平板运动试验对室性期前收缩的观察及分析

目的 通过观察平板运动试验患者室性期前收缩(室早)的数量及性质,探讨在临床研究中的价值.方法 对180例室早患者在平板运动试验中室早情况进行分析,按有无器质性心脏病及年龄是否大于35岁这2种不同标准进行分组、比较.结果 有器质性心脏病组和年龄大于35岁组平板运动试验中室旱数量比对照组增多,性质比对照组严重,差异均有统计学意义(P＜0.05).结论 平板运动试验对室早的分析有较高的临床价值.     

无器质性心脏病患者的室性心律失常与自主神经功能的关系

无器质性心脏病的室性心律失常的发生机制尚不清楚 ,是否治疗也存在争议 ,本文用心率变异性对无器质性心脏病的室性早搏 (室早 )患者的自主神经功能变化进行分析 ,以揭示室性早搏与自主神经功能的关系。　　资料和方法　经临床常规检查无器质性心脏病的患者1 0 3例 ,男性 46例 ,女性 5 7例 ,年龄 34～ 5 2 (43± 6 )岁 ,健康对照组 43例 ,偶发室早组 (室早总数 2 4h≤ 72 0次 ) 2 9例 ,频发室早组 (室早总数 2 4h>72 0次 ) 31例。用长程心率变异性的分析方法记录 2 4h心电图 ,心率变异性指标用时域指标SDANN、RMSSD及 PNN5 0 结合频域…     

盐酸安他唑啉片治疗室性早搏的随机、双盲、阳性药对照研究

目的治疗无明显器质性心脏病室性期前收缩(室早)的意义目前尚不清楚,但因室早引发的一系列症状在临床上很常见,此时减少早搏数量成为改善患者生活质量的主要治疗方法。盐酸安他唑啉(安他唑啉)是一种治疗多种心律失常的药物,本研究目的就是观察安他唑啉治疗无明显器质性心脏病患者的安全性与有效性。方法本研究为双盲、随机、阳性药对照研究,对照药物为稳心颗粒。在2009年11月至2010年4月期间入选60例不伴有明显器质性心脏病的室早患者,停用其他抗心律失常药2周后随机分为安他唑啉治疗组和稳心颗粒治疗组。服药治疗第2周进行随访记录不良反应等临床资料,满4周后复查Holter。疗效结果为对比治疗前后24小时室早的数目,安全性指标为治疗前后患者生化检查结果。结果共入选72例患者,男性37例(51.39%),平均年龄(45.06±12.33)岁,实际完成随访67例(研究组34例)。两组间基本临床资料匹配。研究组与对照组服药治疗4周后24小时室早数目均有明显降低,分别为70.11%和67.80%,两组间没有统计学差异(P=0.35)。研究组有88.24%(30/34)的患者24小时室早减少超过75%,对照组为78.79%(26/33),但两组间没有统计学差别(P=0.61)。两组均没有出现严重的不良反应。结论安他唑啉在临床上治疗一些不合并严重心脏疾病的室早具有较好的有效性和较高的安全性。     

器质性心脏病患者DC与HRV的相关性分析

目的探讨器质性心脏病患者与非器质性心脏病患者心率减速力(DC)与心率变异性(HRV)时域、频域及Lorenz散点图指标的相关性及临床意义。方法选择35例器质性心脏病患者和35例对照组,进行24h动态心电图检查离线测定DC、HRV时域、频域及Lorenz散点图指标长轴L和短轴W。结果与对照组比较,器质性心脏病组DC值减少较明显,HRV时域、频域指标亦减少,散点图指标中,L明显减少,差异有显著性意义(p<0.01～0.001)。散点图W无统计学差异(p>0.05)。器质性心脏病组患者DC与HRV时域、频域指标呈正相关(p<0.01～0.001),DC与散点图L、W无明显相关性。结论 DC与HRV时域、频域指标有较好的相关性,DC与Lorenz散点图指标,特别是W的内在联系还有待深入探讨。     

频发室性早搏患者早搏和心率变异的昼夜节律

受检对象为24小时动态心电图检查中室性早博（简称室早）＞10次地的30例无器质性心脏病患者，分析其每小时的室早和心率变异[窦性RR间期标准差（SD）和RR连续差异均方根（rMSSD）]的分布。结果显示睡眠期的室早和心率变异分别是最小和最大值，凌晨1～6时的SD和rMSSD均值均高于其它3个6h时段的均值，各小时的室早对数与相应时间的SD和rMSSD均无显著相关性。表明无器质性心脏病的频发室早患者的室早和心率变异具有昼夜变化节律，各小时室早对数与心率变异之间无明显相关性。     

平板运动试验对室性早搏危险性的预测

目的探讨平板运动试验时室性早搏(室早)数和质的变化,以预测室早的危险系数。方法选择24小时动态心电图室性早搏>200次的患者270例,按Bruce方法进行亚极量平板运动试验,并随访2年以上。结果270例患者中64例运动后室早增多呈二联律,25例出现成对室早,于恢复期2、4、6、8min后室早逐渐减少至消失,11例短阵室性心动过速(室速)伴恢复期心电图ST段压低,T波倒置,运动停止后逐渐恢复正常。随访中有5例猝死,其中3例为短阵室速、1例成对多源室早、1例频发室早。结论平板运动预测室性早搏的危险性及诊断各种器质性心脏病或非器质性心脏病引起的功能性早搏有重要的价值。     

高血压患者频发室性早搏与心率变异的关系

目的分析伴有频发室性早搏（室早）的高血压患者的心率变异及二者的关系。方法对２４ｈ动态心电图检查中室早＞１０次／ｈ的２６例高血压患者和２６例无器质性心脏病患者（室早对照组）的心率变异时域指标进行分析，并与２６例无室早的正常人和２７例无室早的高血压患者对照。用直线相关分析确定室早与心率变异指标之间的关系。结果室早对照组平均Ｒ－Ｒ间期显著小于高血压组，其余各心率变异指标无明显差异；这两组的窦性Ｒ－Ｒ间期标准差和全部５ｍｉｎ节段Ｒ－Ｒ间期均值的标准差均显著低于正常对照组。有室早的高血压组与无室早的高血压组之间的心率变异无显著差异。相关分析显示室早对照组的室早对数与平均Ｒ－Ｒ间期呈显著负相关，其余心率变异指标与室早之间无显著相关性。结论高血压患者心率变异下降，但其室早与心率变异之间未发现明显关系。     

动态心电图中频发室早与血压的关系

目的 分析中老年患者动态心电图中频发室早与血压变动之间的关系,为临床诊断及治疗提供可靠的依据.方法 选取原发性高血压伴频发室早患者、原发性高血压无室早患者、频发室早不伴有原发性高血压且无器质性心脏病的患者各148例及148名正常人作为研究对象,所有患者均进行动态心电图和动态血压监测,并用统计学软件从多维度进行统计学分析.结果 在无器质性心脏病患者组中,伴室早患者的收缩压高于无室早组;伴有室早的高血压患者频发室早的发生率较高,心电图异常也较为严重,而无室早的高血压患者中大多伴有不同程度的心律失常.结论 频发室早的发生与血压的改变之间存在一定的相关性.     

盐酸关附甲素注射液治疗室性心律失常的多中心随机双盲试验

目的 评价国家一类新药盐酸关附甲素注射液（GFA）治疗室性心律失常的疗效和安全性.方法 随机双盲多中心阳性药对照试验,由全国8家临床药理基地完成.入选不伴严重器质性心脏病的频发室性早搏（室早）患者,室早平均每小时≥150次（用Holter评价）,伴或不伴短阵室性心动过速.采用1∶1随机对照使用GFA或盐酸普罗帕酮.采用静脉负荷加维持量的方法维持6 h.用药前一天和用药日均进行24 h Holter及心电监测进行疗效评价.监测生命体征、心电图及观察不良事件.结果 共入选201例患者,用药前两组在病史、体检、实验室检查、室早数量、短阵室性心动过速数量差异均无统计学意义.GFA组与盐酸普罗帕酮组室早减少百分数和总有效率差异无统计学意义.室早减少百分数分层分析,GFA有优于盐酸普罗帕酮的趋势,达到统计学差异临界值（P=0.0609）.GFA抑制室早的程度以及控制室早的作用出现时间与盐酸普罗帕酮差异无统计学意义.GFA静脉应用耐受性较好,发生不良事件的严重程度明显轻于盐酸普罗帕酮,差异有统计学意义.结论 GFA控制室性心律失常安全有效,其疗效相当于盐酸普罗帕酮,发生的不良事件较盐酸普罗帕酮为轻,今后应对其抗心律失常作用进行进一步的研究.     

运动试验QT离散度变化与心肌缺血或T波改变相关性的研究

目的 :探讨运动试验QT离散度 (QTd)变化与心肌缺血和T波变化的相关性及评价QTd的临床应用价值。方法 :2 4 2例经冠脉造影证实冠心病而静息心电图正常 ,平板运动试验阳性 (冠心病组 )和 16 8例静息心电图有T波低平、双向、倒置或有u波 ,平板运动试验心电图正常 ,并经冠脉造影及其他检查排除器质性心脏病 (非器质性心脏病组 )。观察两组平板运动试验QTd的变化与心肌缺血和T波变化的相关性。结果 :设QTd >5 0ms为异常 ,冠心病组运动前QTd异常率为18% ,运动后为 80 % ;非器质性心脏病组运动前QTd异常率为 84 % ,运动后为 12 %。QTd的变化与T波改变相关 ,r=0 .86 ,P <0 .0 1;与冠心病运动后单纯缺血性ST段下移无相关性。结论 :运动试验QTd变化与心肌缺血无相关性 ,QTd异常不能判断心肌复极不均一性进而预测恶性心律失常或心脏猝死 ,而只是反映T波非特异性异常的一个粗浅的量化指标     

The usefulness of Holter monitoring in the evaluation of antiarrhythmic drug efficacy for tachycardia

Using Holter monitoring tachycardia was found in 145 out of 2058 patients suffering from various underlying diseases. Three thousand seven hundred and forty monitorings were performed. The mean age of patients was 54.5 years with a range of 19 to 83 years. The observed tachycardia was classified into three types: tachycardia with short duration, tachycardia with long duration and tachycardia with complex form. The attacks of tachycardia were more frequently observed during periods of physical activity than during sleeping periods. The relationship of the number of tachycardia with short duration between 24-hour Holter monitorings was examined in order to establish day to day variability of the attacks. The 95% confidence interval about the resultant regression line was calculated and the percent reduction required for the evaluation of drug efficacy to avoid the chances of interference of spontaneous variation was found to be about 44.0, 55.0 and 82% when the total number of attacks during a 24-hour period were 50, 100 and 1,000, respectively. Holter monitoring showed higher positive results as compared to exercise testing for detection of tachycardia. Higher correlation coefficients between numbers of premature ventricular contractions (PVCs) and the plasma concentrations of procainamide or N-acetylprocainamide were observed in 3 or more successive PVCs than in individually occurring PVCs. Using repeated 24-hour Holter monitorings a significant reduction in the number of tachycardia was observed when the therapeutic concentration was reached after the combined or single administration of the drug. These results suggest that repeated Holter monitorings, exercise testing and determination of plasma level of the drug may be useful for the evaluation of antiarrhythmic drug efficacy for tachycardia.     

Usefulness of severity of myocardial ischemia on exercise testing in predicting the severity of myocardial ischemia during daily activities

To determine the relation between myocardial ischemic indexes on exercise testing and on ambulatory Holter recording, 60 patients with stable coronary artery disease who exhibited an ischemic response to both testing procedures were studied. All patients performed a Bruce protocol exercise test and underwent 24-hour Holter recording within 2 weeks without antianginal medications. Mean exercise duration was 7.4 +/- 2.8 minutes, mean heart rate at 1-mm ST depression was 118 +/- 20 beats/min and mean maximal ST depression during exercise was 2.2 +/- 1 mm. During Holter recording the average number of ischemic episodes was 4.7 +/- 2.6 per patient, mean duration of daily ischemia was 62 +/- 54 minutes, mean maximal ST depression was 3.2 +/- 1.3 mm and average heart rate at 1-mm ST depression was 93 +/- 17 beats/min. Overall, the correlations between ischemic indexes on both testing procedures were very weak (mean r2 = 0.054). The only exercise variable that had a significant correlation (p less than 0.05) with all Holter variables was heart rate at 1-mm ST depression, yet it correlated very weakly (0.064 less than or equal to r2 less than or equal to 0.125) with most Holter covariates and had a better correlation (r2 = 0.256) only with average heart rate at 1-mm ST depression during Holter. Thus, ischemic indexes on exercise testing cannot accurately predict ischemic indexes on ambulatory Holter recording in patients with stable coronary artery disease who exhibit ischemic changes on both tests.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ventricular arrhythmias in patients recovering from myocardial infarction: Do residual myocardial ischemia and anti-ischemic medical intervention influence the one-month prevalence?

The relationship between myocardial ischemia revealed by exercise testing and ventricular arrhythmias on Holter monitoring, and the effect of anti-ischemic intervention on the incidence of ventricular arrhythmias in patients with residual ischemia were studied in 125 patients recovering from myocardial infarction. Prior to discharge exercise testing and 24-h Holter monitoring were carried out In patients with ST-segment depression (n = 34), ventricular arrhythmias on Holter monitoring were seen in 7 (21%) compared with 20 (22%) patients without ST-segment depression (NS). Patients were hereafter double-blindly randomized to intervention with verapamil (n = 63) or placebo (n = 62). One month after discharge, 24-h Holter monitoring was repeated. In the verapamil group ventricular arrhythmias increased from 25 to 33% (NS). In the placebo group the figures were 18 and 27%, respectively (NS). In patients with ST-segment depression and verapamil treatment, the prevalence increased from 25 to 38% (NS). In the placebo group the figures were 17 and 22%, respectively (NS). The differences between the groups were not significant. A significantly increased prevalence of ventricular arrhythmias was found in patients with either heart failure or non-Q-wave infarct. In these patients myocardial ischemia during exercise did not correlate with ventricular arrhythmias either. ST-segment depression during predischarge exercise testing correlated with neither the prevalence nor the incidence of ventricular arrhythmias, and anti-ischemic intervention with verapamil did not influence the incidence of ventricular arrhythmias in both patients with and without myocardial ischemia.     

Ventricular arrhythmias in relation to coronary artery stenosis and left ventricular performance

The relationship between ischaemic heart disease and occurrenceof ventricular arrhythmias has been studied in a prospectiveinvestigation of 41 patients with severe stable angina pectoris.The patients had a median age of 54 years (range 38–67).Following the therapeutic evaluation of the patients, they weresubjected to exercise testing, 24 h ambulatory ECG monitoring,selective coronary arteriography, ventriculography and cardiaccatheterization. Nineteen patients had been under treatmentwith a beta blocking agent, 16 with verapamil, three with bothand three had not been receiving any anti-anginal treatment.The treatment was discontinued over a period of three days priorto coronary arteriography and haemodynamic measurements. A comparisonof the patients under treatment with a beta blocking agent andthose receiving verapamil demonstrated no difference in thenon-invasive and invasive variables. Ventricular arrhythmias were found in only one patient duringexercise testing. The occurrence of ST segment deviation duringexercise was not correlated with the number of stenotic coronaryvessels due to low maximum heart rate and treatment. A heartrate during maximum exercise of < 120/min was observed significantlymore frequently in patients with multivessel disease. The data of the 24 h Holter monitoring were analysed in orderto evaluate whether the prevalence (percentage number of patientswith ventricular ectopic beats) or the persistence (number of6 h periods with ventricular ectopic beats) is the better indicatorof myocardial function and coronary artery anatomy. The resultsdemonstrated a significant correlation between a high persistenceand elevated left ventricular enddiastolic presure, high dp/dt/_max/P,reduced ejection fraction as well as the number of stenoticcoronary arteries and hypokinetic segments in the left ventricularwall. The latter correlation especially applies when the hypokinesiais localized to the anterior wall of the left ventricle. It is concluded from this investigation that a high persistenceof ventricular arrhythmias during 24 h of ECG monitoring reflectsmultivessel disease and poor left ventricular function. Thecombination of a high persistence of complicated ventriculararrhythmias and only a slight rise in heart rate during maximumexercise can possibly identify a group with an especially highrisk of sudden cardiac death.     

Holter monitoring, exercise test and atropine test in isolated congenital atrioventricular block in children

Twenty-four patients with isolated congenital heart block were investigated by 24-hour Holter monitoring at an average age of 9.3 +/- 5.5 years. Six patients were symptomatic and 18 were asymptomatic. Eight asymptomatic patients underwent exercise stress tests and an atropine test was performed in 10 asymptomatic patients to evaluate the capacity to accelerate the heart rate. The symptomatic patients were older than the asymptomatic patients. None of the parameters which analyse ventricular rate were significantly different in the two groups of patients. Significant ventricular arrhythmias (Lown Grade 2 or over) were recorded in 1 symptomatic and 3 asymptomatic patients. The incidence of these ventricular arrhythmias increased with age and degree of bradycardia. The percentage increase in ventricular rate after atropine correlated with what was observed on effort (r = 0.95, p = 0.01) but there was no relationship between the ventricular rates during these two tests and those recorded on Holter monitoring. The results of this series of children with isolated congenital heart block show the Holter parameters cannot distinguish symptomatic from asymptomatic patients. The exercise stress and atropine tests gave very similar results but their prognostic value has not yet been established.     

The analysis of the parameters of 24‐hr ECG Holter monitoring in patients with blood neoplasms undergoing high‐dose chemotherapy and stem cell transplantation

Background

Hematopoietic stem cell transplantation (HSCT) is a widely used procedure in the treatment of malignant diseases, including blood neoplasms and has increased survival in hematological diseases. The aim of the study was to analyze parameters of 24‐hr ECG monitoring in patients with selected blood neoplasms in whom the procedure of hematopoietic stem cell transplantation was performed.

Methods

The study group consisted of 64 adults diagnosed with hematologic cancer qualified for HSCT with the previous high dose chemotherapy (HDC). In all patients 24‐hr Holter monitoring was carried out twice. First examination took place prior to the HSCT procedure, and the second after finishing the procedure of HSCT.

Results

The minimal and mean heart rate (HR min and HR max) from 24‐hr ECG recording was statistically significantly higher after the transplantation in comparison with the first test. The number of premature ventricular complexes (PVCs) was higher in the test after HSCT. In the second examination there was significantly higher percentage of premature ventricular complexes, incidents of tachycardia, and Mobitz type 1 second degree atrioventricular block. In regression analysis, in a group of patients with blood neoplasms after HSCT and HDC, administration of cyclophosphamide, fludarabine and total body irradiation were independent risk factors for electrocardiographic abnormalities in 24‐hr Holter monitoring, that is, the increase in HR min, HR mean and PVCs.

Conclusion

In patients with blood neoplasms undergoing HSCT more electrocardiographic abnormalities may be found after this procedure in comparison with the 24‐hr Holter monitoring before transplantation.

     

不同负荷特发性室性早搏对心脏结构和功能的影响

目的探讨不同负荷特发性室性早搏(简称室早)对心脏结构和功能的影响。方法入选102例特发性室早患者,根据室早数量与24 h总心搏的比值,将入选患者分为室早负荷<10%组(低负荷组),10%～20%组(中等负荷组),>20%组(高负荷组)。采用二维心脏超声分别测量左室射血分数(LVEF),左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)值,并检测以上患者血清N-末端脑钠肽(NT-proBNP)水平。结果室早负荷与LVEDD(r=0.27,P=0.003)、LVESD(r=0.31,P=0.001)大小、血清NT-proBNP水平呈正相关(r=0.21,P=0.02),和LVEF呈负相关(r=0.21,P=0.02);高负荷组与低负荷组、中等负荷组相比,LVEDD、LVESD值明显增大,LVEF值明显降低(P<0.05),而NT-proBNP的升高无显著性。结论随着室早负荷的增大,左室的结构与功能出现重构性变化。     

Suppressive effect of nicorandil in ventricular arrhythmias after reperfusion therapy in patients with acute myocardial infarction

BACKGROUND: Nicorandil is reported to inhibit reperfusion arrhythmias in patients with acute myocardial infarction (AMI), but few studies have counted ventricular arrhythmias with Holter electrocardiograms in patients treated with nicorandil following AMI reperfusion. OBJECTIVES: In the present study, we examined the effects of nicorandil by investigating the occurrence of ventricular arrhythmia with Holter electrocardiogram monitoring after percutaneous coronary intervention with acute myocardial infarction. METHODS: Forty patients with AMI who underwent successful percutaneous coronary intervention (PCI) were enrolled and randomly assigned to nicorandil or placebo groups. Following PCI, nicorandil was infused intravenously at 6 mg/hr for 24 hr, with Holter electrocardiogram monitoring. Patients with 100 or more premature ventricular contractions (PVCs) over the 24-hour period were studied. The total number of PVCs, frequency of occurrence of ventricular tachycardia, and clinical characteristics were compared between the two groups. RESULTS: Fourteen patients in the nicorandil group and 12 patients in the placebo group exhibited 100 or more PVCs over the 24-hour period. Lesion characteristics and procedural factors did not differ between the two groups. Fewer PVCs were counted in the nicorandil group than in the placebo group(144.6 +/- 106.5 vs 286.8 +/- 159.1 beats/day, p = 0.012). The frequency of coupled PVCs was lower in the nicorandil group (6.9 +/- 6.9 vs 16.3 +/- 12.8 beats/day, p = 0.025). Although the frequency of ventricular tachycardia did not differ between the two groups, ventricular tachycardia duration was significantly shorter in the nicorandil group (3.73 +/- 2.30 vs 8.34 +/- 7.45 sec, p = 0.03). CONCLUSIONS: Our study indicates nicorandil inhibits ventricular arrhythmias following PCI for patients with AMI. Nicorandil treatment following PCI for AMI is convenient and may reduce the rate of cardiac events by inhibiting ventricular arrhythmias, thereby potentially improving the prognosis.     

The effect of propafenone on premature ventricular contractions (PVC): an analysis based on heart rate dependency of PVCs

The effect of 450 mg/day propafenone for two weeks on premature ventricular contractions (PVCs) was studied in combination with an assessment of heart rate (HR) dependency of PVCs using Holter ECG monitoring in patients with more than 720 PVCs per day. The PVC-HR correlation was classified into positive (P), bidirectional (B), and flat and negative (FN) correlation groups. The positive group included only patients in whom PVC frequency increased with a heart rate increase, while the bidirectional group included patients with PVCs whose frequency increased at low heart rates and decreased at high heart rates. The FN group contained both flat (PVC frequency was almost fixed regardless of heart rate changes) and negative (PVC frequency decreased as heart rate increased) correlations. The effectiveness of propafenone was 70% in the positive group and 50% in the nonpositive group which included both bidirectional (67%) and FN (0%) groups, using a > 70% PVC reduction as a criterion of efficacy. From this, we concluded that propafenone is effective in patients showing either positive or bidirectional PVC-HR correlation. The coupling interval (CI) of PVCs was also prolonged by propafenone as a whole. The present study suggests that there are differences in the mechanism of PVC development in patients with flat or negative correlation and those with a positive or bidirectional correlation. Thus, this type of analysis contributes to an understanding of the action of antiarrhythmic agents, and may allow the prediction of their efficacy on PVCs.     

Heart rate decline after exercise in patients with hypertrophic cardiomyopathy

To evaluate the heart rate recovery, submaximal exercise, echocardiographic examination, and Holter monitoring were performed on 30 patients with hypertrophic cardiomyopathy and 11 controls. The time constant of heart rate decline after exercise was calculated. Spectral analysis was performed on Holter recordings. The time constant did not correlate with heart rate, left ventricular end-diastolic pressure, ejection fraction, or wall thickness. There was no correlation between the time constant and any mean spectral indices over 24 hours in patients. However, the time constant correlated with high frequency component in the night. Nocturnal high frequency component in patients with short time constant was significantly less than in those with long time constant, but did not significantly differ from that in controls. In conclusion, the heart rate decline after exercise does not primarily reflect the severity of hypertrophy or hemodynamic impairment but is associated with nocturnal parasympathetic modulation in patients with hypertrophic cardiomyopathy.