室早性心肌病的诊断及治疗:附病例报道

<正>左室扩大合并频发室性心律失常在临床中比较常见,可见于各种心肌病和冠心病心肌梗死后,多认为该室性心律失常为继发性,通常以药物治疗为主,必要时植入埋藏式心脏除颤器(implantable cardioverter defibrillator,ICD),但疗效欠佳。近年来,提出频发室性早搏/室性心动过速可导致室早性心肌病     

室性早搏诱发心肌病的诊疗进展

室性早搏(简称室早)是临床上最常见的室性心律失常,过去的观点认为在心脏结构正常的患者中发生的室早是良性的。但是近期研究发现,频发室早会导致左室扩大、左室功能障碍进而发展为心肌病,甚至导致心脏功能衰竭。近来提出室早诱导心肌病(PVCiCMP)的概念,并逐渐引起人们的重视。值得注意的是,并不是所有的室早最终均会发展为心肌病。PVCiCMP的发生可能与室早负荷、室早形态、室早起源、伴随症状等因素有关。     

室性早搏性心肌病的相关危险因素分析和射频导管消融

【】目的 分析室性早搏性心肌病的相关危险因素以及射频导管消融治疗的可行性。 方法 功能性频发单源室性早搏成功进行射频消融治疗的患者192例,分为单纯室性早搏组和左室扩大组,分析两组患者性别、年龄、病程、体重指数、室性早搏数量及来源、是否合并室性心动过速等特点并进行比较。 结果 与单纯室性早搏组比较,左室扩大组男性更为多见（60.78% vs.34.75% P<0.01）、体重指数更高（25.22±4.31 vs. 22.94±3.85 P<0.01）、室性早搏总负荷量更大（836.19±345.61 vs 762.12±165.71 P<0.05）、合并室性心动过速的比例更高(60.78% vs.18.44% P<0.01)。室性早搏性心肌病行室性早搏射频导管消融术安全、有效。 结论 室性早搏性心肌病较为常见,无其它器质性心脏病的频发室性早搏患者中,男性、室性早搏总负荷量较大、体重指数较高、合并室性心动过速可能是室性早搏性心肌病的高危因素,射频导管消融治疗室性早搏可行,预后良好。     

胺碘酮治疗室性早搏51例疗效分析

胺碘酮是Ⅲ类抗心律失常药物。应用小剂量胺碘酮(100mg/d)对51例不同病因所致的难治性室性早搏患者进行了疗效分析,报道如下。1 对象与方法1.1 对象 51例患者均曾选用其它抗心律失常药物无效或疗效欠佳而改用胺碘酮治疗。治疗组中男性30例,女性21例。年龄19～70岁,平均49岁。室性心律失常类型:频发室早26例,多源或多形性室早5例,     

消融右室流出道起源频发室性期前收缩心功能改善2例

一般认为心动过速性心肌病与各种心律失常有关,包括心房纤颤、心房扑动、室上性心动过速和室性心动过速。近来国内外也有少量报道频发性的单形性室性期前收缩(室性早搏,室早)也可导致心肌病的发生[1～3]。2000年10月～     

消融右室流出遵起源频发室性期前收缩心功能改善2例

一般认为心动过速性心肌病与各种心律失常有关,包括心房纤颤、心房扑动、室上性心动过速和室性心动过速。近来国内外也有少量报道频发性的单形性室性期前收缩（室性早搏,室早）也可导致心肌病的发生。     

射频消融先天性心脏病合并右心室流出道室性心律失常

特发性右心室流出道（RVOT）室性心律失常的射频消融已有较多报道,但某些先天性心脏病合并RVOT起源的室性心动过速（VT）、频发室性早搏（室早）的射频消融少见报道,本文报道房间隔缺损5例及法洛四联症术后2例合并RVOT起源的室性心律失常的心电生理特性及射频消融特点。 资料和方法7例患者,男性3例、女性4例,年龄13～37岁。以近半年至5年出现明显心悸、胸闷入院。房间隔缺损5例,缺损2.0～3.2cm,4例未经治疗,1例房间隔缺损修补术后3年;法洛四联症外科矫正术后12年和15年各1例。7例患者24 h动态心电图均示频发多源性室早,但以1种形态室早为频发,而其它形态室早为偶发,其中5例伴VT及晕厥或黑矇史。     

心大静脉与左冠状动脉窦内联合消融左室顶部起源室性早搏一例

患者女,61岁,临床诊断为室性早搏(简称室早),原发性高血压。动态心电图提示频发室早,17 730次/天,给予抗心律失常药物无效。在心大静脉与左冠状动脉窦内联合消融,成功消除室早,推测室早可能起源于左室顶部。     

30例老年无症状频发室性心律失常分析

1资料与方法 1．1一般资料 30例病例选自2003年-2008年我院体检者，均为体检发现频发室性早搏，动态心电图观察频发室性早搏总计8000／24h～20000／24h，5例心电图有ST—T异常，均靠近交界区的16例，有部分室早远离交界区14例，有短暂性阵发性室性心动过速6例（1例室速的形态远离交界区，5例室速的形态靠近交界区），合并短阵房颤的8例，合并室上性心律失常30例。30例患者均无症状。     

室性早搏性心肌病的相关危险因素分析

目的:分析室性早搏性心肌病的相关危险因素以及射频导管消融治疗的可行性。方法:功能性频发单源室性早搏成功进行射频消融治疗的患者192例,其中单纯室性早搏组141例、室性早搏性心肌病组51例,分析2组患者性别、年龄、病程、体重指数、室性早搏数量及来源、是否合并室性心动过速等特点并进行比较。结果:与单纯室性早搏组比较,室性早搏性心肌病组男性更为多见(P0.01),体重指数更高(P0.01),室性早搏总负荷量更大(P0.05),合并室性心动过速的比例更高(P0.01)。结论:无其它器质性心脏病的频发室性早搏患者中,男性、室性早搏总负荷量较大、体重指数较高、合并室性心动过速可能是室性早搏性心肌病的高危因素。室性早搏性心肌病行室性早搏射频导管消融术安全、有效。     

高血压左室肥厚与室性心律失常的研究进展

研究表明高血压左室肥厚的患者室性心律失常,尤其是复杂性室性心律失常发生率增高,目前认为主要与左室重构、心肌缺血、肥厚心肌的电生理改变、神经内分泌因子分泌异常等多种因素有关。在对高血压病的患者进行降压治疗的同时逆转左室肥厚能减少室性心律失常的发生,肾素-血管紧张素系统抑制剂因在此方面作用显著而倍受关注。     

Diastolic Ventricular Interaction and Ventricular Diastolic Filling

Because the ventricles share a common septum, the filling of one may influence the compliance of the other, a phenomenon known as direct diastolic ventricular interaction (DVI). This interaction is markedly enhanced when the force exerted by the surrounding pericardium is raised (pericardial constraint). In health, in the resting state, we operate near the top of the flat component of a J-shaped pericardial stress–strain relation. Therefore, pericardial constraint (and hence DVI) is only minor. When right ventricular volume/pressure acutely increases, such as during exercise, massive pulmonary embolism, or right ventricular infarction, pericardial constraint increases and significant DVI develops. In this setting, the measured left ventricular intracavitary diastolic pressure markedly overestimates the true left ventricular filling pressure, because the external forces must be subtracted. Although the pericardium can grow during chronic cardiac enlargement, we present evidence that in certain chronic disease processes, including heart failure, DVI may also be important.     

心室重构和室性心律失常

心室肌在受到损伤时发生的电、结构和功能的适应变化称心室重构,心室重构后室性心律失常的发生率升高了.目前研究发现,室性心律失常的发生与心室重构有关.心室重构在室性心律失常的病理生理过程中具有重要作用.抑制心室重构可能是更有效的治疗、预防心律失常的方法.     

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.     

Prognosis in Patients with Left Ventricular Dysfunction and Ventricular Tachycardia Following Programmed Ventricular Stimulation

We performed programmed ventricular stimulation on 69 patients with left ventricular ejection dysfunction (ejection fraction < 50%) and clinically recognized ventricular tachycardia including 28 patients with sustained ventricular tachycardia and 41 patients with nonsustained ventricular tachycardia. An inducible arrhythmia (> 6 beats ventricular tachycardia) was found in 74% of patients. Patients with clinically sustained arrhythmias were frequently inducible (89%) with a high incidence of inducible monomorphic ventricular tachycardia (82%). Patients with clinically nonsustained ventricular tachycardia had a lower rate of inducibility (63%) including a high incidence of inducible polymorphic ventricular tachycardia (27%). Inducible patients with left ventricular dysfunction and ventricular tachycardia had a low incidence of electrophysiologically demonstrated effective drug therapy (16%). However, if an effective drug was found, the prognosis was good. Empirical drug therapy was associated with a poor prognosis in inducible and noninducible patients. Finally, an unfavorable prognosis was associated with a clinically sustained arrhythmia, a lower ejection fraction, and the presence of a left ventricular aneurysm. An inducible arrhythmia did not predict an unfavorable course. Indeed, patients with noninducible ventricular tachycardia in this group of patients were still at risk for sudden cardiac death.     

Ventricular tachycardia

The major differential diagnosis for VT is supraventricular tachycardia with a wide QRS complex due to aberrant conduction. Although VT may be slightly irregular, gross irregularities, such as those typically seen in atrial fibrillation, are uncommon during VT; such marked irregularities suggest atrial fibrillation. The QRS configuration is helpful in differentiating supraventricular tachycardia from VT. Supraventricular tachycardia with aberration generally produces QRS complexes that are less than 0.14 second in duration, whereas wider complexes are common in VT. The presence of an antiarrhythmic drug may, however, render this criterion unhelpful.     

心室分离

患者男性,78岁,因反复咳痰18年,胸闷、气短5年,胸痛2d于200年7月12日入院。临床诊断为慢性气管炎急性发作,肺源性心脏病,呼吸衰竭三级。入院后体