致心律失常性右心室心肌病临床诊断探讨

目的探讨致心律失常性右心室心肌病的临床诊断标准.方法将19例致心律失常性右心室心肌病患者常规行超声心动图、心电图、X线胸片、24小时动态心电图、心房调搏及心内电生理检查.结果本组19例患者均有心悸,晕厥发作,心电图多为右束支传导阻滞(78.95%),频发室性早搏(89.5%),右心室源性短阵室性心动过速(78.95%),超声心动图右心室50.80±9.88?mm,右心房48.00±8.79?mm,均增大,右心功能减退,射血分数0.294±0.0812.结论致心律失常性右心室心肌病,可根据发作性晕厥,右束支传导阻滞,频发室性早搏及左束支传导阻滞型室性心动过速,右心室、右心房增大,右心室功能减退,并排除其他各类心脏和胸肺疾病后确诊.     

室间隔缺损介入封堵治疗发生心律失常的临床研究

目的探讨室间隔缺损(VSD)经导管介入治疗发生心律失常的机制及防治对策。方法对79例VSD患者进行介入封堵治疗。膜周部VSD单纯型50例,膨出瘤型28例,肌部VSD1例。选用Rashkind双伞闭合器2例,Sideris钮扣闭合装置16例,Amplatzer PDA封堵器45例,Amplatzer偏心型膜周部封堵器11例,Am-platzer肌部VSD封堵器1例。结果79例患者75例封堵成功(94.9%)。术后新出现心律失常31例(41.3%),其中不完全性右束支传导阻滞17例(22.7%),完全性右束支传导阻滞3例(4%),完全性左束支传导阻滞6例(8%),室性早搏3例(4%),间歇性室上性心动过速2例(2.7%)。1例患者术前心电图示完全性右束支传导阻滞,术后第4天心电图表现为Ⅲ度房室传导阻滞,临床伴发阿—斯综合征。经紧急开胸心脏挤压,气管插管,安置心外膜临时起搏器,复苏成功,出院时患者心电图恢复至术前状态。其余25例束支传导阻滞,其中5例应用强的松30mg/日,一周后仅有2例存在不完全性右束支传导阻滞,1例存在不完全性左束支传导阻滞。3例室性早搏,2例为一过性,1例经抗心律失常药物治疗,出院时室性早搏仍有591次/24小时。结论经导管封堵VSD,出现心律失常达41.3%,但严重心律失常发生率低,是安全、有效可靠的治疗方法。     

以心律失常、传导阻滞为主征的心肌病患者的心内膜心肌活体检查所见

本文报告24例以心律失常、束支传导阻滞等心电图改变为主诉而入院的24名患儿的心内膜心肌活检所见.患儿男、女各12名,年龄为1～15岁(平均9.4±4.4岁).心电图异常的表现为莫氏Ⅰ型Ⅱ度房室传导阻滞3例,Ⅲ度房室传导阻滞及高度房室传导阻滞8例,室性早搏7例,阵发性室性心动过速1例,病态窦房结综合征3例,不完全性右束支传导阻滞1例,完全性右束支传导阻滞1例.临床诊断分别考虑为肥厚型心肌病,扩张型心肌病,心内膜弹力纤维增生症,或是为冠状动脉畸形.全部病例     

58例扩张型心肌病l2导联动态心电图分析

目的 观察扩张型心肌病(DCM)24h 12导联动态心电图改变.方法 58例均经心脏超声检查诊断为DCM,再行24h 12导联动态心电图监测.结果 所有病例动态心电图均有异常改变,以心律失常最为常见.其中室性心律失常56例(96.6%),房性心律失常43例(74.1%),ST-T改变32例(55.2%)、室性心动过速29例(50.0%).心功能越差,复合性心律失常越多见.传导阻滞25例(43.1%),房室肥大27例(46.6%),Q-T间期延长24例(41.4%),异常Q波8例(13.8%)等.结论 DCM有多种心电图表现,其多发、多样性心律失常对DCM早期诊断有重要意义.有复合心律失常的患者有必要进行心脏超声心动图检查.     

46例老年男性退行性心脏瓣膜病心律失常10年随访分析

目的探讨老年男性退行性心脏瓣膜病(SDHVD)患者病程长短对心律失常的影响及临床意义。方法心脏彩超首次诊断SDHVD患者46例(A组)及无SDHVA患者46例(B组),应用动态心电图对两组患者进行10年的动态心电图随访,对心律失常进行对比分析。结果两组患者各类心律失常发生率随年龄增加呈上升趋势,快速房性心律失常(包括房性心动过速、心房颤动及心房扑动)的发生率随年龄增加两组差异不断缩小,一度房室传导阻滞,完全性右束支传导阻滞的发生率随年龄增加及SDHVD患者病程延长两组差异呈增大趋势。结论随着年龄的增加及病程的延长,SDHVD患者一度房室传导阻滞及右束支传导阻滞的发生率增加,建议对SDHVD患者定期进行动态心电图检查,及时发现心电图改变,并针对所发现的心电图改变并进行必要的干预,提高SDHVD患者生命质量。     

房室滞后功能致起搏器介导的心动过速一例

患者男性,76岁,临床诊断:心律失常:病窦综合征;窦性心动过缓;间歇性II度II型房室传导阻滞;完全性右束支传导阻滞。入院后植入双腔起搏器,术后程控将IRSplus功能打开,患者诉间断心悸,术后5天动态心电图示频繁发作起搏器介导的心动过速(PMT),再次程控将IRSplus功能关闭,调整后患者心悸症状改善,行动态心电图提示未见PMT发作。     

预激合并房室正道与旁道或束支传导阻滞的心电图表现

报道2例预激合并房室正道和旁道同时存在传导阻滞以及2例预激合并束支传导阻滞。例1,男性,54岁,临床诊断:扩张型心肌病、心动过速原因待查。心电图诊断有:房室正道一度传导阻滞;间歇性完全性B型预激综合征,系房室旁道存在长P-R间期二度Ⅱ型传导阻滞所致。例2,女性,33岁,临床诊断:扩张型心肌病、预激综合征、晕厥原因待查。心电图诊断有:间歇性完全性预激综合征;房室正道高度传导阻滞伴3相超常期传导、房室旁道二度Ⅱ型传导阻滞,呈2∶1~3∶2传导。例3,例4均为女性,年龄分别为51,16岁,均诊断为Ebstein畸形。心电图诊断为B型预激综合征,完全性右束支传导阻滞。     

起搏治疗使扩大心脏恢复正常9例报告

现已公认快速心律失常持续或频繁发作 ,可产生心动过速所致的心肌病 [1 ] 。快速心律失常被控制后 ,这类心肌病可恢复原有的心脏情况。但持久缓慢心律失常是否可引起心脏扩大及心力衰竭目前尚缺乏报道 ,我们报道一组 9例持久缓慢心律失常患者 ,起搏术前心脏明显扩大 ,经安置永久心脏起搏器后 ,心脏大小恢复正常。1　对象和方法1.1　对象　 1993- 0 6～ 1999- 0 6安置各类永久心脏起搏器患者中 ,术前超声心动图发现左心室扩大者 9例 ,年龄 48～ 74岁 ,平均 6 0岁。病窦综合征 3例 ,高度房室传导阻滞伴完全性左束支传导阻滞 1例 ,完全性房室传…     

多形性室性心动过速酷似心房颤动伴束支传导阻滞合并室性期前收缩1例

报道重庆市壁山区人民医院2021年4月2日收治的1例多形性室性心动过速酷似心房颤动（下称房颤）伴束支传导阻滞合并室性期前收缩的病例。患者因晕厥伴低血压入院,心电图提示单形性室性心动过速,经电复律、抗心律失常等治疗,复查心电图示QRS波群呈多种形态酷似房颤伴束支传导阻滞合并室性期前收缩,最后诊断为多形性室性心动过速。结合相关检查,考虑低钾血症所致室性心动过速,通过补钾等治疗室性心律失常消失,患者好转出院。     

肥厚型梗阻性心肌病围术期心律失常特点及治疗策略

目的:分析外科手术矫治肥厚型梗阻性心肌病(HOCM)患者围术期心律失常特点及治疗策略.方法:1996-10至2009-12,76例患者因HOCM经常规主动脉切口行室间隔心肌切除术.术前主要心律失常类型:偶发室性早搏(6例)、完全右束支传导阻滞(5例)、阵发性房性心动过速(4例)、心房颤动(3例)、短阵室性心动过速(3例).结果:全组手术死亡4例(5.3%,4/76),主要死因:顽固性心律失常、严重低心排血量综合征及急性肾功能衰竭.与术前比较,生存患者术后左心房内径及左心室内径均减小、左心室流出道压差下降、室间隔厚度变薄,差异均有统计学意义(P<0.01-0.05).术后主要心电图异常表现:完全左束支传导阻滞(40例)、室内传导阻滞(8例)、Ⅲ度房室传导阻滞(7例)、心房颤动(7例)、偶发室性早搏(7例)、左前分支传导阻滞(6例)、I度房室传导阻滞(5例).结论:HOCM患者术后心电图主要异常表现为传导束传导异常和心房颤动.如术前合并完全右束支传导阻滞,术后极易合并Ⅲ度房室传导阻滞,需引起重视.     

The interruption of atrioventricular conduction by cardiac fulguration in patients with supraventricular tachycardias. The mid- and long-term results]

Catheter ablation of the atrioventricular node is a therapeutic technique for the treatment of patients with drug-refractory supraventricular tachyarrhythmias. In our Arrhythmia Unit 25 patients (8 women, 17 men) aged (mean +/- DE) 56 +/- 10 years have undergone fulguration of the atrioventricular junction since 1986. The more frequent treated rhythm disturbance was atrial flutter or fibrillation, with uncontrolled rapid ventricular response. Absence of organic heart disease was diagnosed in 9 patients; the remainder had valvular heart disease (2), cor pulmonale (2), cardiomyopathy (7), hypertensive heart disease (2) and Wolff-Parkinson-White syndrome (3). Under general anesthesia 1.8 +/- 0.8 shocks/patients were delivered along 1.2 +/- 0.7 sessions/patient. In 23 of 25 patients (92%) complete atrioventricular block was achieved, and a pacemaker was implanted. There were no complications. The other 2 patients were referred to surgery for cryoablation of the atrioventricular junction. Patients were followed for an average of 21 +/- 12 months. Four patients have died: two due to congestive heart failure, which was present prior to the ablation procedure, the third because of a metastatic carcinoma, and the fourth had a sudden death 14 months after the procedure (he had dilated cardiomyopathy and Wolff-Parkinson-White syndrome). The remainder in chronic stable complete atrioventricular block are asymptomatic for arrhythmias and without antiarrhythmic medication.     

Isolated Cardiac Involvement in Primary Amyloidosis: Presenting as Sick Sinus Syndrome and Heart Failure

Cardiac amyloidosis is an infiltrative cardiomyopathy with a grave prognosis. Its clinical manifestations include restrictive cardiomyopathy, diastolic heart failure, conduction defects, and arrhythmias. Isolated cardiac involvement and significant conduction disturbances are reported very infrequently. We report a rare case of isolated cardiac involvement in primary amyloidosis, in a 76-year-old man who initially presented with sick sinus syndrome that necessitated permanent pacemaker insertion. Subsequent symptoms of heart failure led to additional evaluation, including an endomyocardial biopsy that revealed primary cardiac amyloidosis. Medical therapy improved the patient''s symptoms, and he was discharged from the hospital in stable condition. In addition to discussing the patient''s case, we review the relevant medical literature.Key words: Amyloidosis/complications/drug therapy/pathology, cardiomyopathies/complications/pathology, heart failure/diagnosis/etiology, prognosis, treatment outcomeCardiac amyloidosis is an infiltrative cardiomyopathy caused by the deposition of proteinaceous material, called amyloid, in the extracellular space of the heart. Clinical manifestations can include restrictive cardiomyopathy, diastolic heart failure, conduction defects, and arrhythmias.¹ We describe a rare case of primary cardiac amyloidosis in an elderly man who initially presented with sick sinus syndrome that necessitated permanent pacemaker insertion. Subsequent symptoms of heart failure prompted additional evaluation that established a diagnosis of primary cardiac amyloidosis.     

Efficacy of atrial antitachycardia pacing using the Medtronic AT500 pacemaker in patients with congenital heart disease

Patients with congenital heart disease are vulnerable to atrial tachyarrhythmias, especially after atrial surgeries. We evaluated the efficacy of atrial arrhythmia detection and antitachycardia pacing (ATP) using the Medtronic AT500 pacemaker in 28 patients with congenital heart disease (age 30 +/- 18 years). Of 15 patients with atrial arrhythmias, 14 had atrial tachycardia events that were appropriately detected. ATP was enabled for 167 treatable episodes, successfully converting 90 (54%). Rhythms classified as ventricular tachycardia were detected 127 times, yet most were actually atrial or sinus tachycardia with 1:1 atrioventricular conduction. Atrial tachycardias in congenital heart disease are amenable to ATP algorithms in the AT500 pacemaker.     

Mechanism and prediction of sudden cardiac death in arrhythmia patients using electrophysiological studies

Thirty nine cases, in which sudden cardiac death (SCD) was suspected, were studied to evaluate the mechanism and the prediction of SCD in arrhythmia-patients using electrophysiological studies (EPS). The 39 cases (28 male and 11 female) were located by surveying 2098 patients who underwent EPS for the evaluation of arrhythmias. Age at time of EPS ranged from 4 to 86 years, average 50.5 years. Time from EPS to death was 2 to 163 months, average 27.9 months. Underlying heart disease was: dilated cardiomyopathy in 11, old myocardial infarction in 5, ischemic heart disease in 5, hypertensive heart disease in 5, valvular heart disease in 3, hypertrophic cardiomyopathy in 2, arrhythmogenic right ventricular dysplasia in 1, myocarditis in 1, sarcoidosis in 1, cor pulmonale in 1, and no obvious heart disease in 4. Fifteen had a permanent pacemaker implanted. SCD in cases without a permanent pacemaker (24 cases): 2 had chronic complete A-V block (one BH block, one HV block), 1 had advanced A-V block (HV block), 3 had bundle branch block with first degree HV block, 9 had ventricular tachycardia (VT), 3 had sick sinus syndrome (SSS), 3 had paroxysmal atrial flutter, 1 had WPW syndrome and paroxysmal atrial fibrillation, 1 had paroxysmal atrial tachycardia, and 3 had premature ventricular beats and first degree HV block. SCD in cases with permanent pacemaker (15 cases): 5 had SSS, and 10 had A-V block. In 3 of the 5 with SSS and 7 of the 10 with A-V block, VT was found before pacemaker implantation. In our study, brady and tachyarrhythmias coexisted in 25 cases (64%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Arrhythmias in Patients with Heart Failure

Opinion statement Both atrial and ventricular arrhythmias are very common in patients with congestive heart failure, and their presence is associated with symptoms, significant morbidity, and mortality. Studies have attempted to determine the prognostic significance of atrial and ventricular arrhythmias in patients with heart failure. Whether atrial fibrillation is an independent risk factor of mortality remains controversial. The presence of ventricular arrhythmias in patients with ischemic cardiomyopathy identifies patients at high risk for sudden death. However, in patients with nonischemic cardiomyopathy there is not a strong correlation between ventricular arrhythmias and increased risk for sudden death. Multiple trials using antiarrhythmic drugs, pharmacologic therapy, and implantable cardioverter defibrillators have been performed in an attempt to improve survival in patients 1) post-myocardial infarction; 2) with congestive heart failure, with and without nonsustained ventricular tachycardia; and 3) with sustained ventricular tachycardia and those who have survived an out-of-hospital cardiac arrest. The purpose of this article is to present an overview of arrhythmias in patients with heart failure and discuss the prevalence, prognostic significance, complications, mechanisms, and trials that have formed the current therapies presently used.     

A syndrome of congenital cardiomyopathy with mitral regurgitation, complete heart block and atrial arrhythmia

A distinctive syndrome of cardiomyopathy with mitral regurgitation, complete heart block and atrial arrhythmia was noted in four male patients aged 19 to 49 years. Each presented with cardiac enlargement and varying degrees of left ventricular failure. One patient was known to have had complete heart block from infancy and another patient from 13 years of age. Each had chronic atrial fibrillation or flutter, with a regular ventricular rhythm at 35 to 45/min. Hemodynamic studies showed dilatation and poor contractility of the left ventricle, considerable mitral regurgitation, reduced resting cardiac output and elevated left ventricular end-diastolic pressures. The clinical course in follow-up periods of up to 5 years has been one of relatively mild, slowly progressive congestive heart failure. Mitral valve replacement and permanent pacemaker installation in one patient had no effect on the clinical course. The mitral valve showed redundant leaflet tissue with mucoid degenerative changes. This syndrome appears to represent a form of congenital cardiomyopathy which involves degeneration or fibrotic changes in both the myocardium and the conduction system. Familial occurrence has not been recognized.     

Arrhythmia in patients with a DDD bicameral pacemaker

Dual chamber pacemakers, with coordinate atrial and ventricular sensing and stimulation (DDD), even if allowing "physiological" pacing, exhibited new and complicated arrhythmic manifestations, whose real frequency is still unascertained. In 65 patients (mean age 68 +/- 12 years), implanted with a DDD multiprogrammable device (15 pts. Medtronic Versatrax 7000 A, 50 pts. Pacesetter AFP 283), we carried out a 24 hours Holter monitoring while pacemaker was programmed with standard parameters. In a subset of 15 patients Holter monitoring was performed before and after pacemaker implantation. We evidenced: a) atrial sensing and/or pacing malfunction in 3 patients (4.5%); b) pacer-unrelated arrhythmias in 49 patients (75%): atrial extra beats 35 patients (54%), ventricular extra beats 23 patients (35%), non-sustained ventricular tachycardias 10 patients (15%), atrial tachyarrhythmias 8 patients (12%); c) supraventricular arrhythmias with PM-mediated high rate ventricular pacing in 12 patients (18%); d) PM induced and sustained endless loop tachycardias in 31 patients (47%); e) arrhythmias depending on over-sensing in 11 patients (17%): myopotential interferences 9 patients (14%), cross-talk ventricular pacing inhibition 2 patients (3%). The prevalence of ventricular arrhythmias was not different before and after the pacemaker implantation. The prevalence of atrial extrasystoles (53% versus 40%) and atrial tachyarrhythmias (26% versus 6%) decreased after the pacemaker implantation. Aimed reprogramming with progressive extension of atrial refractory period (from 250 to 400 msec and DDX) achieved disappearance of PM-endless loop tachycardias in 95%. Use of multi-programmability lowered the incidence and symptoms of most PM-related arrhythmias. Drug therapy was of choice in clinical arrhythmias unrelated to pacer.     

Isolated noncompaction cardiomyopathy presenting with paroxysmal supraventricular tachycardia--case report and literature review

Isolated noncompaction cardiomyopathy is an exceedingly rare congenital cardiomyopathy. A case of isolated noncompaction cardiomyopathy is reported and the literature on the subject collected through a comprehensive literature search is reviewed. Fewer than 100 cases of this condition have been reported. Isolated noncompaction cardiomyopathy is caused by a defect in cardiac morphogenesis resulting in an arrest of compaction of loose interwoven meshwork of myocardial fibers during intrauterine life, which results in severe systolic dysfunction as well as undue hypertrophy of the involved walls of the ventricles. Although the most frequent sites involved are left ventricular apex and inferior wall, involvement of other left ventricular walls and right ventricle has also been reported. Etiology of the isolated noncompaction of myocardium is not clear. Familial cases have been reported and the mode of inheritance is heterogeneous. In X-linked form of the disease, a locus has been found on Xq28, and mutations have been reported in G4.5 gene. The age of onset of symptoms ranges from infancy to the geriatric age. Patients with isolated noncompaction cardiomyopathy have a high incidence of heart failure, arrhythmias, and thromboembolism. The most common presentation is congestive heart failure. Arrhythmias include atrial arrhythmias, ventricular tachycardia, and sudden cardiac death. The patient reported in this article presented with paroxysmal supraventricular tachycardia. Echocardiography is the procedure of choice to establish diagnosis. Due to the lack of associated cardiac anomalies, antenatal detection is difficult. The treatment is that for congestive heart failure, arrhythmias, and thromboembolism. The end-stage congestive heart failure is managed with heart transplantation and potential life-threatening ventricular tachyarrhythmias with an implantable cardioverter defibrillator. Prognosis is poor and the common causes of death are intractable heart failure and sudden cardiac death.     

Arrhythmias in Children Having a Single Left Superior Vena Cava and Minimal Structural Heart Disease

Background: The presence of a single left superior vena cava in the absence of complex congenital heart disease is uncommon, and, in the absence of hemodynamic consequences, it would not be expected to result in cardiovascular signs or symptoms. Single case reports and our anecdotal experience suggested to us that this anomaly is highly associated with cardiac arrhythmias.
Objective: We sought to describe the clinically important arrhythmias in a population of young patients having this anomaly.
Methods: A retrospective chart review was performed from all patients <20 years old and who were determined by echocardiography over an 11-year-period to have a single left superior vena cava and minor or no coexisting congenital heart defects. The prevalence of nonsinus pacemaker, age-corrected sinus rate percentile, and prevalence of brady- or tachyarrhythmias was compared with a control group of patients having bilateral superior vena cavae.
Results: Eight patients having a single left and 55 patients having bilateral superior vena cava(e) were identified. The existence of this anomaly tended to be associated with a lower age-corrected sinus rate percentile (17.5% vs 75%, P = 0.09), and was associated with a higher prevalence of arrhythmias (50% vs 7%, P = 0.014) compared with the control group. In the study group, one patient each had clinically relevant sinus node dysfunction, third-degree AV block, Wolff-Parkinson-White syndrome and atrial fibrillation, and AV nodal reentrant tachycardia.
Conclusion: Even in the absence of symptoms, patients found to have a single left superior vena cava should be monitored long-term for clinically important arrhythmias.     

Clinical study of double-chamber stimulation. Apropos of 50 cases followed-up for 1 to 5 years

The authors report their experience of dual chamber pacing in 29 men and 21 women of mean age 71 +/- 4 years. 35 had sinus node dysfunction associated with node-His bundle conduction disorders; 31 presented with neurological symptoms and 4 with heart failure (due to pacemaker syndrome in 1 case). Sinus node dysfunction was diagnosed by surface ECG in 25 cases and after electrophysiological studied in only 10 cases. Fifteen patients had atrioventricular block without sinus node dysfunction: 2 of them were young subjects, 1 had pacemaker syndrome and 12 were actual or potential heart failure patients for whom preservation of the atrial systole was justified. Nine patients presented with neurological symptoms. 43 (86%) had cardiac or arterial disease associated with cardiac rhythm and conduction disorders. The percutaneous single subclavian vein approach was used in 36 cases (78%). 41 active and 9 passive fixation electrodes were utilized. The mean follow-up period was 25 months (12 to 70 months), with a cumulative figure of 1,253 months/patients. Two late re-operations for displacement of the atrial electrode were performed. Dual chamber pacing was abandoned, 14 months on average after implantation, in 9 patients (18%), on account of arrhythmias in 4 of them. Three cases of tachycardia from "electronic re-entry" and 6 cases of supraventricular arrhythmia transferred to the ventricle by the pacemaker were observed. Sixteen patients (32%) died 12 +/- 4 months on average after surgery: 12 (33%) had sinus node dysfunction and 4 (26%) had AV block. Death was caused by a cardiovascular disease in 12 cases.(ABSTRACT TRUNCATED AT 250 WORDS)