美托洛尔与乙吗噻嗪对心室晚电位阳性的室性心律失常影…

８８例心室晚电位（ＶＬＰ）阳性的室性心律失常（ＶＡ）患者随机分为Ａ、Ｂ两组，分别服用美托洛及吗噻嗪，４周后复查２４小时动态心电图（ＤＣＧ）及ＶＬＰ。结果：乙吗噻嗪虽能有效控制ＶＡ，但不能使ＶＬＰ转阴，且有致心律失常作用（３／４２）；而美托洛尔不但能较好控制ＶＡ（３８／４６），且可使ＶＬＰ逆转（３９／４６），又无致心律失常及其它明显副作用，疗效与５０－１００ｍｇ／ｄ剂量之间无明显关系。作者认为：对Ｃ     

美托洛尔与心律平对心室晚电位阳性的室性心律失常影响的对比…

８６例心室晚电位（ＶＬＰ）阳性的室性心律失常（ＶＡ）患者随机分为Ａ、Ｂ两组，分别服美托洛尔及心律平，４周后复查２４小时动态心电图（ＤＣＧ）及ＶＬＰ。作者认为，对ＶＬＰ阳性的ＶＡ药物治疗，只要无β－受体阻滞剂应用的禁忌症，应首选美托洛尔。     

尿毒症患者心室晚电位记录的临床意义

对５８例尿毒症病人心室晚电位（ＶＬＰ）进行检测并结合临床资料进行分析，结果显示，尿毒症患者的ＶＬＰ阳性率为１５．５％，显著高于正常对照组（０／１５）；ＶＰＬ阳性组严重心肌缺血、心功能衰竭、恶性室性心律失常等心脏阳性事件的发生率显著高于ＶＬＰ阴性组（Ｐ＜０．０１）。随访期间，２例猝死病人生前ＶＬＰ阳性。提示：ＶＬＰ检测对尿毒症，尤其是透析患者心脏性猝死具有较高的预测价值。     

应用动态心电图观察乙吗噻嗪抗心律失常51例短期疗效分析

目的：观察51例心律失常患者口服乙吗噻嗪30天的疗效和安全性。方法：51例无心肌梗塞及心衰的心律失常患者，口服乙吗噻嗪300mg-800mg/d，随访30天，在服药前，后均行动态心电图评价。结果：总有效率82．4％，显效率64．7％，不良反应率为15．7％。结论：虽然乙吗噻嗪有较轻的不良反应，但致心律失常作用少见，它对于无心肌梗塞及心律失常患者是较为有效和安全的。     

时间频谱标测229例心肌梗塞患者心室晚电位

时间频谱标测（ＳＴＭ）心室晚电位（ＶＬＰ）在提高ＶＬＰ阳性病人的准确性上有较大的优势。本文经２２９例心肌梗塞患者的大样本临床验证，并与时域分析进行对照。其结果时域分析ＶＬＰ阳性６６例，ＳＴＭＶＬＰ阳性３７例。在ＶＬＰ阳性病例中发生室性心律失常的分别是时域分析３４例（３４／６６）占５１．５２％，ＳＴＭ３０例（３０／３７）占８１．０８％，Ｐ＜０．０１。对３８例合并室内传导阻滞者且ＶＬＰ阳性并发室性心律失常者，时域分析７例（７／１４）占５０％，ＳＴＭＩ２例（１２／１６）占７５％，Ｐ＜０．０２，利用心电图Ｗａｇｎｅｒ积分判定心肌梗塞面积，时域分析与ＳＴＭ在大面积心梗（≥１０分）组，分别是１０例（１０／６６）占１５．１５％、与１３例（１３／１７）占３５．１３％，Ｐ＜０．０２，有显著性差异。作者认为ＳＴＭ更为合理，它可使ＶＬＰ检测的准确性提高。     

加味生脉散治疗冠心病心室晚电位的疗效观察

为观察加味生脉散对冠心病心室晚电位（ＶＬＰ）阳性转阴的疗效，用加味生脉散与消心痛分别治疗ＶＬＰ阳性患者３２例；两组患者的年龄、性别和病程均无显著性差异。治疗结果：用加味生脉散治疗组ＶＬＰ阳性转阴率为７５．００％，而消心痛治疗组ＶＬＰ阳性转阴率为９．３８％，两组比较差异极显著（Ｐ＜０．０１）。作者认为：加味生脉散对心肌缺血后再灌注损伤有良好的保护作用，能改善心肌细胞的代谢，消除心肌细胞的非同步除极和延迟传导的生物电活动，最终使冠心病ＶＬＰ阳性转阴。加味生脉散是预防致命性心律失常的有效方剂。     

抗氧化剂治疗大鼠肾病模型的初步探讨

目的：探讨抗氧化剂对大鼠肾模型治疗作用。方法：给大鼠１次性静脉注射阿霉素（ＡＤＲ）制作肾病模型。选用抗氧化剂维生素Ｅ（ＶＥ）为治疗因素，测定血清中脂质过氧化物（ＬＰＯ），红细胞超氧化物歧化酶（ＳＯＤ）水平及相关血尿生化指标。结果：模型物组动物实验第１４天出现典型肾病综合征表现，血清中ＬＰＯ水平明显升高、红细胞ＳＯＤ活性明显降低。ＶＥ治疗组动尿、血生化指标及病理改变明显改善，且血清ＬＰＯ水平明显降低，红细胞ＳＯＤ活性明显高于ＡＤＲ组动物。结论：氧自由基，脂质过氧化损伤与ＡＤＲ肾病发生密切相关，ＶＥ能通过清除自由基、阻断脂质过氧化物对ＡＤＲ肾病起一定治疗作用     

参麦注射液对冠状动脉粥样硬化性心脏病患者心室晚电位影响的观察

参麦注射液对冠状动脉粥样硬化性心脏病患者心室晚电位影响的观察贾连旺朱苏航心室晚电位（Ｖｅｎｔｒｉｃｕｌａｒｌａｔｅｐｏｔｅｎｔｉａｌ，ＶＬＰ）与致命性室性心律失常及心脏性猝死的关系密切。有关ＶＬＰ阳性的治疗报道较少。为探索治疗ＶＬＰ阳性患者的有效而安...     

心率变异、心室晚电位和Q-T离散度预测急性心肌梗死预后的探讨

目的 了解心率变异（ＨＲＶ）、Ｑ－Ｔ离散度（Ｑ－Ｔｄ）和心室晚电位（ＶＬＰ）在预测急性心肌梗死９ＡＭＩ）预后的价值。方法 ４０例ＡＭＩ患者ＨＲＶ（ＳＤＮＮ）、Ｑ－Ｔ、ＶＬＰ测定,与４０例正常人进行对比分析。结果人ＡＭＩ组ＳＤＮＮ与对照组比较明显减低（Ｐ〈０．００１）,Ｑ－Ｔｄ明显延长（Ｐ〈０．００１）,ＶＬＰ阳性率明显增高（Ｐ〈０．０１）。梗死患者室性心律失常事件组与非事件组ＨＲＶ（ＳＤＮＮ）、Ｑ     

急性心肌梗塞早期QT离散度与室性心律失常事件的关系

目的：研究急性心肌梗塞（ＡＭＩ）早期ＱＴ离散度（ＱＴｄ）改变与室性心律失常（ＶＡ）的关系及预测价值。方法：随机选择ＡＭＩ后４８小时内收住ＣＣＵ患者５６例，首次常规心电图（ＥＣＧ）检查所测ＱＴｄ值与ＶＡ事件相关性分析。结果：发生ＶＡ组ＱＴｄ值６９４±１６５ｍｓ＞无室性心律失常（ＮＶＡ）组ＱＴｄ５０５±８７ｍｓ（Ｐ＜００５）；ＱＴｄ与ＶＡ分级序数呈显著正相关（γ＝０５６，Ｐ＜００１）。如以ＱＴｄ＝６９４ｍｓ做为判断ＣＶＡ下限值，则敏感性为８５％，特异性８２％，阳性预测值６９％，准确性９５％。结论：ＱＴｄ与ＡＭＩ早期ＶＡ密切相关，可做为预测ＣＶＡ及猝死发生的重要指标     

Left ventricular enlargement

Electrophysiology/Characteristics/Morphology: Increased duration of QRS interval, delay of intrinsicoid deflection, and increased QRS voltage tend to occur. "Strain" refers to T-wave inversion with depressed upwardly convex ST segments in the setting of LVE. Leftward axis is common, but not always found with LVE. EKG diagnosis: See Romhilt-Estes Scoring System outlined in Table 1. Conditions impairing diagnosis: asymmetrical septal hypertrophy, prior MI, CHF, pericardial or pleural effusions, anasarca, pulmonary emphysema, RBBB, LBBB, obesity, concomitant right ventricular enlargement. False positive diagnosis can occur in children and young adults, or in patients who are emaciated or have a slender body build. Significance: Hypertension is the most common cause. New onset or increasing strain pattern may signify LV dilatation and failure, or myocardial ischemia, and warrants careful evaluation. Treatment: As per underlying cause.     

Right ventricular enlargement

Right ventricular enlargement (RVE) encompasses dilatation and hypertrophy of the right ventricular chamber. Severe RVE produces characteristic ECG changes including right axis deviation and large S waves in the left precordial leads. Treatment is directed at the underlying cause.     

Epicardial ablation of ventricular tachycardia associated with isolated ventricular noncompaction

A 52-year-old man presented with sudden onset of palpitations and dizziness. Echocardiogram confirmed the diagnosis of isolated noncompaction of ventricular myocardium with moderated systolic dysfunction, and the electrocardiogram (ECG) revealed ventricular tachycardia (VT), of which the focus seemed to match an area of prominent left ventricular noncompaction on the 12-lead surface ECG. Through the activation mapping from the endo- and epicardium, simultaneously, a discrete potential preceding the QRS during VT was observed at the anterolateral epicardial wall. He subsequently underwent radiofrequency ablation, and VT was successfully eliminated.     

New strategies for ventricular tachycardia and ventricular fibrillation ablation

Patients with ventricular tachycardia (VT) and ventricular fibrillation (VF) and no reversible cause are difficult to treat. While implantable defibrillators prolong survival, many patients remain symptomatic due to device shocks and syncope. To address this, there have been recent advances in the catheter ablation of VT and VF. For example, non-invasive imaging has improved arrhythmia substrate characterisation, 3D catheter navigation tools have facilitated mapping of arrhythmia and substrate and ablation catheters have advanced in their ability to deliver effective lesions. However, the long-term success rates of ablation for VT and VF remain modest, with nearly half of treated patients developing recurrence within 2–3 years, and this drives the ongoing innovation in the field. This review focuses on the challenges particular to ablation of life-threatening ventricular arrhythmia, and the strategies that have been recently developed to improve procedural efficacy. Patient sub-groups that illustrate the use of new strategies are described.     

频发右心室流出道室性期前收缩对右心室流出道结构影响的研究

目的 探讨右心室流出道(RVOT)起源频发室性期前收缩对RVOT结构的影响.方法 选取2009～2011年行射频消融治疗的频发RVOT起源室性期前收缩患者30例,分析其心电图特征、动态心电图、心脏彩色超声结果及术中精确定位,分析室性期前收缩对RVOT结构的影响.结果 射频消融术前RVOT直径为(31.76±3.33)mm,术后6个月为(30.93±2.68)mm(P＜0.01);相关性分析显示:RVOT直径与室性期前收缩负荷呈正相关(r=0.484,P＜0.05).RVOT间隔部来源室性期前收缩QRS时限为(157.69±18.33) ms,游离壁来源室性期前收缩QRS时限为(179.23±16.05)ms(P＜0.01),QRS时限与来源部位相关(r=0.566,P＜0.01).室性期前收缩QRS时限与RVOT直径无相关性(r=0.097,P＞0.05).结论 RVOT来源室性期前收缩经射频消融治疗后,RVOT直径有减小的趋势,其与室性期前收缩负荷呈正相关,与室性期前收缩形态无相关性.     

室性心动过速和心室颤动治疗进展

室性心动过速（室速）和心室颤动（室颤）是心源性猝死最常见的原因。本文就器质性、特发性和离子通道病性室速/室颤的药物、器械、导管消融术及其他治疗等的最新进展进行了总结,以期能够达到规范临床诊疗的作用。     

Effects of proximal ventricular septal pacing on hemodynamics and ventricular activation

Recently the use of alternate site pacing to improve cardiac function in patients with bradyarrhythmias has increased. In the present study, hemodynamics of right ventricular septal pacing were studied in seven dogs. A bipolar screw-in lead and endocardial lead were placed in the proximal right ventricular septum and right ventricular apex, respectively. The right ventricle was paced from each site. A conductance catheter and Millar catheter were inserted into the left ventricle to determine the left ventricular pressure and the pressure-volume loop. Cardiac output was measured using the thermodilution method. In five of the seven dogs, ventricular activation was documented by isochronal epicardial activation mapping during each pacing mode. Mean arterial pressure and cardiac output during septal pacing were significantly higher than during apical pacing (110 +/- 17 mmHg vs 100 +/- 18 mmHg; 1.00 +/- 0.39 L/min vs 0.89 +/- 0.33 L/min). The positive dp/dt during septal pacing was significantly higher than during apical pacing (2137 +/- 535 mmHg/s vs 1911 +/- 404 mmHg/s). End-systolic elastance during septal pacing was significantly higher compared to apical pacing (13.1 +/- 0.3 mmHg/mL vs 8.9 +/- 4.0 mmHg/mL). The ventricular activation time during septal pacing was significantly shorter than during apical pacing. The epicardial maps generated during septal pacing were similar to those from atrial pacing. We conclude that hemodynamics and interventricular conduction are less disturbed by proximal right ventricular septal pacing than apical pacing in dogs with normal hearts.     

Effect of pacing-induced ventricular dyssynchrony on right ventricular function

Background: Asynchronous electrical activation induced by right ventricular (RV) pacing can cause several abnormalities in left ventricular (LV) function. However, the effect of ventricular pacing on RV function has not been well established. We evaluated RV function in patients undergoing long‐term RV pacing. Methods: Eighty‐five patients and 24 healthy controls were included. After pacemaker implantation, conventional echocardiography and strain imaging were used to analyze RV function. Strain imaging measurements included peak systolic strain and strain rate. LV function and ventricular dyssynchrony by tissue Doppler imaging (TDI) were assessed. Intra‐ and interobserver variabilities of TDI parameters were tested on 15 randomly selected cases. Results: All patients were in New York Heart Association functional class I or II and percentage of ventricular pacing was 96 ± 4%. RV apical induced interventricular dyssynchrony in 49 patients (60%). LV dyssynchrony was found in 51 patients (60%), when the parameter examined was the standard deviation of the time to peak myocardial systolic velocity of all 12 segments greater than 34 ms. Likewise, septal‐to‐lateral delay ≥65 ms was found in 31 patients (36%). All echocardiographic indexes of RV function were similar between patients and controls (strain: ?22.8 ± 5.8% vs ?22.1 ± 5.6%, P = 0.630; strain rate: ?1.47 ± 0.91 s^?1 vs ?1.42 ± 0.39 s^?1, P = 0.702). Intra‐ and interobserver variability for RV strain was 3.1% and 5.3%, and strain rate was 1.3% and 2.1%, respectively. Conclusions: In patients with standard pacing indications, RV apical pacing did not seem to affect RV systolic function, despite induction of electromechanical dyssynchrony. (PACE 2011; 34:155–162)     

第三脑室穿刺液化引流术治疗危重型自发性脑室出血

目的研究应用第三脑室穿刺液化引流术治疗危重型自发性肿室出血的方法与疗效观察。方法依据脑室内积血的量及其形态、形状、病情、原发病，应用第三脑室穿刺液化引流术和／或辅以侧脑室液化引流术、脑脊液／生理盐水差额置换术，清除出血，抢救患者生命，改善预后。结果治疗53例，出院44例（基本痊愈13例，显著进步18例，进步9例，无变化4例），术后3个月内死亡12例（病死率22．6％）：门诊或家庭随访35例（6个月～7年），按日常生活活动（ADL）量表Barthel指数记分：ADLI 15例（42．9％），ADL Ⅱ10例（28．6％），ADL Ⅲ6例（17．1％），ADLⅣ3例（8．6％），ADLV1例（2．9％）。结论应用第三脑室穿刺液化引流术治疗危重型自发性脑室出血能最大限度地清除脑室出血，真正地实现微创，避免或减轻了并发症，有效改善预后，具有较大的优越性。     

QT interval dispersion in ventricular beats: a noninvasive marker of susceptibility to sustained ventricular arrhythmias

Increased QT dispersion (QTd) calculated from sinus beats has been shown to identify patients prone to sustained VT. However, predictive accuracy of this parameter is limited. Electrophysiological properties of the myocardium may be altered by a premature ventricular beats, which is a well-established trigger for sustained VT. Therefore, the author hypothesised that QTd in spontaneous or paced ventricular beats may improve identification of patients with inducible sustained VT. In 28 consecutive patients (men, mean age 61 +/- 13 years) who underwent programmed ventricular stimulation, the values of QTd calculated in sinus and ventricular beats were compared between inducible and noninducible patients. The mean QTd values obtained using three different methods differed significantly, QTd in paced ventricular beats being the highest, QTd in spontaneous ventricular beats was intermediate, and QTd in sinus beats was the lowest (83.9 +/- 30 vs 63.0 +/- 29 ms vs 53.9 +/- 27 ms, P < 0.0001 and P < 0.004, respectively). In 13 (46%) patients sustained VT was induced. QTd values were significantly higher in inducible than noninducible patients (QTd sinus beats: 67.5 +/- 31 vs 42.1 +/- 11 ms, P = 0.02; QTd spontaneous ventricular beats: 79.3 +/- 35 vs 46.7 +/- 13 ms, P = 0.008, and QTd-paced ventricular beats: 104.8 +/- 32 vs 65.9 +/- 9 ms, P = 0.0009). The receiver operator characteristic curves showed that at a sensitivity level of 100%, the highest specificity for identification of inducible patients had QTd measured in paced ventricular beats (87%) followed by QTd in spontaneous ventricular beats (45%), and QTd in sinus beats (40%). In conclusion, (1) QTd in ventricular beats is greater than in sinus beats, and (2) QTd calculated from paced ventricular beats identifies patients with inducible sustained VT better than QTd measured during sinus rhythm.