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SUMMARY OBJECTIVE: Premature ventricular contraction is generally known as benign in the absence of structural heart disease; however, premature ventricular contraction-induced left ventricular systolic dysfunction or ventricular arrhythmias are defined in some cases. Ventricular repolarization duration differs between myocardial cells, which causes myocardial electrical heterogeneity and is thought to be responsible for ventricular arrhythmias. In our study, we aimed to evaluate the association of ventricular repolarization parameters including Tp-Te interval, Tp-Te/QT ratio, and QRS-T angle with premature ventricular contraction frequency in patients with premature ventricular contraction burden. METHODS: A total of 80 subjects who were admitted to our cardiology department and underwent 24-h electrocardiography Holter monitoring were included. Patients were divided into two groups: group 1 is defined as premature ventricular contraction burden that had frequent premature ventricular contraction ≥1% in 24-h Holter monitoring, and group 2 is defined as rare premature ventricular contraction <1% in 24-h Holter monitoring. RESULTS: Tp-Te interval and Tp-Te/QT ratio are statistically significantly prolonged in the premature ventricular contraction burden group than in the control group (85.3±13.9 vs. 65.7±11.9, p<0.001; 0.19±0.03 vs. 0.15±0.02, p<0.001, respectively). QRS-T angle was statistically significantly abnormal in the premature ventricular contraction burden group (p=0.024). CONCLUSION: Increased Tp-Te interval and widened QRS-T angle are associated with ventricular arrhythmias and might be used for the prediction of premature ventricular contraction burden in patients with premature ventricular contraction in electrocardiography in the absence of 24-h Holter monitoring.
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Resumen Los complejos ventriculares prematuros (CVP) son hallazgos frecuentes en individuos con o sin enfermedad estructural cardiaca. Los CVP cuyo origen se localiza en la región parahisiana son poco frecuentes y su manejo a través de ablación con catéter de radiofrecuencia es un reto, pues su localización favorece un alto riesgo de desarrollo de bloqueo aurículo-ventricular. Se describen dos casos de pacientes con CVP parahisianos llevados a ablación con catéter de radiofrecuencia.
Abstract Premature ventricular complexes (PVC) are common findings in patients with or without structural heart disease. Parahisian PVC are uncommon and their management through radiofrequency catheter ablation remains a challenge, since their location favors a high risk for developing atrioventricular block. Two cases of patients with parahisian PVC undergoing radiofrequency catheter ablation are described.
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Objective:To explore the value of using bipolar electrogram to guide target selection in patients with frequent premature ventricular contractions in the right ventricular outflow tract (RVOT-PVC).Methods:The clinical data of 115 patients with idiopathic and frequent RVOT-PVC from October 2018 to January June 2020 in Guangzhou First People′s Hospital were retrospectively analyzed. The number of PVCs in Holter 24 h before ablation was 19 802.6±4916.7, and the load was (20.3±5.0)%. The Johnson & Johnson Carto 3.0 system was used to guide RVOT-PVC radiofrequency ablation, and the morphological characteristics of the bipolar electrogram in the cavity of the successful ablation target were observed. According to whether the starting part of the bipolar electrogram of the distal ablation catheter showed a steep negative shape recorded by the Carto 3.0 system, the patients were divided into positive group and negative group. The differences in ablation success rate, effective discharge time, total ablation time and other indicators of the two groups were compared.Results:Steep negative wave was recorded in the initial part of the effective target site of 87 patients (75.7%). The ablation success rate of the patients was 95.4%(83/87) based on the excitation mapping and unipolar morphology combined with the above initial part of the bipolar electrogram. Compared with the negative group, the PVC disappeared faster in patients of positive group [(6.9±2.3)s vs (10.2±2.9)s, P<0.05] and the total ablation time was shorter [(187.5±35.7)s vs (267.3±54.1)s, P<0.05]. Ambulatory electrocardiogram (ECG) was rechecked at 3 months. At 3 months, there was 1 case recurrence in the positive group and 1 case recurrence in the negative group, and there was no significant difference in the long-term recurrence rate between the two groups ( P=0.422). Conclusions:On the basis of traditional mapping, the bipolar electrogram combined with the steep negative shape of the initial part can be used as an alternative RVOT-PVC ablation strategy.
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Objective:With the aid of the Inheritance Support System of Traditional Chinese Medicine V2.5 （TCMISS V2.5），to study the experience and prescription rules of professor WANG Jie in the treatment of frequent ventricular premature complexes，and inherit his clinical experience in diagnosis and treatment. Method:Professor WANG Jie's medical records and prescriptions for frequent ventricular premature complexes from 2016 to 2020 were collected and sorted out. Improved mutual information method，association rules，complex system entropy clustering，and unsupervised entropy hierarchical clustering were used to analyze the nature and flavor，channel tropism，concerted application rules，pair and combination of herbs for statistics， association rules analysis and discovery of new prescriptions. Result:A total of 122 prescriptions of professor WANG Jie on the treatment of frequent ventricular premature complexes were collected. 110 herbs，mostly with pungent and sweet flavors，were mainly on spleen channel and also on heart，kidney，liver，lung，and stomach channels. Cinnamomi Ramulus，Paeoniae Alba Radix<italic>，</italic>Os Draconis<italic>，</italic>Ostreae Concha<italic>， </italic>Glycyrrhizae Radix<italic>，</italic>and Jujubae Fructus<italic> </italic>had the highest frequency in use. The high-frequency herbal pair was Cinnamomi Ramulus-Paeoniae Alba Radix（116 times， accounting for 95.08%），the commonly used corner drugs were Cinnamomi Ramulus<italic>-</italic>Os Draconis<italic>-</italic>Ostreae Concha<italic> </italic>（108 times，88.52%），Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Ostreae Concha （106 times， 86.89%），Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Os Draconis （106 times，86.89%）. Commonly used herbal pair was<italic> </italic>Aucklandiae Radix-Amomi Villosi Fructus. The core prescription herbs included Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Os Draconis<italic>-</italic>Ostreae Concha<italic>-</italic>Glycyrrhizae Radix<italic>-</italic>Jujubae Fructus<italic>-</italic>Zingiberis Recens Rhizoma<italic>-</italic>Achyranthis Bidentatae Radix<italic>-</italic>Codonopsis Radix<italic>-</italic>Astragali Seu Hedysari Radix<italic>-</italic>Cistanches Herba-Poria<italic>-</italic>Ziziphi Spinosae Semen. Conclusion:Professor WANG Jie's prescription for the treatment of frequent ventricular premature complexes is Guizhi Jia Longgu Mulitang，and the main herbs are Cinnamomi Ramulus，Paeoniae Alba Radix，Os Draconis，Ostreae Concha，Glycyrrhizae Radix，and Jujubae Fructus. The final prescription could be adjusted according to the diseases and symptoms of patients.
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Objective:To investigate the efficacy and safety of Danhong injection combined with Bisoprolol on ventricular arrhythmia in patients with type 2 diabetes mellitus complicated by coronary heart disease. Methods:A total of 100 patents with type 2 diabetes mellitus complicated by coronary heart disease who received treatment in Dezhou Second People's Hospital, China between January and December 2019 were included in this study. They were randomly assigned to receive treatment either with bisoprolol (control group, n = 50) or bisoprolol + Danhong injection (treatment group, n = 50) based on routine treatment. Therapeutic effects, arrhythmia improvement, blood glucose index, islet function index, and adverse reactions during treatment were compared between the control and treatment groups. Results:Total effective rate in the observation group was significantly higher than that in the control group (88.0% vs. 70.0%, χ2 = 4.883, P < 0.05). After treatment, there were significant differences in the number of ventricular premature beats [(1 412.52 ± 587.85) beats/24 hours vs. (2 247.96 ± 761.52) beats/24 hours], paroxysmal supraventricular tachycardia [(46.58 ± 10.12) bursts/24 hours vs. (79.45 ± 12.01) bursts/24 hours], and ST segment depression [(1.24 ± 0.19) mm vs. (1.41 ± 0.24) mm] between the observation and control groups ( t = -6.141, -14.799, -3.927, all P < 0.001). After treatment, fasting blood glucose level, 2-hour postprandial glucose value and glycosylated hemoglobin level in the treatment group were (6.58 ± 1.61) mmol/L, (8.35 ± 1.72) mmol/L, and (6.14 ± 1.58)%, respectively, which were significantly lower than those in the control group [(8.24 ± 1.87) mmol/L, (9.69 ± 1.91) mmol/L, (7.68 ± 1.92)%, t = -4.757, -3.686, -4.379, all P < 0.001]. After treatment, islet beta cell function in the observation group was significantly higher than that in the control group [(56.52 ± 10.28) % vs. (47.96 ± 9.72)%, t = 4.278, P < 0.001). Insulin resistance index in the observation group was significantly lower than that in the control group [(2.06 ± 0.32) vs. (2.54 ± 0.35), t = -7.157, P < 0.001]. After treatment, there was no significant difference in the incidence of adverse reactions between the control and observation groups (12.00% vs. 8.00%), χ2 = 0.444, P > 0.05]. Conclusion:Danhong injection combined with bisoprolol is more effective in treating ventricular arrhythmia in patients with type 2 diabetes mellitus complicated by coronary heart disease than Danhong injection and bisoprolol alone. The combined treatment can reduce the incidence of ventricular arrhythmia, regulate blood glucose level, and improve islet function.
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Objective@#To explore the clinical efficacy of Yangxin-Fulv decoction combined with amiodarone hydrochloride in the treatment of dilated cardiomyopathy (DCM) complicated with ventricular arrhythmia (VA).@*Methods@#According to the random table method, 103 DCM patients with VA were divided into the control group (n=51) and the research group (n=52). The patients in the control group were given amiodarone hydrochloride orally on the basis of routine treatment, while the research group was given Yangxin-Fulv decoction on the basis of the control group. The treatment course of two groups was 3 months. The total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, short-term ventricular tachycardia,left ventricular ejection fraction (LVEF), left ventricular diastolic internal diameter (LVEDD), left ventricular end systolic diameter (LVESV) and left ventricular posterior wall thickness (LVPWT) were recorded by dynamic electrocardiogram analyzer. The Dynamic electrocardiogram was used to monitor QT interphase dispersion (QTd) and calibrate QT interphase dispersion (QTcd) and change of QTc interval. Clinical efficacy was evaluated and adverse reactions were recorded.@*Results@#The total effective rate of the research group was 88.5% while the control group was 62.8%, where the difference between two groups was statistically significant (χ2=6.106, P=0.014). After treatment, the total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, and short-term ventricular tachycardia in the research group were significantly lower than those in the control group (t=-7.005,-4.760,-16.111,-12.059, P<0.001). After treatment, the LVEF of the research group was significantly higher than that of the control group (t=4.024, P<0.01), while the LVEDD, LVESV and LVPWT of the research group were significantly lower than those of the control group (t=-3.913,-6.623,-5.719, P<0.001). After treatment, the changes of QTc interval (402.08 ± 30.14 ms vs. 421.08 ± 32.19 ms, t=-3.093), QTd (65.25 ± 5.63 ms vs. 72.18 ± 5.92 ms, t=-6.089) and QTcd (72.18 ± 10.56 ms vs. 80.53 ± 12.09 ms, t=-3.735) in the research group were significantly lower than those in the control group (P<0.01). During the treatment period, the incidence of adverse reactions in the control group was 7.8% (4/51) and in the research group was 5.8% (3/52). There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.175, P=0.676).@*Conclusions@#The Yangxin-Fulv decoction combined with amiodarone hydrochloride can improve the clinical symptoms and clinical efficacy of DCM patients with VA by inhibiting ventricular remodeling and arrhythmia.
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Objective To explore the clinical efficacy of Yangxin-Fulv decoction combined with amiodarone hydrochloride in the treatment of dilated cardiomyopathy (DCM) complicated with ventricular arrhythmia (VA). Methods According to the random table method, 103 DCM patients with VA were divided into the control group (n=51) and the research group (n=52). The patients in the control group were given amiodarone hydrochloride orally on the basis of routine treatment, while the research group was given Yangxin-Fulv decoction on the basis of the control group. The treatment course of two groups was 3 months. The total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, short-term ventricular tachycardia,left ventricular ejection fraction (LVEF), left ventricular diastolic internal diameter (LVEDD), left ventricular end systolic diameter (LVESV) and left ventricular posterior wall thickness (LVPWT) were recorded by dynamic electrocardiogram analyzer. The Dynamic electrocardiogram was used to monitor QT interphase dispersion (QTd) and calibrate QT interphase dispersion (QTcd) and change of QTc interval. Clinical efficacy was evaluated and adverse reactions were recorded. Results The total effective rate of the research group was 88.5% while the control group was 62.8%, where the difference between two groups was statistically significant (χ2=6.106, P=0.014). After treatment, the total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, and short-term ventricular tachycardia in the research group were significantly lower than those in the control group (t=-7.005,-4.760,-16.111,-12.059, P<0.001). After treatment, the LVEF of the research group was significantly higher than that of the control group (t=4.024, P<0.01), while the LVEDD, LVESV and LVPWT of the research group were significantly lower than those of the control group (t=-3.913,-6.623,-5.719, P<0.001). After treatment, the changes of QTc interval (402.08 ± 30.14 ms vs. 421.08 ± 32.19 ms, t=-3.093), QTd (65.25 ± 5.63 ms vs. 72.18 ± 5.92 ms, t=-6.089) and QTcd (72.18 ± 10.56 ms vs. 80.53 ± 12.09 ms, t=-3.735) in the research group were significantly lower than those in the control group (P<0.01). During the treatment period, the incidence of adverse reactions in the control group was 7.8% (4/51) and in the research group was 5.8% (3/52). There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.175, P=0.676). Conclusions The Yangxin-Fulv decoction combined with amiodarone hydrochloride can improve the clinical symptoms and clinical efficacy of DCM patients with VA by inhibiting ventricular remodeling and arrhythmia.
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Objective To evaluate the safety and clinical effect of radiofrequency catheter ablation below tricuspid valve using Carto3 system combined with SmartTouch contact force catheter in premature ventricular contraction (PVC) originating from tricuspid annulus. Methods The clinical data of 21 patients with PVC originating from tricuspid annulus from September 2016 to September 2018 were retrospectively analyzed. Radiofrequency catheter ablation below tricuspid valve was performed using Carto3 system combined with SmartTouch contact force catheter. Results The result of intraoperative mapping under Carto3 guidance showed that premature ventricular contraction in 12 cases originated from septal portion of the tricuspid annulus and in 9 cases originated from free wall of the tricuspid annulus. All patients′ ablation were successful, and no operative complications occurred. The patients were followed up for 1 to 23 months, and no recurrence occurred. However, there was 1 patient whose first radiofrequency ablation on the tricuspid valve was immediately successful, and PVC recurred 2 h after operation. Finally, radiofrequency ablation was performed successfully at 12 O′clock below the tricuspid valve 9 months later. Conclusions Radiofrequency catheter ablation below the tricuspid valve using carto3 guidance combined with SmartTouch contact force is safe in PVC originated from tricuspid annulus, and it can improve the success rate.
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Objective To observe whether catheter ablation for ventricular premature complexes (PVC) has an effect on ventricular diastolic function in elderly patients.Methods Elderly patients older than 65 years of age who underwent catheter ablation from March 2012 to May 2015 for idiopathic ventricular premature complexes were enrolled.Preoperative echocardiography was performed using E／e′ for left ventricular diastolic function and venous brain natriuretic peptide (BNP) levels were measured.All patients underwent catheter ablation under the guidance of a three?dimensional mapping system.Cardiac ultrasound and BNP levels were repeated 6 months after ablation, and 24?hour electrocardiogram was performed to confirm ventricular premature complexes.Results There were a total of 89 patients with idiopathic ventricular premature complexes ( PVC) who underwent catheter ablation.81 cases were successed at 6 months,with a success rate of 91.0%.At 6 months after ablation,the E／e′ values were significantly lower ((15.3±5.2) vs ( 10.2± 3.2),( P＜0.001)) and BNP levels were significantly lower (( 202.0 ± 23.2) pg／L vs (94±13.3) pg／L),(P＜0.001).For the unsuccessful subgroup,there was no significant change in E／e′values (16.3±6.3 vs 15.2±5.6) and BNP levels ((223.0±26.8) pg／L vs (245.0±23.9) pg／L), (P＞0.05).Conclusion The number of premature ventricular beats is associated with left ventricular diastolic function,and ventricular premature catheter ablation can improve left ventricular diastolic function in elderly PVC patients.
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Objective To assess alternations in left ventricular( LV) torsion parameters in healthy subjects and patients with premature ventricular complexes ( PVCs) from the right ventricular outflow tract (RVOT) .Methods ThirtypatientswithPVCsfromRVOTand31healthysubjectswereincluded.Two-dimensional speckle tracking imaging( 2D-STI) was applied to evaluate LV torsion parameters ,including LV rotational degrees in basal and apical levels respectively ,LV total torsional degrees ,and time to peak rotational and torsional degrees . All values of patients with PVCs were recorded during both sinus beats ( PVC-S) and premature ventricular beats ( PVC-V) . Results No significant difference was observed in left ventricular ejection fraction(LVEF) between PVC-S group and control subjects( P > 0 .05) ,while LV rotational degrees in apical levels[( 8 .47 ± 3 .54)° vs (9 .50 ± 3 .21)° , P = 0 .042] and LV total torsional degrees [ (11 .25 ± 6 .31)° vs (14 .00 ± 4 .07)° , P =0 .046] were significantly reduced in PVC-S group . In addition to the reduction of LV rotational degrees in apical levels[( 3 .93 ± 7 .23)° vs (9 .50 ± 3 .21)° , P =0 .000] and LV total torsional degrees[ ( 4 .35 ± 9 .62)° vs (14 .00 ± 4 .07)° , P =0 .000] ,lower apical levels[ ( -0 .57 ± 4 .44)° vs ( -5 .26 ± 3 .84)° , P =0 .000] and advanced LV rotational degrees [ ( 40 .5 ± 18 .6)％vs (48 .0 ± 9 .1)％ , P =0 .05] in basal levels were observed in PVC-V group in comparison with the control subjects . Compared with the PVC-S group ,PVC-V group showed lower LV rotational degrees in basal levels [ ( -0 .57 ± 4 .44)° vs ( -4 .57 ± 4 .57)° , P = 0 .000] and advanced time to peak rotational degrees [ (40 .5 ± 18 .6)％ vs (48 .1 ± 12 .6)％ , P =0 .018] ,as well as advanced time to peak and lower LV total torsionaldegrees[(39.3±15.4)％ vs(46.7±13.8)％ ,P =0.007 ;(4.35±9.62)°vs(11.25±6.31)°,P=0 .001] .Conclusions As to RVOT-PVC patients ,LV myocardial torsional motion has changed in PVC-S mainly manifested as a decrease of rotation degrees in apical levels even if the LVEF is still in the normal range . During PVC-V the rotation and twist degree is further reduced ,and the time sequence altered , accompanied with significantly decreased LVEF .
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The clinical presentation,chest image and electrocardiogram of 4 cases of premature complex-induced chronic cough admitted in the First Affiliated Hospital of Guangzhou Medical University from March 2008 to February 2009,were retrospectively analyzed.And other 6 cases of premature complex-induced chronic cough were retrieved for literature review.In total 10 patients,there were 3 males and 7 females aged 58(36-74) years,with a disease duration of 10.5 (3.0,264.0) months.The main clinical presentations were chronic dry cough with post-sternal thump and premature beats as shown by auscultation and 24 h-electrocardiogram examination.Cough was relieved after the premature beats were controlled with the treatment of arrhythmia drugs or radiofrequency ablation.Premature complex-induced cough is rare but it should be considered when the chief complaint of patients with premature beat is chronic cough.
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Abstract Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.
Resumo Fundamento: As contrações ventriculares prematuras (CVPs) podem provocar arritmias ventriculares letais em pacientes com doença cardíaca estrutural, no entanto o papel das CVPs em indivíduos saudáveis permanece controverso, já que não há muitos estudos clínicos disponíveis. Recentemente, alguns marcadores de repolarização do miocárdio, tais como o intervalo Tp-e e as relações Tp-e/QT e Tp-e/QTc, foram relatados como úteis para prognosticar arritmias ventriculares letais em diversos transtornos clínicos sem doença cardíaca estrutural. Objetivo: Neste estudo, o objetivo foi investigar a relação entre os marcadores de repolarização do miocárdio e as CVPs frequentes em indivíduos sem doença cardíaca estrutural. Métodos: Este estudo incluiu 100 pacientes com queixas de tonturas e palpitações. Eletrocardiografia de 12 derivações e registros de Holter ambulatorial de 24 horas foram obtidos de todos os pacientes. A carga de CVP foi calculada como o número total de CVPs dividido pelo número de todos os complexos de QRS no tempo de registro total. Foram considerados significativos valores p < 0,05. Resultados: O intervalo Tp-e e a relação Tp-e/QTc foram significativamente mais altos em pacientes com carga de CVP mais alta do que nos pacientes com carga de CVP inferior, e encontrou-se correlação positiva entre esses marcadores e a carga de CVP. Tp-e (β = 1,318, p = 0,043) e Tp-e/QTc (β = -405,136, p = 0,024) na derivação V5 foram identificados como preditores independentes da carga de CVP aumentada. Conclusões: O intervalo Tp-e e a razão Tp-e/QTc foram mais altos em pacientes com um valor mais alto de CVP. Nosso estudo mostrou que CVPs podem ter um efeito negativo na repolarização do miocárdio. Essa interação pode resultar em risco aumentado de arritmias malignas.
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Humans , Adult , Middle Aged , Aged , Electrocardiography, Ambulatory , Ventricular Premature Complexes/physiopathology , Heart/physiopathology , Arrhythmias, Cardiac/physiopathology , Echocardiography , Cross-Sectional Studies , Prospective Studies , Regression Analysis , Analysis of Variance , Statistics, Nonparametric , Heart Ventricles/physiopathologyABSTRACT
Cardiac arrhythmias are a common problem in the neurological intensive care unit and represent a major cause of ischemic stroke. Significant arrhythmias are most likely to occur in elderly patients. In this review, we focus on three arrhythmias: premature beats, atrial fibrillation, and QT prolongation. The goal of this review is to provide a current concept of diagnosis and acute management of arrhythmias in the neurological intensive care unit.
Subject(s)
Aged , Humans , Arrhythmias, Cardiac , Atrial Fibrillation , Atrial Premature Complexes , Cardiac Complexes, Premature , Critical Care , Diagnosis , Intensive Care Units , Stroke , Ventricular Premature ComplexesABSTRACT
Object@#To explore the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating from tricuspid annulus region.@*Methods@#Present study included 169 consecutive patients undergoing catheter ablation of VAs from tricuspid annulus origin in our department from August 2007 to September 2016. Based on the origin sites, the patients were divided into two subgroups, the free wall group (81 cases) and septal wall group (88 cases). Based on the location, patients in the free wall group were classified into anterolateral (22 cases), lateral (26 cases) and posterolateral (33 cases) subgroups. Patients in the septal group were classified into anteroseptal (10 cases), midseptal (71 cases) and posteroseptal (7 cases) subgroups. We analyzed the electrocardiographic features of these patients and in 87 patients with PVCs/VT originating from right ventricular outflow tract.@*Results@#(1) A positive R wave inⅠ, aVL, V5-V6 leads were found among most of patients, only few cases originating from tricuspid annulus anteroseptum group and tricuspid annulus anterolateral group demonstrated qr or qs pattern in aVL lead. 97.53% (79/81) patients demonstrated rS pattern in V1-V3 leads with VAs originating from tricuspid annulus free wall, and 9/10 patients demonstrated rS pattern in V1 lead with VAs originating from anteroseptum, and 97.44% (76/78) patients demonstrated QS pattern in V1 lead with VAs originating from midseptum and posteroseptum. Precordial lead transition zone was on or behind V3 for tricuspid annulus free wall group (96.3%, 78/81), but in front of V3 for tricuspid annulus septum wall group (47.73%, 42/88) (P<0.01). The S wave's amplitude smaller than-1.81 mV in lead V2 can be used as a cutoff value to identify if PVC/VT is originating from free wall or septum of TA. R wave in inferior wall leads was found among 98.85% (86/87) patients with PVCs/VT originating from right ventricular outflow tract.@*Conclusion@#A positive R wave in Ⅰ, aVL, V5-V6 leads was found among most of patients with idiopathic ventricular arrhythmias originating from the tricuspid annulus regions, but VAs originating from different portions of tricuspid annulus area have distinct electrocardiographic characteristics.
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Objective@#To evaluate the clinical effect and summarize the experience of radiofrequency catheter ablation (RFCA) for children suffered from premature ventricular contractions (PVCs).@*Methods@#This retrospective study was conducted by descriptive analysis. A total of 108 cases with frequent PVCs from Shanghai Children's Medical Center were treated with RFCA under the guidance of CARTO3 system from January 2011 to December 2016. The immediate success rate of the procedure, the recurrence rate and the perioperative complications were summarized. The constituent ratio of different PVCs origins, the trend of overall procedure time and success rate in recent years were analyzed. Statistical analyses were performed using F test.@*Results@#Immediate success of RFCA was achieved in 104 cases (96.3%, 104/108) and 4 cases (3.7%, 4/108) failed. The PVCs recurred during follow-up of over 6 months in 5 cases (4.8%, 5/104) . There were no severe complications related to the procedure. The sites of PVCs origin, in 52 cases originated from right ventricular outflow track (48.2%, 52/108) , 17 cases originated from left ventricular outflow track (15.7%, 17/108) and 26 cases originated from tricuspid annulus (24.1%, 26/108) . Among the three predilection sites of PVCs, the operation time was (141±46) min for right ventricular outflow track, (155±50) min for left ventricular outflow track, and (166±57) min for tricuspid annulus. However, the difference was not statistically significant (F=1.79, P=0.17) . X-ray exposure time was (14±8) minutes for right ventricular outflow track ablation, (32±14) minutes for left ventricular outflow track ablation and (16±8) minutes for tricuspid annulus ablation respectively. The exposure time for the ablation on left ventricle was significantly longer than the other two sites (F=5.12, P=0.018) .@*Conclusion@#RFCA is safe and effective for PVCs in children with high success rate and low recurrence and complication rates.
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Premature ventricular complex (PVC) usually follows a benign course and shows good response to medical therapy. However, high burden of PVC deteriorates cardiac function and is often associated with progression into dilated cardiomyopathy (DCMP). We report a case of a young patient who recovered from DCMP after PVC ablation. The patient complained of palpitations and dyspnea on exertion. Holter examination revealed an isolated PVC burden of 29%. Despite intensive medical therapy for more than a year, symptoms aggravated and PVC burden was not diminished on follow-up Holter examination. Furthermore, the echocardiogram revealed deteriorated systolic function as well as left ventricular enlargement, indicating progression into DCMP. Surface electrocardiogram indicated PVC origin in the left ventricular outflow tract. Detailed mapping at the right ventricle and left ventricle outflow tract with the aid of 3-dimensional mapping system, demonstrated PVC origin from the left ventricular outflow tract area, between the right and left coronary cusps. Radiofrequency ablation successfully abolished all ventricular premature beats. Follow-up Holter examination revealed no PVC, and the echocardiogram showed recovery to normal systolic function and chamber size. In conclusion, ablation of PVC should be considered when it does not respond to medical therapy and is associated with deterioration of cardiac function.
Subject(s)
Humans , Cardiac Complexes, Premature , Cardiomyopathy, Dilated , Catheter Ablation , Deoxycytidine Monophosphate , Dyspnea , Electrocardiography , Follow-Up Studies , Heart Ventricles , Ventricular Function, Left , Ventricular Premature ComplexesABSTRACT
Objective:To explore the characteristics of original site of premature ventricular contraction (PVC) in pa‐tiets with acute myocardial infarction (AMI) .Methods:Among ECG‐detected single‐source PVC patients ,a total of 150 idiopathic PVC patients and 150 AMI patients were randomly selected as control group and AMI group respec‐tively .Original sites of PVC was compared between AMI group and control group and between left and right ventri‐cle of AMI group ,and the relationship between original sites of PVC and diseased coronary in AMI patients was an‐alyzed .Results:Compared with control group ,there was significant rise in percentage of PVC originated from left ventricular apex (6.0% vs .46.0% ) ,and significant reductions in percentages of PVC originated from right ventric‐ular outflow tract (54.7% vs .27.3% ) and right ventricular anterior wall (10.0% vs .3.3% ) in AMI group , P<0.05 or <0.01. In AMI group ,compared with PVC originated from right ventricular outflow tract ,there was sig‐nificant rise in incidence rate of PVC originated from left ventricular apex (27.3% vs .46.0% ) , P=0.001 ;com‐pared with right ventricle , there was significant reduction in incidence rate of outflow tract PVC (66.1% vs . 13.6% ) ,and significant rise in incidence rate of apex PVC (24.4% vs .78.4% ) in left ventricle , P<0.01 both . Relevance test analysis of two‐way disordered classified data indicated that diseased coronary was not related to orig‐inal sites of PVC in AMI patients (χ2 =0.519 ,P=0.134) .Conclusion:Original sites of premature ventricular con‐traction has its own characteristics in patients with acute myocardial infarction ,which may possess certain guidance significance for its treatment .
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Objective:To explore correlation among heart structure , cardiac function and premature ventricular systo‐le (PVS) of different loads ,.Methods :A total of 220 PVS patients treated in our hospital were selected .According to PVS number‐to‐24h total heart rate ratio ,they were divided into low load group (20% ,n=62) .Another 68 subjects without PVS were regarded as normal control group .Cardiac function indexes and serum level of N terminal pro brain natriuretic peptide (NT‐proBNP) were measured in all groups ,and their correlation was analyzed .Results :Compared with normal control group ,there were significant rise in QT interval ,QRS wave duration and corrected QT interval in medium and high load groups , P<0.05 or <0.01. Compared with normal control group ,there were significant rise in left atrial di‐ameter ( LAD ) , left ventricularoutflow tract dimension ( LVOT ) , left ventricular end‐diastolic dimension (LVEDd) ,right ventricular end‐diastolic dimension (RVEDd) ,left ventricular end‐diastolic volume (LVEDV) , stroke volume (SV) ,left ventricular mass index (LVMI) and NT‐proBNP level ,and significant reduction in left ventricular ejection fraction (LVEF) in medium and high load group ,P<0.05 or <0.01. Bivariate linear correla‐tion analysis indicated that PVS load was significant linear positively correlated with QRS wave duration ,corrected QT interval ,LVEDd ,RVEDd and NT‐proBNP level (r=0.42~0.65 ,P<0.01 all);and significant linear inverse‐ly correlated with LVEF (r= -0.62 ,P=0.001) .Conclusion:Changes may occur in left ventricular structure and function along with PVS load rises .Therefore ,attention should be paid on monitoring related indexes in order to perform early intervention .
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Objective@#To explore the electrocardiographic characteristics of patients with idiopathic ventricular arrhythmias (VAs) originating from different portions of distal great cardiac veins (DGCV).@*Methods@#The study included 49 patients underwent successful RFCA of premature ventricular complex(PVCs)/ventricular tachycardia(VT) from different portions of the DGCV in our department from July 2009 to March 2016. The surface 12-lead electrocardiogram (ECG) and intraventricular ablation mapping features were analyzed. Patients were divided into four groups according to the mapping and ablation results: DGCV1(10 patients), DGCV2 (13 patients), proximalanterior interventricular vein (PAIV, 17 patients)and extend distal great cardiac vein (EDGCV, 9 patients). We analyzed the similarities and differences between surface 12-lead ECG of patients with PVCs/VT from different portions of DGCV, and compared with random chosen 290 patients with PVCs/VT from ventricular outflow tract and adjacent structure.@*Results@#A positive R wave in inferior leads, a negative QS morphology in lead aVL and aVR were found among all groups. The different characteristics of surface 12-lead ECG of VAs originating from DGCV were as follows: (1)EDGCV patients demonstrated a positive R or r wave on lead Ⅰ(6/9) while a negative rS or qr wave was evidenced in other three groups (39/40). (2)A positive R pattern on lead V1, V5-V6 (11/13) was presented in patients of DGCV2 group; R (without S or s) wave on V1 (9/10), RS or Rs wave on V5-V6 were found in DGCV1 group; RS or rS wave was seen on lead V1, R(without S)wave in lead V5-V6 (25/26) were found in EDGCV and PAIV group and the amplification of R wave in EDGCV was higher than V1 of PAIV group.(3)Precordial lead transition zone was in front of V1 for DGCV1 and DGCV2 groups (23/23), within V1-V3 for EDGCV group, but on V2 or within V2-V3 for PAIV group.(4)Patients of DGCV1 and DGCV2 demonstrated a longer Pseudo delta wave time(PdW), intrinsicoid deflection time (IDT), significantly larger maximum deflection index (MDI) than those in PAIV and EDGCV groups (P<0.001). (5)The different characteristics of surface 12-lead ECG between VAs originating from DGCV and those from ventricular outflow tract and adjacent structure were as follows: ① The ECG features were similar between PVIA and LCC group, both demonstrated a rs wave on the lead Ⅰ, rS wave on V1-V2 and R wave on V5-V6; ②The ECG features were similar betweenEDGCV and RCC group, both presented with R or r wave on the lead Ⅰ, the QRS wave of precordial leads was similar as PAIV and LCC groups; ③A R wave on the lead V1, V5-V6 was found in group DGCV2, and ILCC; ④Similar to the group Endo-MAA, patients in DGCV1 group also demonstrated a R wave on the lead V1 and a Rs wave on V5-V6.@*Conclusion@#A positive R wave in inferior leads, a negative QS morphology in lead aVL and aVR are seen in all patients, but different electrocardiographic characteristics of PVC/VT originating from the different portions of the DGCV are presented on lead Ⅰ and V1-V6.
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Objective:To explore diagnostic value of exercise ECG and dynamic ECG (DCG)for organic heart disease (OHD)ventricular premature beat (VPB).Methods:A total of 135 VPB patients were selected from our hospital.Ac-cording to examination outcome,they were divided into OHD group (n=75)and non-OHD group (n=60).Results of ex-ercise ECG and DCG were compared between two groups.Results:Compared with non-OHD group,there were significant reductions in percentages of Lown grade Ⅰ and Ⅱ,and significant rise in percentages of Lown grade Ⅲ,IV-A and IV-B in OHD group,P <0.05 or <0.01. DCG indicated that compared with non-OHD group,there was significant reduction in percentage of type B (90.0% vs.14.67%),and significant rise in percentages of type A (1.67% vs.49.33%)and D (0% vs.34.67%)in OHD group,P =0.001 all;exercise ECG indicated that compared with non-OHD group,there was significant reduction in percentage of type E (61.67% vs.14.67%),and significant rise in percentages of type F (38.33%vs.85.33%)and ischemic ST segment change (0% vs.40.0%)in OHD group,P =0.001 all.Compared with non-OHD group,there were significant rise in incidence rates of atrial premature beat,paroxysmal supraventricular tachycardia,atrial flutter in OHD group,P <0.05 or <0.01.Sensitivity,specificity,positive and negative predictive value and accuracy of exercise ECG and DCG were higher both,and there were no significant difference between two groups (P >0.05 all). Conclusion:Diagnostic value of exercise ECG and DCG are significant for organic heart disease ventricular premature beat, but it is no significant difference between two methods,which is worth extending.