Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Cardiovasc Transl Res. 2008 Dec;1(4):258-72. doi: 10.1007/s12265-008-9061-x. Epub 2008 Sep 30.
Great strides have been made over the last two decades in the management of patients with rhythm disorders. Despite this, however, the remaining critical problems of stroke related to atrial fibrillation or as a result of radiofrequency ablation require innovative solutions to fully realize the potential of these recent advances. Similarly, implanted cardiac devices have revolutionized the care of patients with bradyrhythmias and tachyarrhythmias. Dyssynchronus ventricular pacing associated with present devices; however, results in heart failure, tricuspid regurgitation, and inappropriate device therapy once again create a demand for creative solutions. While not technically an arrhythmia, epilepsy management today is riddled with many of the problems that plagued cardiac arrhythmia management previously, and thus an appreciation of the similarities in requirement for investigative solutions may yield groundbreaking solutions. In this paper, we describe some novel methods to reduce complications associated with rhythm disorders and their treatment and apply the lessons learned from cardiovascular arrhythmia management to the brain. These include: a method to reduce coagulum formation and thus subsequent thromboembolism with indwelling catheters specifically during radiofrequency ablation procedures; a technique to ligate the left atrial appendage through percutaneous subxiphoid pericardial access; development and testing of a novel intramyocardial pace-sense lead, particularly used in a unique anatomic location (the atrioventricular septum) to allow pacing the ventricles in a relatively synchronous manner without crossing the tricuspid valve or entering the coronary sinus; finally, novel modifications of the cardiovascular mapping and ablation techniques used for the management of the central nervous system disorders primarily via the venous drainage of the brain. Innovative and potential solutions to treat the patient with arrhythmia are presented.
在过去的二十年中，在管理节律紊乱患者方面取得了巨大的进展。然而，尽管如此，与房颤相关或射频消融引起的中风等剩余的关键问题仍需要创新的解决方案，以充分实现这些最新进展的潜力。同样，植入式心脏设备也彻底改变了缓慢性心律失常和快速性心律失常患者的治疗方法。然而，目前设备引起的心室不同步起搏导致心力衰竭、三尖瓣反流和不适当的设备治疗，再次需要创造性的解决方案。虽然从技术上讲不是心律失常，但目前的癫痫管理仍然存在许多以前困扰心脏心律失常管理的问题，因此，对调查解决方案的需求相似性的认识可能会产生开创性的解决方案。在本文中，我们描述了一些减少节律紊乱及其治疗相关并发症的新方法，并将心血管心律失常管理的经验教训应用于大脑。这些方法包括：一种减少留置导管中凝块形成从而减少随后血栓栓塞的方法，特别是在射频消融过程中；一种经皮剑突下心包入路结扎左心耳的技术；开发和测试一种新型的心肌内起搏感知导线，特别是用于一种独特的解剖位置（房室间隔），以允许以相对同步的方式起搏心室，而无需穿过三尖瓣或进入冠状窦；最后，对用于管理主要通过大脑静脉引流的中枢神经系统疾病的心血管映射和消融技术进行了新的修改。本文介绍了治疗心律失常患者的创新和潜在解决方案。
