Effect of long-term use of antipsychotics on the ventricular repolarization index.

BACKGROUND: The risk of arrhythmia is usually assessed by the length of the corrected QT interval (QTc) when patients use antipsychotics. Prolonged QTc intervals are thought to increase the probability of malignant ventricular arrhythmias, and if we focus only on the QTc interval, we may be influenced by a single factor and make decisions that are not conducive to effective treatment. The index of cardiac electrophysiological balance (iCEB) is considered more valuable than the QTc for predicting drug-induced arrhythmias. It has been used in clinical practice, but no studies have observed changes in this index after the use of antipsychotics. OBJECTIVE: To investigate the changes in ventricular repolarization indices and the occurrence of arrhythmias in patients who have been using antipsychotic drugs for a long time, to compare the changes in iCEBc and QTc and to predict abnormal iCEBc values. METHODS: Patients with schizophrenia who had been hospitalized for more than 4 years and who were receiving atypical antipsychotics underwent a 12-lead synchronized electrocardiogram (ECG) every 2-4 weeks. The baseline data were measured at admission, defined as the baseline (time0), and the most obvious abnormal changes in ventricular depolarization and repolarization measured every 12 months were one-year follow-up (time1), two-year follow-up (time2), three-year follow-up (time3), and four-year follow-up (time4). Repeated measures analysis of variance was used for comparisons. The types and doses of drugs taken at 5 time points were recorded and converted into chlorpromazine equivalents for comparison. The incidence of arrhythmia during the observation cycle was recorded. RESULTS: The patients had been treated with antipsychotic medication for 4 years, and the duration of the QRS wave was longer in males than in females. TpTe, TpTe/QRS, TpTe/QT, TpTe/QTc, iCEB, and iCEBc increased significantly with hospital stay, while TpTe, TpTe/QRS, TpTe/QT, and TpTe/QTc exhibited more obvious changes in these indicators in female patients (P < 0.01). The changes in iCEB and iCEBc were more significant in males (P < 0.01). The incidences of arrhythmia (arrhythmic events included premature ventricular beats and premature atrial beats) within 5 time points were 2.5%, 6.25%, 6.25%, 6.25% and 5%, respectively. More than 90% of patients treated with antipsychotics did not have any arrhythmias. No TdP syncope or other cardiovascular symptoms were found in any of the patients. CONCLUSION: After long-term use of antipsychotics, the ventricular repolarization index gradually increased with time. The new ventricular repolarization indices iCEB and iCEBc were more sensitive than the QTc at predicting arrhythmia. According to the abnormal QTc values in men and women, we predict that the abnormal value of the iCEBc in males is 4.528 and that in females is 5.315.

Biotronik Implantable Cardioverter Defibrillator for Measurement of Intrathoracic Impedance: A Report of Two Cases.

OBJECTIVES: Two patients were received ICDs (Biotronic Iforia7 VR-TDX). Holter analysis revealed pacing spikes, which occurred regularly at 100 ms intervals following QRS complexes, with consecutive 1024 test pulses at hourly intervals during a specific time, and the VP was 0%. METHODS: By analyzing the dynamic electrocardiogram and consulting relevant literature, it was found that this is a feature of the ICD that measures thoracic impedance. RESULTS: This phenomenon is a special function for the purpose of transthoracic impedance measurement, which can monitor the heart failure. CONCLUSIONS: This phenomenon should not be regarded as an interference signal or an abnormal sign of pacemaker malfunction.

The rare cause of ST segment elevation in left precordial leads - Diagnostic clues from subtle waveforms.

We report a case of ST segment elevation in left precordial leads with a convex shape caused by a rare etiology. By carefully analyzing the electrocardiogram (leads I, II, V3 to V9) of a patient with convex ST segment elevation in the left-sided chest leads, relevant etiological clues were derived. The findings were further supported by cardiac ultrasound and cardiac magnetic resonance imaging, ruling out other common causes. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) was postulated as the underlying cause, and potential mechanisms were discussed. The diagnosis was further confirmed through a follow-up period of over three years.

Surface guided radiation therapy with an innovative open-face mask and mouth bite: patient motion management in brain stereotactic radiotherapy.

INTRODUCTION: To guarantee treatment reproducibility and stability, immobilization devices are essential. Additionally, surface-guided radiation therapy (SGRT) serves as an accurate complement to frameless stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) by aiding patient positioning and real-time monitoring, especially when non-coplanar fields are in use. At our institute, we have developed a surface-guided SRS (SG-SRS) workflow that incorporates our innovative open-face mask (OM) and mouth bite (MB) to guarantee a precise and accurate dose delivery. METHODS: This study included 40 patients, and all patients were divided into closed mask (CM) and open-face mask (OM) groups according to different positioning flow. Cone beam computed tomography (CBCT) scans were performed, and the registration results were recorded before and after the treatment. Then Bland-Altman method was used to analyze the consistency of AlignRT-guided positioning errors and CBCT scanning results in the OM group. The error changes between 31 fractions in one patient were recorded to evaluate the feasibility of monitoring during treatment. RESULTS: The median of translation error between stages of the AlignRT positioning process was (0.03-0.07) cm, and the median of rotation error was (0.20-0.40)°, which were significantly better than those of the Fraxion positioning process (0.09-0.11) cm and (0.60-0.75)°. The mean bias values between the AlignRT guided positioning errors and CBCT were 0.01 cm, - 0.07 cm, 0.03 cm, - 0.30°, - 0.08° and 0.00°. The 31 inter-fractional errors of a single patient monitored by SGRT were within 0.10 cm and 0.50°. CONCLUSIONS: The application of the SGRT with an innovative open-face mask and mouth bite device could achieve precision positioning accuracy and stability, and the accuracy of the AlignRT system exhibits excellent constancy with the CBCT gold standard. The non-coplanar radiation field monitoring can provide reliable support for motion management in fractional treatment.

Recent death early warning value of ECG changes in patients with NSCLC.

We aimed to explore the predictive value of abnormal electrocardiogram (ECG) changes in non-small-cell lung carcinoma non-small cell lung cancer (NSCLC) patients for near-term mortality. Seventy-eight NSCLC patients hospitalized in Chaohu Hospital Affiliated to Anhui Medical University from October 2017 to August 2021 were selected as the observation group. Baseline medical history and type of ECG abnormalities were the same. Seventy-eight patients were included in the control group. To compare the difference in mortality within 3 months between the observation group and the control group after the occurrence of the same type of electrocardiogram abnormalities, and to explore the value of electrocardiogram abnormalities in the early warning of NSCLC patients recent death. When the average ventricular rate of patients in the observation group was ≥100 beats/minute, ST-segment depression ≥0.05 mm, QRS voltage decrease ≥0.5 mm, new atrial fibrillation and other electrocardiogram changes, all patients died within 3 months. The control group with the same abnormal ECG had no death within 3 months (P < .05). In the resting 12-lead synchronous ECG in NSCLC patients, when the average ventricular rate ≥100 beats/minute, QRS wave voltage significantly decreased ≥0.5 mm, ST segment depression ≥0.05 mm, new atrial fibrillation appeared, it suggested that the patients' cardiac function decreased and the potential for near-term adverse outcomes is high.

Cardiac arrhythmia caused by a novel type of atrial conduction block: A case report.

INTRODUCTION: We report an extremely rare case of atrial conduction block with unusual electrocardiogram (ECG) results, which has never been reported before. There are 2 types of atrial conduction block that result in atrial irregularities or complete atrial conduction block. The former is similar to other types of cardiac blocks such as sinus node to atrial block, atrial to ventricular block, or bundle branch blocks, which are characterized by 2 P waves at a specific frequency. This is due to the complete inner atrial block that results in the atrial muscle being divided into 2 parts without conduction between them so that each part has its rhythm generator. The objective of this report is to examine the cause of inner atrial conduction block and to promote awareness of this disorder. PATIENT CONCERNS: An 81-year-old Chinese male patient was examined after complaining about chest discomfort, and it was found that he had atrial tachycardia; ECG results revealed a P wave loss at specific intervals (or P wave separation). DIAGNOSIS: A diagnosis of P wave loss at specific intervals (or P wave separation) was made based on ECG results. INTERVENTIONS: An ECG was performed on the patient OUTCOMES:: It was unclear whether this patient has atrial separation or a new type of atrial conduction block, but our results revealed that this case presents a novel type of atrial conduction block, which we named 'P wave block.' CONCLUSION: The type of EKG shown in this case has never been reported. This EKG shows a new type of conduction block in the atrium, temporarily named as a new type of P wave block.