心脏康复治疗对类风湿性关节炎病人心室复极指数的影响

目的评估心脏康复治疗对类风湿性关节炎病人心室复极指数的影响。方法连续纳入45例类风湿性关节炎病人作为观察组及50名年龄和性别与观察组匹配的健康对照者作为对照组。通过普通12导心电图比较类风湿性关节炎病人和健康对照者心室复极参数,包括最大QT(QT_(max))间期和最小QT(QT_(min))间期及校正最大QT(cQT_(max))间期、校正最小QT(cQT_(min))间期和离散度(QTd)、校正离散度(cQTd),JT间期和校正JT(cJT)间期,Tp-e间期和校正Tp-e(cTp-e)间期,Tp-e/QT和Tp-e/cQT比值。通过比较心脏康复前后心电图、运动耐量试验(MET、VO_(2max))及类风湿性关节炎相关指标包括C反应蛋白(CRP)、疾病活动度评分28(DAS28)、健康评定问卷(HAQ)评分差异,并评价6周心脏康复治疗对类风湿性关节炎病人的影响。结果与健康对照者比较,类风湿性关节炎病人cQT_(max)和QT_(min)间期、QTd、cQTd、Tp-e和cTp-e间期、Tp-e/QT和Tp-e/cQT比值增高。心脏康复治疗后,除QTd外,其他各项心室复极指标均降低;CRP、DAS28和HAQ降低(P0.05),MET和VO_(2max)升高(P0.05)。结论应用心脏康复治疗类风湿性关节炎有助于改善病人与室性心律失常和心源性猝死相关的心室复极指标,运动耐量试验参数和类风湿性关节炎特征指标变化可能有助于改善心脏康复结束时心室复极指标cQTd、cJT和Tp-e间期。     

短QT综合征的心电图表现

心电图上QT间期 (QTI)代表了心室复极时间 ,在正常情况下 ,QT间期决定于内向钠电流、钙电流和外向钾电流、氯电流的表达、特性及其之间的平衡。同时QT间期也受心率及心脏外因素的影响 ,如酸中毒、高钾血症、高钙血症、儿茶酚胺、乙酰胆碱等。QT间期随着心率的逐渐变化是心脏正常的电生理反应 ,但其缩短程度应在可预测的生理范围内。图 1　特发性家族性短QT综合征　A图　 1例 17岁短QT综合征患者的 12导联心电图。QT间期 2 80ms,为预测值的 71% ;心率 69bpm ,QT间期预测值 3 93ms,QTc间期 (Bazett公式 ) 3 0 0ms。　B图　该患者的 …     

急性心肌梗死溶栓前后QT离散度变化的临床价值

QT间期离散度(QTcd)指心电图(ECG)各导联间QT时限变异的程度。它与心室肌复极不一致有关。QTcd与各种心脏疾病的关系时有报道。本文测量47例急性心肌梗死(AMI)患者溶栓前后QTcd,发现溶栓     

QT离散度不能反映心肌复极的区域性差异

目的　探讨体表心电图上QT离散度 (QTd)是否可以反映区域性的心肌复极差异。方法　正常对照 (对照 )组和心肌梗死 (心梗 )组各有 12 0例 ,记录同步 12导联心电图 ,人工测量各导联QT间期 ,计算QTd。结果　与对照组相比 ,心梗组QTd明显增加 ,分别为 (5 6 3± 17 8)ms与 (10 0 9±5 4 3)ms,P <0 0 0 1;但两组之间存在很大交叉 ,无法确立参考值。最长QT和最短QT在两组的导联分布呈现一致趋势。心梗组全部 12导联QT间期均较对照组明显延长 ,平均QT间期分别为 (397 0± 4 6 8)ms与 (36 7 3± 2 2 8)ms ,P <0 0 0 1。不同梗死部位各亚组之间心电图各导联QT间期均值差异无显著性(P =0 6 36 ) ,未见到与梗死部位相关的区域性QT间期改变。结论　QTd增大常与QT间期延长同时出现 ,QTd增大从整体上反映了心肌复极异常 ,但是不能代表心肌复极的区域性差异。     

室性心律失常与Q-T离散度的关系分析

体表心电图测量到的Q-T间期反映了心室肌跨膜动作电位的时间，代表心肌的复极过程。各导联的QT差值被称为QT离散度(QTd)，代表心室肌复极不同步性和电不稳定性的程度。对预测急性心肌梗死、心肌疾病和慢性心衰患者发生室性心动过速，室颤或猝死等具有重要意义。本文对动态心电图(DCG)检出的46例恶性室性心律失常患者与35例正常人的QTd进行分析比较，旨在探讨QTd与室性心律失常的关系。     

QT间期与离子通道

QT间期是心室除极和复极的总时程。心室除极的QRS波时限对QT间期有一定的影响,但QT间期的主要成分是心室复极,因而QT间期受复极变化的影响最大,心电图QT间期的变化几乎是心室复极变化的同义语。QT间期与离子通道的关系是指QT间期内,离子流及其变化对QT间期的影响。1.参与QT间期     

通过体表心电图评价不同部位起搏时心脏整体复极离散的变化

目的观察心脏不同部位起搏时体表心电图评价心室肌复极指标的变化,了解不同部位起搏对心室肌整体复极离散的影响。方法 10只健康猪,分别在右心房(RA)、右心室心尖部心内膜(RVEndo)及左心室心外膜(LVEpi)起搏,记录并测量体表心电图12个导联的T波峰-末间期(Tpe)和QT间期,计算Tpe平均值(Tpe-AVE)、Tpe最大值(Tpe-MAX)以及QT间期离散度(QTd),比较不同部位起搏时上述各参数的差异,进一步评价不同起部位对心室整体复极离散的影响。结果 LVEpi、RA、RVEndo起搏时的QT间期分别为(328±24)ms、(295±13)ms、(304±17)ms,LVEpi起搏时的QT间期明显长于RA及RVEndo起搏时的QT间期(P<0.05),RA与RVEndo起搏时QT间期没有明显差别。LVEpi、RA、RVEndo起搏的QT离散度(QTd)分别为(33±6)ms、(17±3)ms、(18±3)ms,LVEpi起搏时的QTd明显大于RA及RVEndo起搏时的QTd(P>0.05),RA与RVEndo起搏时QTd没有明显差别(P>0.05)。RA起搏时Tpe-AVE及Tpe-MAX分别为49±6ms及58±8 ms,与RVEndo起搏相近(49±8)ms及(60±8)ms,P>0.05);LVEpi起搏时Tpe-AVE及Tpe-MAX明显增大(63±7)ms及(71±8)ms,与RA、RVEndo起搏时比较两者(P<0.05)。结论与RA及RVEndo起搏时比较,LVEpi起搏时的QT间期、QTd、Tpe-AVE及Tpe-MAX均明显增大,LVEpi起搏可能会增加心室整体复极离散。     

不同部位起搏对体表心电图有关参数的影响

目的观察心脏不同部位起搏对体表心电图有关参数的影响。方法 10只健康猪,分别在右房(RA)起搏、右室心尖部心内膜起搏(RVEndo)及左室心外膜(LVEpi)起搏,记录并测量不同部位起搏后体表心电图12个导联的QRS波时限、QT间期、JT间期和T波峰-末间期(Tpe),计算Tpe平均值(TpeAVE)、Tpe最大值(TpeMAX)。结果 LVEpi起搏时QT间期、JT间期大于RA及RVEndo起搏时(P均<0.05);LVEpi起搏时TpeAVE,TpeMAX大于RA及RVEndo起搏时(P均<0.05),而RA与RVEndo起搏时此两指标无差异。结论 LVEpi起搏可能会增加健康心室整体复极离散。     

Q-T间期离散度的临床意义

Q—T间期离散度（QTd）是指同一心电图各导联最长与最短Q—T间期的差值,它反映了心室复极的非同步性和心电学不稳定的程度。1990年Day等首次证实其具有重要的临床价值。本文通过对冠心病、心肌病、慢性心力衰竭、长QT综合征、急性心肌梗死（AMI）等QTd的测定及其与心脏性猝死关系的分析,旨在探讨QTd的临床意义。     

临终患者伴发QT间期缩短的心电图分析

目的:探讨临终患者伴发QT间期缩短的心电图特征和临床意义。方法:常规测量10例临终患者的QT间期实测值(QT),通过QT间期换算公式计算QT间期预测值(QTp)、校正后QT间期值(QTc)以及QT/QTp比值。结果:10例临终患者心电图除出现各型传导阻滞、心室停搏等心电异常外,均伴随QT间期缩短(QTc<0.32～0.34s、QT/QTp<0.88)。结论:继发性QT间期缩短可能是出现于临终患者的一种罕见心电图表现,在一定程度上反映了心脏电活动衰竭,其预后不良,应引起临床高度重视。     

Comparison of the results of programmed ventricular stimulation from the right ventricular apex and outflow tract: a randomized, prospective study

Objective: The aim of this prospective study was to analysethe yield of programmed ventricular stimulation at the rightventricular apex compared with the outflow tract. Methods: A stepwise randomized cross-over protocol of programmedventricular stimulation with alternating stimulation at bothsites was used in 66 patients who were studied because of sustainedventricular tachycardia (n = 30), ventricular fibrillation (n= 7), or non-sustained ventricular tachycardia and/or syncope(n = 29). Results: There were no significant differences between the resultsof stimulation from either right ventricular site with regardto the presence or absence of structural heart disease, spontaneousarrhythmia, ejection fraction or effective refractory periods.Overall, monomorphic ventricular tachycardia was inducible in33 patients (50%); in 25 patients (75.8%), this arrhythmia wasinduced from both sites. However, in only 17 of these 25 patients(68%) did the induced monomorphic ventricular tachycardias havethe same morphologies and similar (± 50 ms) cycle lengths.Ventricular fibrillation was inducible in 11 patients (17%),mostly by three extrastimuli (n=8; 73%). Conclusions: (1) stimulation from at least two right ventricularsites is desirable because of their independent contributionto the induction of ventricular tachyarrythmias, (2) the non-inducibilityor inducibility at one ventricular site does not predict theeffect at another stimulation site, (3) the effective refractoryperiod at the right ventricular apex and outflow tract do notdiffer, (4) the inducibility of multiple ventricular tachycardiamorphologies emphasizes the importance of documenting the causeof spontaneous arrhythmias with multiple electrocardiographicleads to ensure the correct interpretation of arrhythmias inducedby programmed stimulation, (5) clinical or haemodynamic featurescannot predict whether one or more stimulation sites will berequired for induction of ventricular tachycardia. These resultsare important for the diagnostic evaluation and assessment ofpharmacological or non-pharmacological interventions.     

特发性右心室流出道室性心动过速/室性早搏的性别、年龄和临床特点

Objective The aim of this study was to clarify gender,age and clinical feature of idiopathic right ventricular outflow tract ventricular tachycardia/premature ventricular complexes(ROVT/PVC). Methods We studied 478 patients[mean age(39. 8 ± 13. 8)years]with idiopathic ROVT/PVC who were admitted to our center consecutively in past 15 years. All of them underwent catheter mapping and radiofrequency catheter ablation (RFCA), and the original sites of ventricular tachycardia/premature ventricular complexes were confirmed by catheter mapping and radiofrequency catheter ablation. Results Of 478 patients, 288 patients (60. 3% )were female, 190 patients(39. 7% )were male, female/male ratio was 1.52. The early onset of symptom was at (41.2 ± 12. 7 ) years for female, and ( 37.6 ± 15. 0) years for male ( P ＜ 0. 05 ). Almost all patients had palpitation in varying degrees. Sixty-seven of 478 patients( 14.2% ) had history of near-syncope,and 13 of 478 patients(2. 7% )had history of syncope. Two hundred and sixty-three patients( 55% )underwent unsuccessful treatment with antiarrhythmic drugs before the radiofrequency ablation. Of them, 110 patients (23%)had received one kind of antiarrhythmic drug, 104 patients (21.8%)had received two types of antiarrhythmic drugs,49 patients( 10. 3% )had received three types of antiarrhythmic drugs. Conclusion ROVT/VPC occur more in female than in male,the early onset of symptom is older for female than for male. Almost all patients have symptom in varying degrees, some of them have near-syncope or syncope.     

特发性右心室流出道室性心动过速/室性早搏的性别、年龄和临床特点

Objective The aim of this study was to clarify gender,age and clinical feature of idiopathic right ventricular outflow tract ventricular tachycardia/premature ventricular complexes(ROVT/PVC). Methods We studied 478 patients[mean age(39. 8 ± 13. 8)years]with idiopathic ROVT/PVC who were admitted to our center consecutively in past 15 years. All of them underwent catheter mapping and radiofrequency catheter ablation (RFCA), and the original sites of ventricular tachycardia/premature ventricular complexes were confirmed by catheter mapping and radiofrequency catheter ablation. Results Of 478 patients, 288 patients (60. 3% )were female, 190 patients(39. 7% )were male, female/male ratio was 1.52. The early onset of symptom was at (41.2 ± 12. 7 ) years for female, and ( 37.6 ± 15. 0) years for male ( P ＜ 0. 05 ). Almost all patients had palpitation in varying degrees. Sixty-seven of 478 patients( 14.2% ) had history of near-syncope,and 13 of 478 patients(2. 7% )had history of syncope. Two hundred and sixty-three patients( 55% )underwent unsuccessful treatment with antiarrhythmic drugs before the radiofrequency ablation. Of them, 110 patients (23%)had received one kind of antiarrhythmic drug, 104 patients (21.8%)had received two types of antiarrhythmic drugs,49 patients( 10. 3% )had received three types of antiarrhythmic drugs. Conclusion ROVT/VPC occur more in female than in male,the early onset of symptom is older for female than for male. Almost all patients have symptom in varying degrees, some of them have near-syncope or syncope.     

The “Short‐Coupled” Variant of Right Ventricular Outflow Ventricular Tachycardia: A Not‐So‐Benign Form of Benign Ventricular Tachycardia?

Idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT-VT) and idiopathic RVOT-extrasystoles are generally considered benign arrhythmias. We described three cases who originally presented with typical "benign looking" RVOT-extrasystoles or RVOT-VT but developed malignant polymorphic VT during follow-up. The unusual aspect of their RVOT-extrasystoles was their coupling interval, which appears to be intermediate between the ultra-short coupling interval of idiopathic VF and the long coupling interval seen in the truly benign RVOT-VT.     

Idiopathic Left Ventricular Aneurysm: An Unusual Substrate of Ventricular Fibrillation and Ventricular Tachycardia

Idiopathic left ventricular aneurysm (LVA) is a very rare clinical condition. This article describes a patient with idiopathic LVA associated with episodes of ventricular tachycardia and ventricular fibrillation. Clinical and instrumental examinations did not reveal the pathogenesis of the aneurysm. The malignant clinical course suggests that an aggressive antiarrhythmic treatment, including ICD implantation, may be warranted.     

Effect of Basic Drive Train Cycle Length on Induction of Ventricular Tachycardia by a Single Extrastimulus

This study determined the effects of a wide range of basic drive cycle lengths on the induction of ventricular tachycardia (VT) by a single extrastimulus (S₂). Seventy-one patients with coronary artery disease and inducible sustained monomorphic VT underwent 121 electrophysiology tests either in the control state or during treatment with an antiarrhythmic drug. Ventricular basic drive trains were eight beats in duration and the intertrain interval was three seconds. Programmed ventricular stimulation was performed with S₂ using the longest possible basic drive cycle length rounded off to the nearest multiple of 100 msec, then using basic drive train cycle lengths that decreased in 100 msec steps to 400 msec, and finally using a basic drive cycle length of 350 msec. At each drive cycle length, an interval of > 50 msec beyond the effective refractory period (ERP) was scanned with S₂. Monomorphic VT was induced by S₂ in 52/121 studies (43%). The drive cycle length had a significant linear effect on the log odds of inducing VT (P < 0.0001). The highest yield of VT occurred with a drive cycle length of 350 msec (42/121, 34%), and with each increment in drive cycle length, the expected odds of inducing VT decreased by a factor of 1.7. In 88% of cases in which VT was induced at a particular drive cycle length but not at longer drive cycle lengths, the coupling intervals that induced VT exceeded the ERP measured at one or more of the longer basic drive cycle lengths. In conclusion, there is an inverse relationship between the basic drive cycle length and the yield of monomorphic VT induced by S₂. The use of shorter basic drive cycle lengths often facilitates the induction of VT by some effect other than critical shortening of the S₂ coupling interval.     

Vulnerability of the right ventricle to cathodal,anodal, and bipolar stimulation at double diastolic threshold strength

Summary The repetitive ventricular response (RVR) to three stimulation techniques (bipolar, cathodal and anodal) was investigated in 35 patients. 26 patients suffered from coronary heart disease and 9 patients from dilative cardiomyopathy. The stimulation study was performed at a ventricular driving rate of 120/min with one and two premature ventricular extrastimuli. We used rectangular impulses of 1.8 ms duration at duable diastolic threshold strength. RVR was scored as follows: 0: no RVR, 1: one nonstimulated RVR, 2: two nonstimulated RVR, 3: three nonstimulated RVR, 4: four to ten nonstimulated RVR, 5: more than ten nonstimulated RVR lasting less than 2 minutes, 6: sustained ventricular tachycardia or ventricular fibrillation. We found that with unipolar anodal stimulation the diastolic threshold was significantly greater and the effective refractory period of the right ventricle was significantly shorter as compared to the other stimulation techniques. Between the three different electrode configurations there were no significant differences concerning the number of consecutive ventricular depolarizations following premature stimulation. Conclusion: the phenomenon of RVR is not influenced by the stimulation technique (bipolar, cathodal and anodal) at double diastolic threshold.Supported by the Robert-Müller-Stiftung     

Hoffmayer心电图积分识别ARVC室早／室速

目的探讨应用Hoffmayer心电图积分鉴别致心律失常性右室心肌病（arrhvthmogenic right ventricular cardiomyopathy,ARVC）和特发f生右室流出道室早／室速的临床意义。方法收集2009年9月至2013年5月就诊于北京大学人民医院患者中,心电图表现为右室流出道起源室早／室速患者57例。其中明确诊断为ARVC患者4例,经电生理检查及射频消融治疗成功的特发性右室流出道室早／室速患者53例。由两位电生理医生在不知道确切诊断的情况下,依据Hoffmayer心电图积分对上述患者的心电图进行分析,计算总积分≥5分,各单项积分诊断ARVC伴发的室早／室速的敏感度、特异度、阳性预测值、阴性预测值及诊断符合率。结果Hoffmayer心电图积分≥5分诊断ARVC伴发室早／室速的敏感度75％,特异度96．23％,阳性预测值60％,阴性预测值98％、诊断符合率94．7％。结论Hoffmayer积分≥5可有效鉴别右室流出道室早／室速是ARVC伴发的还是特发性的。应用此项积分具有简单、快速、敏感度及特异度均较高的优点,具较高的临床应用价值。     

Selective right ventricular angiography in apparently idiopathic ventricular fibrillation

Summary The definition of underlying heart disease in apparently idiopathic ventricular fibrillation seems to be important in regard to prognosis and choice of therapy. From October 1989, until August 1993, cardiac arrest due to the documented ventricular fibrillation occurred in eight consecutive patients with normal results on clinical examination, normal echocardiography, and normal or apparently nonspecific electrocardiogram (ECG) findings. Complete invasive investigations, including selective right ventricular angiography, were done; regional hypokinesia and segmental bulging of the right ventricle were found in seven patients (88%). Arrhythmogenic right ventricular dysplasia was suspected in these patients, although endomyocardial biopsy was not performed. After the finding of localized right precordial QRS prolongation of more than 110 ms in November 1993 in five patients, a retrospective, a more precise approach to QRS duration in standard ECG supported this diagnosis. Selective right ventricular angiography is of great help in identifying underlying heart disease in patients with apparently idiopathic ventricular fibrillation, and confirms ECG findings.