射频导管消融治疗起源于左心室游离壁的频发室性早搏

目的报道1组起源于左心室游离壁的无器质心脏病基础的频发室性早搏（室早）射频消融结果。方法共11例特发性室早患者,男性7例,女性4例,平均年龄（47．2±14．4）岁。均接受常规电生理检查及射频消融治疗,所有病例室早体表心电图均呈右束支阻滞图型。消融术中采用激动标测和起搏标测相结合的方法。结果11例室早均消融成功（2例复发经再消融成功）,所有室早被证实均起源于左心室游离壁,6例起源于前外侧游离壁中、高段,4例起源于后下侧游离壁中段,1例起源于游离壁低段近心尖部。术中成功消融部位局部V波较体表心电图QRS波起点提前24～41（27±9）ms。其中9例成功消融部位起搏心电图与室早图形基本相同。结论起源于左心室游离壁的室早是特发性室早的一个亚组,射频消融治疗可取得良好效果。     

Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization

Objectives

In patients with acute coronary syndrome (ACS), we sought to: 1) describe arrhythmias during hospitalization, 2) explore the association between arrhythmias and patient outcomes, and 3) explore predictors of the occurrence of arrhythmias.

Methods

In a prospective sub-study of the IMMEDIATE AIM study, we analyzed electrocardiographic (ECG) data from 278 patients with ACS. On emergency department admission, a Holter recorder was attached for continuous 12-lead ECG monitoring.

Results

Approximately 22% of patients had more than 50 premature ventricular contractions (PVCs) per hour. Non-sustained ventricular tachycardia (VT) occurred in 15% of patients. Very few patients (≤1%) had a malignant arrhythmia (sustained VT, asystole, torsade de pointes, or ventricular fibrillation). Only more than 50 PVCs/hour independently predicted an increased length of stay (p < .0001). No arrhythmias predicted mortality. Age greater than 65 years and a final diagnosis of acute myocardial infarction independently predicted more than 50 PVCs per hour (p = .0004).

Conclusions

Patients with ACS seem to have fewer serious arrhythmias today, which may have implications for the appropriate use of continuous ECG monitoring.     

起源点邻近房室瓣环的特发性室性心律失常体表心电图特点及射频消融治疗

目的 评估起源点邻近房室瓣环附近的室性心动过速和室性早搏(室速/室早)的体表心电图特点及射频消融治疗效果.方法 共19例特发性室速/室早患者接受常规电生理检查及射频消融治疗,对所有病例12导联体表心电图进行分析.结果 19例室速/室早术中均消融成功.10例起源于二尖瓣环附近,包括前侧壁(5例)、后侧壁(3例)、后间隔(2例).9例起源于三尖瓣环附近,包括游离壁侧5例、间隔侧4例.对各组瓣环室速/室早心电图做进一步分析,可概括出系列心电图判断指标用以估计消融靶点的部位.结论 起源点邻近房窜瓣环附近的室速/窒早是特发件室速/室早的一个亚组,射频消融治疗可取得良好效果,掌握其体表心电图特点有助于判定室速/室早的起源部位.     

Electrocardiographic characteristics of premature ventricular contractions in subjects with type 1 pattern of Brugada syndrome

Background

The ECG characteristics of premature ventricular contractions (PVCs) in subjects with Brugada syndrome (BrS) phenotype were investigated.

Methods and results

A total of 96 patients with type 1 ECG pattern of BrS were screened for PVCs. The study population consisted of 10 male individuals (mean age 41.9 ± 5.6 years) with spontaneous (n = 2) or drug-induced (n = 8) type 1 ECG phenotype of BrS and PVCs. Twenty patients (11 males, age 44.6 ± 15.1 years) with idiopathic right ventricular outflow tract (RVOT) PVCs (LBBB/inferior axis morphology with a negative QRS complex in lead aVL) successfully ablated from an endocardial site were also included in the study, and served as comparative controls. Six subjects with BrS phenotype (five during drug challenge) displayed PVCs with LBBB/inferior axis morphology and negative QRS complex in aVL lead which indicates an RVOT origin. The ECG characteristics of PVCs with LBBB/inferior axis in subjects with BrS and idiopathic RVOT arrhythmia were subsequently compared. QRS duration in inferior (p = 0.001) and right precordial leads (p < 0.001) was significantly longer in subjects with BrS phenotype. The RS interval in lead V2 was also significantly prolonged in individuals with BrS phenotype (p = 0.016). Subjects with BrS phenotype exhibited an increased intrinsicoid deflection time measured in right precordial leads compared to those with idiopathic RVOT PVCs (46.0 ± 7.6 vs. 27.2 ± 9.5 ms, p < 0.001). Finally, a pseudo-delta wave in precordial leads was more commonly observed in subjects with BrS ECG pattern (p = 0.029).

Conclusions

PVCs in BrS usually originate from the RVOT and display specific ECG characteristics that might be indicative of an epicardial origin. The prolonged interval criteria may be related to a localized epicardial conduction delay.     

Quantitative localization of premature ventricular contractions using myocardial activation ECGI from the standard 12-lead electrocardiogram

Background

The precise localization of the site of origin of a premature ventricular contractions (PVC) prior to ablation would facilitate the planning and execution of the electrophysiological procedure. Current electrocardiographic imaging (ECGI) techniques require body surface maps, a costly and complex procedure, that requires as many as 256 leads to localize the PVC origin. We developed and tested a novel myocardial activation based ECGI technique utilizing the readily available 12-lead ECG to localize the PVC origin.

Methods

The major components of the 12-lead ECGI method are: the source model, proximity effect and spatial orientation, volume conductor, and patient specific model of the heart, lungs, and thorax as derived from magnetic resonance imaging (MRI). For the PVC origin localization, the fastest route algorithm is used on patient specific models created by newly developed morphing software. PVC localization by the 12-lead ECGI was correlated to the site of successful ablation.

Results

Seven patients that underwent electrophysiological mapping and ablation of PVCs were studied. All patients (7/7) had accurate prediction of the PVC origin. However in two patients, no specific MRI was used for localization that resulted in an incorrect switch between the RV free wall and septum of the RVOT. With patient-specific models, these latter two cases would likely be localized correctly.

Conclusions

This feasibility study of a novel myocardial activation-based ECGI using only the standard 12-lead ECG shows promise to localize the origin of PVC. This ECGI method yields activation estimates of isochrones on both ventricles from which the PVC origin location is derived. This method has the capability to localize the PVC from any part of the ventricular endocardium, intra-myocardium or epicardium.     

分支起源室早的射频消融

目的探讨左室传导分支起源的室性早搏（Premature Ventricular Contractions,PVCs）的心电生理特点及导管射频消融（RadioFrequencyCatheterAblation,RFCA）方法。方法 14例排除器质性心脏病的左室分支起源的PVCs患者,3例行常规导管射频消融治疗,11例在三维电解剖标测（Carto）下射频消融治疗。结果14例患者均表现为＂反复心悸＂,PVCs均大于10000次/24h,7例伴有阵发性左室室性心动过速。6例左前分支起源患者的标准12导联心电图PVCs表现为心电轴右偏、右束支阻滞图形并左后分支阻滞（left posterior hemiblock,LPH）。8例左后分支起源患者的标准12导联心电图PVCs表现为心电轴左偏、右束支阻滞图形及左前分支阻滞（leftanteriorhemiblock,LAH）。在成功消融靶点（最早或提前激动点）附近均记录到浦肯野氏分支电位（Purkinje Potential,PP）,位于左室前外侧间隔、左室中间隔高位或左室后间隔中部,V波提前于体表心电图QRS波（33.0±10.1）ms;11例患者采用冷盐水灌注消融或普通Carto消融导管消融,3例常规7F双弯消融导管消融,放电即刻成功消融,无并发症。术后随访11±5个月,5例患者PVCs完全消失,9例患者24h动态心电图的PVCs小于1000次。结论起源于左室传导前、后分支起源的PVCs各有其临床特征,在消融导管标测到PVC最早或提前激动点并伴有PP处成功消融。     

T-wave inversion and diastolic dysfunction in patients with electrocardiographic left ventricular hypertrophy

Objectives

The aim of this study was to investigate if T-wave inversion (TWI) in the settings of electrocardiogram (ECG)–left ventricular hypertrophy (LVH) is associated with advanced diastolic dysfunction (DD) in subjects with preserved ejection fraction (EF).

Background

Animal studies suggested that an abnormal transmural repolarization sequence from endocardium to epicardium may contribute to DD. However, little is known about abnormal repolarization sequence and DD in humans.

Methods

We studied 231 patients with ECG-diagnosed LVH and with an EF of 50% or greater (measured within 6 months of the index ECG). T-wave inversion was assessed on leads I, aVL, V₄, V₅, or V₆. Diastolic dysfunction was defined based on echocardiographic estimation of the left atrial pressure. We used multiple logistic regression to estimate the odds ratio of DD comparing patients with TWI with those without TWI.

Results

The average age was 65.0 ± 14.2 years, and 61% were women. The mean EF was 61.8% ± 6.6%. Patients with TWIs were more likely to have coronary artery disease (P = .013) and diabetes (P = .007). There was a 5.6-fold increased odds of DD in patients with TWI compared with those without TWI in a model adjusting for sex, age, relative wall thickness, body mass index, hypertension, coronary artery disease, diabetes, hyperlipidemia, and smoking. When comparing different echocardiographic estimates of the left atrial pressure, patients with TWI displayed higher values for septal and lateral E/e′, left atrial volume index, and right ventricular/right atrial peak systolic gradient (P < .01 for each parameter).

Conclusions

T-wave inversion is associated with increased odds of DD in patients with ECG-LVH with preserved systolic function. The reversal of the normal sequence of repolarization manifested on the 12-lead ECG as TWI may be a factor to DD.     

起源于主动脉窦频发室性期前收缩的心电生理特征及射频消融治疗

目的报道11例起源于主动脉窦的频发室性期前收缩（premature ventricular contraction,PVC）患者的心电生理特征、射频消融（radiofrequency catheter ablation,RFCA）方法及疗效。方法分析患者术前体表心电图和动态心电图PVC的特点,测量V1或V2导联r波时限和振幅,计算r波与QRS波时限的比值及r波于S波振幅的比值。术中行主动脉窦内激动标测和起搏标测确定PVC起源部位,并行冠状动脉造影辅助定位后行RFCA。结果11例均有频发PVC,5例有反复短阵室性心动过速。下壁导联QRS波呈R形且高大直立,V1导联呈rS型,胸前导联多移行于V3以前,V6导联多呈Rs型或无S波。V1导联r波时限（84.6±9.8）ms,占QRS波时限的50%以上;r/S振幅比值0.72±0.31。有效消融靶点局部电图V波较体表心电图的QRS波明显提前（35.6±8.9）ms,有效靶点放电2～8 s见PVC减少至消失。结论起源于主动脉窦的PVC其下壁导联QRS波呈R形且高大直立,V1或V2导联r波时限宽（〉50%同导联QRS波）,r波振幅高（〉30%同导联S波）;主动脉窦内PVC的射频消融治疗是安全、有效的。     

Diffuse ST-elevation following J-wave presentation as an uncommon electrocardiogram pattern of Tako-Tsubo cardiomyopathy

Background

Tako-Tsubo cardiomyopathy (TTC) is characterized by symptoms, ECG changes with elevated cardiac markers mimicking acute myocardial infarction, left ventricular (LV) wall motion abnormalities in the apical region with preserved function of base, and normal coronary arteries. Usual ECG anomalies heralding TTC are ST-elevation in anterior leads, QT prolongation and negative T-waves.

Methods

We report the unusual case of TTC with an uncommon ECG presentation: J wave in inferior leads followed by diffuse ST-elevation.

Results

An 82-year-old woman was admitted for dyspnea and chest pain following exacerbation of chronic obstructive pulmonary disease. ECG showed J-wave in inferior leads followed by diffuse ST-elevation. The patient was monitored in intensive care unit and treated with diuretics. Both ECG and echocardiography anomalies gradually recovered.

Conclusions

Diffuse ST-elevation following J-waves may be considered as a possible ECG pattern of presentation in case of TTC.     

Transcatheter ablation through the cardiac veins in a patient with a biventricular device and left ventricular epicardial arrhythmias.

Left ventricular outflow tract (LVOT) may be a source of repeated premature ventricular complexes (PVCs). In symptomatic patients, radiofrequency catheter ablation (RFCA) can be effective, either from endocardial or from epicardial sites. A 50-year-old patient, with dilated cardiomyopathy (DCM) and severe left ventricular (LV) dysfunction, left bundle branch block (LBBB), New York Heart Association (NYHA) class IV, received a biventricular implantable cardioverter/defibrillator (ICD) in 2002. Despite drug therapy, PVCs were frequent (21.019/24 h) including prolonged runs, prompting ICD intervention. Premature ventricular complexes showed an inferior axis morphology, with an R/S ratio in V3>1, suggesting an LVOT origin. Despite the cardiac resynchronization therapy (CRT) device, successful RFCA was performed through the anterior venous branch, with a favourable clinical outcome. To our knowledge, this is the first case describing epicardial RFCA of a PVC focus from cardiac veins in the presence of a CRT device.     

起源于左后分支的室性早搏临床心电图特点和射频消融治疗

目的报道起源于左后分支的室胜早搏（PVC）的临床心电图特点及射频消融经验。方法8例无器质性心脏病且频发PVC的患者（男5例,女3例）,其中5例伴有阵发性左心室室性心动过速（室速）,年龄19—54（42．7±10．6）岁。其中3例患者行常规射频导管消融治疗,5例在三维电解剖标测系统（Carto系统）指导下行射频消融治疗。在左后分支标测到最早心室激动点处给予温度控制下射频导管消融。结果8例患者术前均以体表心电图定位起源于左后分支处区域,其PVC或左心室室速的体表心电图均为典型特发性左心室室速（ILVT）表现（QRS波呈右束支阻滞图形,心电轴左偏,QRS时限≤160ms）。其中,QRS波I导联6例呈rS,2例呈Rs;aVL导联呈qR;II、Ⅲ、aVF导联呈rs。胸前导联多在V,～V,处移形,由R转为Rs或rs。在消融成功部位（最早激动点）消融导管均记录到融合有浦肯野电位（PP）的V波,V波提前于体表心电图QRS波时限20—48（33．0±10．2）ms,8例患者行射频消融即时成功。术后3～15（8．1±4．2）个月复查,8例患者动态心电图的PVC均小于10000／24h。所有患者术中、术后无并发症发生。结论起源于左后分支处的PVC,在消融导管标测到PVC最早激动点并融合有PP时可成功消融PVC。     

The characteristics of a 12-lead electrocardiogram measuring premature ventricular contractions originating from the tricuspid annulus using the clock position method

Objective

This study aimed to analyze the conventional surface electrocardiogram (ECG) characteristics of premature ventricular contractions (PVCs) originating from the tricuspid annulus and to investigate the efficacy of locating their origins according to ECG results.

Methods

Eight patients who underwent radiofrequency ablation in the First Hospital of Shanxi Medical University (China) were included in the study. Pace mapping (PM) was used to analyze the characteristics of the PVCs originating from the tricuspid annulus recorded via 12-lead body surface ECGs.

Results

An R-wave was found in leads I, V₅, and V₆. The QRS wave was narrower when the PVCs originated from the septum and shifted in lead V₃ (R-wave amplitude/S-wave amplitude in the precordial lead—1). The QRS wave was broadest when the PVCs originated from the 7 to 9 o'clock position. The augmented vector left lead showed RS, QS, or RSR-type waves with a low amplitude when the PVCs originated from the upper part of the annulus. When the PVCs originated from the lower part of the annulus, the augmented vector right lead reflected multidirectional and QS-type waves.

Conclusion

The ECG-lead characteristics related to the origin of PVCs in the tricuspid annulus indicate some level of significance and can be used to formulate a specific diagnosis.     

Etiological diagnosis of left ventricular dysfunction: computed tomography compared with coronary angiography and cardiac magnetic resonance

Introduction and objectives

To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance.

Methods

Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment.

Results

The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively.

Conclusions

Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance.Full English text available from:www.revespcardiol.org     

Left ventricular hypertrophy and cardiovascular mortality by race and ethnicity

Background

Left ventricular hypertrophy is a major independent risk factor for cardiovascular mortality. The contribution of left ventricular hypertrophy to racial and ethnic differences in cardiovascular mortality is poorly understood.

Methods

We used data from the Third National Health and Nutrition Examination Survey and from the National Death Index to compare mortality for those with an electrocardiographic (ECG) diagnosis of left ventricular hypertrophy to those without left ventricular hypertrophy separately for whites, African Americans, and Latinos. We used Cox proportional hazards regression to control for other known prognostic factors.

Results

ECG left ventricular hypertrophy was significantly associated with 10-year cardiovascular mortality in all 3 racial/ethnic groups, both unadjusted and adjusted for other known prognostic factors. The hazard ratio for this association was significantly greater for African Americans (2.31; 95% confidence interval [CI], 1.55-3.42) than for whites and Latinos (1.32; 95% CI, 1.14-1.76 and 2.11; 95% CI, 1.35-3.30, respectively), independent of systolic blood pressure.

Conclusions

ECG left ventricular hypertrophy contributes more to the risk of cardiovascular mortality in African Americans than it does in whites. Using regression of ECG left ventricular hypertrophy as a goal of therapy might be a means to reduce racial differences in cardiovascular mortality; prospective validation is required.     

Prognostic impact of morphology and duration of premature ventricular contractions in a population without structural heart disease

Background

Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavorable prognosis in patients with structural heart disease. It is unclear whether PVCs site of origin and QRS-width has a prognostic significance in patients without structural heart disease. The aim of this study was to assess the prognostic importance of PVCs morphology and duration in this patient group.

Methods

We included 511 consecutive patients without a history of previous heart disease. They were examined with echocardiography and exercise test with normal findings. We categorized the PVCs from a 12 lead ECG according to morphology and width of the QRS-complex and analyzed the outcome in terms of a composite endpoint of total mortality and cardiovascular morbidity.

Results

During a median follow-up time of 5.3 years, 19 patients (3.5%) died and 61 (11.3%) met the composite outcome. Patients with PVCs originating from the outflow tracts had a significantly lower risk for the composite outcome compared to patients with non-OT-PVCs. Similarly, patients with PVC originating from the right ventricle had a better outcome than patients with left ventricular PCVs. No difference in outcome depending on QRS-width during PVCs was noticed.

Conclusion

In our cohort of consecutively included PVC patients without structural heart disease PVCs from the outflow tracts were associated with a better prognostic outcome than non-OT PVCs; the same was true for right ventricular PVCs when compared to left ventricular ones. The classification of the origin of the PVCs was based on 12-lead ECG morphology. QRS-width during PVC did not seem to have prognostic significance.     

射频消融治疗起源于左室流出道的非持续性室性心动过速和频发性室性早搏

目的观察左室流出道非持续性室性心动过速（室速）和频发性室性早搏患者的射频消融治疗结果,探讨此类患者的射频消融指证。方法５例患者因非持续性室速和频发性室性早搏而引起明显临床症状,药物治疗无效。采用起搏标测法确定室速和室性早搏的起源部位,并射频消融治疗。结果在升主动脉瓣左窦下方的左室流出道记录到提前（３１±４）ｍｓ的心室激动,起搏心电图１２导联ＱＲＳ波形与室速和室性早搏形态完全相同者４例,１１导联相同者１例,该部位消融后５例患者的室速和室性早搏不被诱发。随访１３±６个月,除１例患者复发,另４例的临床症状明显改善。结论射频消融治疗左室流出道非持续性室速和室性早搏安全有效,但应严格掌握适应证。     

Coronary microvascular spasm triggers transient ischemic left ventricular diastolic abnormalities in patients with chest pain and angiographically normal coronary arteries

Aims

Impaired coronary microvascular dilatory function can lead to exercise induced myocardial ischemia and angina pectoris even in patients without significant (>50%) obstructive coronary atherosclerosis (APWOCA). Diffuse distal vessel epicardial spasm and microvascular spasm have been also proposed as a plausible explanation for angina at rest in these patients. However, objective systematic evidence for the latter i.e. echocardiographic wall motion abnormalities during angina, is lacking at present. Coronary epicardial and microvascular spasm can be triggered in susceptible patients by the administration of intracoronary acetylcholine (Ach). We sought to assess whether Ach induced diffuse distal epicardial coronary artery spasm (≥75% diameter reduction) and coronary microvascular spasm can cause transient ischemic left ventricular dysfunction, as assessed by echocardiography.

Methods

50 patients (19 men aged 60.5 ± 8.9 years) with stable APWOCA were assessed for coronary spasm and myocardial ischemia with intracoronary Ach infusion, 2D transthoracic echocardiography (before and during Ach testing), continuous 12-lead ECG monitoring, and ultrasensitive cardiac troponin (US-cTn) measurement before and within 4 h after Ach testing.

Results

14 patients (28%) had a “negative” Ach test, 14 (28%) developed coronary microvascular spasm and 17 (34%) had diffuse distal epicardial spasm. In 5 patients (10%) the test was inconclusive. Echocardiographic variables including deceleration time, EF slope and E/A, as well as ultrasensitive-cTn concentrations were abnormal during Ach induced ischemic ECG changes. Conclusions: We have, for the first time, demonstrated that Ach induced coronary microvascular spasm is associated with echocardiographic changes and ultrasensitive-cTn elevations, indicative of myocardial ischemia.     

Availability of a baseline Electrocardiogram changes the application of the Sclarovsky-Birnbaum Myocardial Ischemia Grade

Background and aims

The electrocardiogram (ECG) based Sclarovsky-Birnbaum Ischemia Grade may be used to determine the prognosis of patients with ST-elevation myocardial infarction (STEMI). However, application of the method is based on assumption of the baseline QRS morphology. Thus, the aims of this study were to determine if the baseline QRS morphology was correctly assumed based on an ECG recorded during induced ischemia, and if reference to the baseline ECG altered the designated Ischemia Grade.

Methods

Sixty-three patients with chronic ischemic heart disease that underwent elective percutaneous transluminal coronary angioplasty were included. Baseline ECG and ECG during the procedure were recorded. In the latter, Ischemia Grade was classified according to assumed baseline QRS morphology. Then the baseline ECG was used as reference and Ischemia Grade was determined based on change from the baseline ECG.

Results

In 66.6% (42/63) of patients the criteria for STEMI were fulfilled; the incidence was similar between left anterior descending (LAD) and right coronary artery (RCA) occlusion. In LAD patients who fulfilled STEMI criteria, assumption of baseline QRS morphology in involved leads was accurate in only 35% (7/20) and this altered the Ischemia Grade in 10% (2/20) of patients. In RCA patients who fulfilled STEMI criteria, assumption of baseline QRS morphology in involved leads was accurate in 77.3% (17/22) and this altered the Ischemia Grade in 9.1% (2/22) of patients.

Conclusion

Application of the Sclarovsky-Birnbaum Ischemia Grade with reference to a baseline ECG altered Ischemia Grade in approximately 10% of patients. All patients that were reclassified were assigned a higher Ischemia Grade. Future research is needed to determine the impact of availability of the baseline ECG on the clinical diagnostic and prognostic performances of the Sclarovsky-Birnbaum Ischemia Grade.     

起源点邻近二尖瓣环的频发室性早搏体表心电图特征及射频消融治疗

目的评估起源点邻近二尖瓣环的频发室性早搏(简称室早)体表心电图特点及射频消融治疗效果。方法10例频发室早患者接受常规电生理检查及射频消融治疗,对所有病例12导联体表心电图进行分析。结果10例室早均消融成功,并证实起源点邻近二尖瓣环的不同部位,根据成功消融靶点将本组病例分为3组,二尖瓣环前侧壁组(4例)、二尖瓣环后侧壁组(3例)、二尖瓣环后间隔组(3例)。所有病例胸前导联R波移行区位于V1～V2导联,绝大部分病例V6导联可见s波。对各组二尖瓣环室早心电图做进一步比较,可概括出系列心电图判断指标用以估计消融靶点的部位。结论射频消融治疗起源点邻近二尖瓣环的频发室早可取得良好效果,掌握其体表心电图特点有助于判定室早的起源部位。     

Prevalence and severity of ventricular dysfunction in patients with HIV-related pulmonary arterial hypertension

Objectives

To evaluate the occurrence of ventricular systolic dysfunction in human immunodeficiency virus (HIV)-related pulmonary arterial hypertension (PAH).

Background

Patients with HIV-related PAH may develop ventricular systolic dysfunction both as a consequence of PAH progression or of the myocardial involvement from the HIV infection itself.

Methods

Cardiac magnetic resonance imaging was applied to measure ejection fraction for the left ventricle and the right ventricle in patients with HIV-related PAH (n = 27) and in patients with PAH from other aetiologies (n = 115).

Results

In HIV-related PAH, ejection fraction values were lower and a higher proportion of patients presented with an advanced stage of ventricular dysfunction (55% vs. 25%; p = 0.009). In a multivariate model, PAH related to HIV infection remained independently associated with advanced ventricular dysfunction (p = 0.011).

Conclusions

Patients with HIV-related PAH have more prevalent and severe ventricular systolic dysfunction compared to patients with PAH from other aetiologies.