96.8%, and 100%, respectively. Conclusion: A corridor of double potentials along the roof line and a caudocranial activation sequence along the posterior wall during sinus rhythm can indicate conduction block at the LA roof after PVA isolation. © 2010 Wiley Periodicals, Inc.

Correspondence Address: Ma, C.; Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital, 2 Anzhen Road, Chaoyang District, Beijing 100029, China; email:chshma@vip.sina.com 
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 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者,女,69岁。2009年1月无明显诱因下出现乏力,当时程度较轻,未予以重视。2009年3月患者乏力症状加重,尿色逐渐加深,大便习惯改变,颜色变淡。4月18日入我院感染科治疗,诉轻度头晕、心慌,体重减轻10kg。无肝区疼痛,无发热,无腹痛、腹泻、腹胀、里急后重,无恶性、呕吐等。入院半月前于外院就诊,查肝功能:ALT 601IU/L,AST 785IU/L,TBIL 97.7umol/L,白蛋白 41g/L,甲状腺功能:游离T3 30.6pmol/L,游离T4 51.9pmol/L,心电图示快速房颤。
 

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