心脏病室性心律失常患者Tp-e间期、Tp-e/Q-T比值的研究

目的探讨器质性心脏病患者Tp-e间期、Tp-e/Q-T比值与室性心律失常的关系。方法选择器质性心脏病患者85例,分为两组,器质性心脏病室性心律失常组(A组)43例,并进一步按LOWN分级分为两个亚组,A1组(LOWN2-3级)20例,A2组(LOWN3级以上)23例;器质性心脏病无室性心律失常组(B组)42例。另选择健康体检者40例为正常对照组(C组)。采用常规12导联同步心电图及24小时动态心电图分析比较各组的Q-T间期、Q-Tc间期、Tp-e间期、Tp-ec间期和Tp-e/Q-T测值。结果 A组Q-T间期、Q-Tc间期、Tp-e间期、Tp-ec间期、Tp-e/Q-T测值比C组显著升高,差异有统计学意义(P<0.05),而Q-Tc间期、Tp-e间期、Tp-ec间期、Tp-e/Q-T比B组显著升高,差异有统计学意义(P<0.05)。上述各测值A2组比A1组显著升高,差异有统计学意义(P<0.05或P<0.01)。结论 Tp-e间期、Tp-e/Q-T等心电学指标与室性心律失常的发生有关,对室性心律失常的发生具有预测意义。     

冠心病室性心律失常患者的QT变异度

目的 了解冠心病患者室性心律失常与QT变异度的关系。方法 分析了33例冠心病无室性心律失常者(A组),29例冠心病有室性心律失常者(B组)及26例正常对照者的24小时心室复极指标:最快心率的QT间期校正值QTcmax,最慢心率的QT间期校正值QTcmin及其差值QTcd(QT变异度)。结果 B组较对照组及A组QTcmax(P<0.01及P<0.01),QTcd(P<0.01及P<0.05)显著增大,而A组与对照组各项指标均无显著性差异。结论 冠心病室性心律失常患者QT变异度增大,它可能与其室性心律失常的发生有关。     

快速性恶性室性心律失常的发作方式及其临床干预

目的探讨快速性恶性室性心律失常的发作方式及其临床干预。方法对我院收治的快速性恶性室性心律失常56例(入院后至少发生1次以上),根据基础Q-T间期是否延长分为Q-T间期正常和长Q-T(U)间期,并按不同的发作方式临床干预治疗。结果基础心律Q-T间期正常(0.38±0.03s)33例,以室性心动过速或多形性室性心动过速多见,多数可用直流电复律。而Q-T间期延长(0.51±0.04s)23例,以尖端扭转型室性心动过速多见,多数经大剂量补钾、镁+异丙肾上腺素或阿托品静脉治疗。结论快速性恶性室性心律失常由不同形式的室性期前收缩诱发,应针对不同的临床、心电学特征,采取临床干预措施。     

冠心病慢性心力衰竭患者室性心律失常的治疗方案分析

目的分析研究对冠心病慢性心力衰竭室性心律失常患者的有效治疗方案。方法选取我院2014年2月~2015年8月收治的冠心病慢性心力衰竭且室性心律失常患者90例作为研究对象,将其随机分为对照组和实验组,各45例。对照组用常规西医治疗,实验组使用参松养心胶囊治疗,观察疗效。结果实验组患者治疗后室性心律失常的疗效更优,患者Q-T间期离散度(QTcd)优于对照组,差异有统计学意义(P0.05)。结论采用参松养心胶囊对冠心病慢性心力衰竭室性心律失常患者的疗效更优。     

冠心病合并抑郁患者室性心律失常的研究

目的研究冠心病患者抑郁与室性心律失常的关系。方法连续观察入住我科的冠心病患者,按有无抑郁分为研究组与对照组,所有患者进行24h动态心电图监测,观察两组的心率变异性(HRV)、QT离散度与室性心律失常。合并疾病、危险因素也被考虑在内。结果抑郁组患者HRV明显低于非抑郁组[(65.5±38.6)ms比(94.6±29.9)ms,P<0.05],QT离散度及校正的QT离散度明显高于对照组,阵发性室性心动过速(VT)发生率在抑郁组明显高于非抑郁组(28.5%比3.7%,P<0.01)。Logistic回归分析显示抑郁作为独立的危险因素影响室性心律失常的发生。结论抑郁是冠心病患者室性心律失常独立的危险因素,是影响冠心病预后的原因,其机制可能与影响QT离散度有关。     

高血压患者室性心律失常的昼夜变异

对156例原发性高血压患者行24h动态心电图检测，昼夜时间划分6h为一间期。结果发现104例患者24h室早≥100次,各间期的室早发生率分别为40％，26％，19％和15％。6Am～12Am室性心律失常发生的频度和高危级别显著高于其他间期。提示上午猝死发生率增高可能与频发室性心律失常有关。     

室性心律失常患者心率变异性研究

目的探讨冠心病与非冠心病室性心律失常患者心率变异性的差异。方法选自2011年1月至2013年10月于我院行24h动态心电图检查的患者560例。按照患者24h动态心电图室性心律失常的类型、数目、形态及有无冠心病分为5组：健康对照组143例;简单室早非冠心病组100例;简单室早冠心病组102例;复杂室早非冠心病组106例;复杂室早冠心病组109例;各组年龄构成比、男女比例无显著差异。所有患者均进行24h心率变异性检测,并对检测结果进行分析。结果比较这五组患者的24h心率变异性时域分析指标,非冠心病室早组心率变异性时域分析指标增高;冠心病室早组心率变异性时域分析指标降低。室早冠心病组与非冠心病组24h心率变异性时域分析指标有显著差异。结论 24h心率变异性时域分析对于室早的危险分层、科学处理、合理治疗有重要意义,心率变异性时域分析是一项在室早诊疗过程中有价值的辅助检查。     

冠心病合并室性心律失常的心率变异性分析

目的 分析冠心病合并室性心律失常的心率变异性.方法 选择34例冠心病病例,纳入A组,A1组为合并室性心律失常组,A2为无合并症组,B组为健康人群,以上病例均采用GE Mac V8 3导动态心电图检查.结果 将A组及B组SDNN、SDANN、RMSSD、PNN50进行对比分析,明显A组更低(P<0.05);将A1组及A2组以上数据进行比较,明显A1组更低(P<0.05).结论 冠心病合并室性心律失常实施24 h动态心电图检测,可明确了解患者心率变异性,有利于患者诊治.     

室性心律失常与 Tp-e 间期、Tp-e／Q-T比值的相关性研究

目的：探讨室性心律失常与T波峰-末间期（Tp-e间期）、Tp-e/Q-T比值的相关性。方法将199例室性心律失常患者按Lown分级分为Lown 1级组（43例）、2级组（40例）、3级组（35例）、4A级组（39例）和4B级组（42例）,再将所有患者分为无器质性心脏病组（107例）和器质性心脏病组（92例）,另选择健康体检者40例为对照组。采用常规12导联同步心电图及24小时动态心电图检测比较各组的Q-T、Q-Tc、Tp-e和Tp-ec间期及Tp-e/Q-T比值。结果 Q-Tc、Tp-e、Tp-ec、TPe/Q-T各测值随Lown级别的增高而增高,与Lown分级呈正相关（ rs＝0.29-0.62,P＜0.01）。Q-Tc、Tp-e、Tp-ec测值心脏病组与无心脏病组及对照组比较差异有统计学意义（ P＜0.05）,无心脏病组与对照组比较差异也有统计学意义（ P＜0.05）;Q-T测值心脏病组与无心脏病组及对照组比较差异有统计学意义（ P＜0.05）,但无心脏病组与对照组比较差异无统计学意义（ P＞0.05）。Tp-e/Q-T比值心脏病组及无心脏病组与对照组比较差异有统计学意义（ P＜0.05）,但心脏病组与无心脏病组比较差异无统计学意义（ P＞0.05）。结论 Tp-e间期、Tp-e/Q-T比值与室性心律失常的严重程度有关,对预测室性心律失常的发生及评估预后有重要的临床意义。     

吸烟的室性心律失常患者心率变异性分析

目的 探讨吸烟的室性心律失常患者心律变异(HRV)的临床意义。方法应用24h动态心电图(DCG)对50例吸烟组、60例不吸烟组。进行心率变异性时域分析。结果与不吸烟组比较．吸烟组SDNN、rMSSD、PNN50明显降低。结论吸烟可致室性心律失常患者交感神经活性明显增强,副交感神经活性明显降低．心率变异程度减低,从而增加心电的不稳定性。     

直接经皮腔内冠状动脉成形术对急性心肌梗死早期24小时心电稳定性的干预

为探讨直接经皮腔内冠状动脉成形术 (P PTCA)对急性心肌梗死 (AMI)早期 2 4h心电稳定性的影响 ,对发病≤ 6h并接受P PTCA治疗的 2 2例AMI患者 (P PTCA组 )进行动态心电图监测 ,持续观察其 2 4hQT间期值 (QT)和室性心律失常等心电指标变化 ,并与 15例梗死相关动脉 (IRA)未通患者 (对照组 )作对比。结果 :①P PTCA组的QT 2 4h内逐渐延长 ,其最小值 (术前 1h ,34 6± 16ms)与最大值 (术后第 2 3小时 ,391± 16ms)有显著性差异 (P <0 .0 1) ,与对照组的变化趋势类同。②P PTCA术前的心率校正QT(QTc)为 388± 15ms ,于术后开始迅速显著延长 ,至第 2小时达高值 (42 8± 17ms)后轻度缩短 ,然后又有逐渐延长趋势 ;对照组的QTc变化趋势与QT基本相同。③室性异位激动于P PTCA第 1小时 (5 31± 480次 )较术前 (185± 12 0次 )即迅速增加 ,主要见于术后的 3h内 ;对照组的室性异位激动在 2 4h内散在出现。提示AMI患者于P PTCA早期心电不稳定性增加 ,此为IRA开通和心肌再灌注损伤的临床强力指标之一。     

不同程度冠心病患者QT变异和QT变异指数的观察

目的探讨冠心病患者的QT变异(QTV)和病变程度的相关性。方法122例冠心病患者(75例劳累性心绞痛患者,47例非ST段抬高性心肌梗死患者)和55例正常对照组,在保持日常生活起居的情况下佩戴12导联动态心电图监测仪,计算机辅助下自动测量QT间期,计算相应时间段的QT间期均值(QTm)、QTV、HR间期均值(HRm)、HR间期变异(HRV)和QT变异指数(QTVI)。同时采用时域法(SDNN)和频域法(LF、HF)分析心率变异性。结果①正常对照组24hLF/HF、HF、QTV均呈昼夜节律性变化。②非ST段抬高性心肌梗死组、劳累性心绞痛组和正常对照组之间的QTV差异显著(29.2±13.6ms、26.8±13.1ms、21.7±12.4ms,P<0.05)。③正常对照组QTV与SDNN存在负相关,相关系数为-0.40,P<0.05。而劳累性心绞痛组和非ST段抬高性心肌梗死组的QTV与SDNN无相关性,P>0.05。④QTV、QTVI随着冠状动脉病变程度的加重而变大,且各组比较有显著性差异,P<0.05。结论QTV与冠状动脉病变程度有关,QTV的变化不仅依赖于自主神经,而且是许多不同病理生理因素作用的结果,在心肌缺血的情况下,能更直接地反映心肌的代谢和病变状态。     

非心肌梗死冠心病患者心功能变化与室性心律失常的关系

目的　了解心功能不全的恶化 ,对各种室性心律失常发生的影响。方法　选择 2 97例冠心病住院患者 ,根据心功能按纽约心脏病协会 (NYHA)标准分为四组 ,检测 2 4小时动态心电图 (Holter) ,分析有无室性心律失常及其类型 ,进行统计分析。结果　心功能 I级组中 1 8例 (4 1 .86% )发生室性心律失常 ,偶发室性早搏 1 4例 (3 2 .5 6% ) ,频发室性心律失常 4例 (9.3 0 % ) ;心功能 级组中 68例 (5 5 .74% )发生室性心律失常 ,偶发室性早搏 45例 (4 4 .2 6% ) ,频发室性心律失常 45例 (3 6.89% ) ;心功能 级组中 3 3例 (5 5 % )发生室性心律失常 ,偶发室性早搏 2 0例 (3 3 .3 3 % ) ,频发室性心律失常 1 3例 (2 1 .67% ) ;心功能 级组中 42例 (5 8.3 3 % )发生室性心律失常 ,偶发室性早搏 2 5例(3 4.72 % ) ,频发室性心律失常 1 7例 (2 3 .61 % ) ,由多格表 x2检验结果看 ,各级别心功能不全组中室性心律失常的发生率除联律和持续或非持续性室速二组外并无显著性的差异。结论　非心肌梗死患者室性心律失常发作的数量与心功能不全的程度无关 ,但联律和持续性或非持续性室性心律失常在重度心功能不全患者发生率增加。     

室性心律失常与心率变异性的相关性研究

作者用２４ｈ动态心电图研究６６例冠心病患者室性心律失常和心率变异的相关性。结果发现,高危室早（Ｌｏｗｎ分级≥Ⅲ级）的发生与性别、年龄、冠脉病变程度和心肌梗死与否无明显相关,但高危室早者的ＳＤＮＮ（Ｐ＜０．０１）,ＳＤＡＮＮ（Ｐ＜０．０１）和ＬＦ（Ｐ＜０．０５）低于低危室早者（Ｌｏｗｎ分级≤Ⅱ级）。提示ＳＤＮＮ,ＳＤＡＮＮ和ＬＦ减小是高危室早发生的独立危险因子。     

Tp-e间期的研究进展及其在冠心病中的临床应用

Tp-e间期和Tp-e/QT比值是新近提出的可以反映心室跨壁复极离散度(myocardial transmural dispersion of repolarization,TDR)的心电指标,其与恶性室性心律失常发生密切相关.冠心病是导致恶性室性心律失常甚至心源性猝死(sudden cardiac death,SCD)的最常见心脏结构异常,寻找冠心病患者恶性室性心律失常以及SCD的有效预测指标成为近些年临床上的研究重点.     

Beat-to-beat QT interval variability in coronary patients

Changes in ventricular repolarization have been described in patients after myocardial infarction, whereas data for coronary patients without prior myocardial infarction are lacking. This study was designed to evaluate ventricular repolarization in coronary patients with effort angina pectoris. Beat-to-beat QT interval variability (QTV) using 5-minute resting high-resolution ECG recordings was measured in 26 men (mean age 62.1 years) with effort angina pectoris and without prior myocardial infarction, and in 30 age-matched men without clinically evident coronary heart disease (controls). To evaluate the degree of coronary artery disease in coronary patients, coronary angiography was performed. Coronary patients displayed significantly higher values of QTV compared with the control patients (P < .001). Rate adaptation of QT interval correlated significantly with the degree of coronary artery disease in the study group patients (P < .05). The significant association between QTV and coronary heart disease suggests altered ventricular repolarization in coronary patients without prior myocardial infarction.     

Heart rate variability, arrhythmia and magnesium in hemodialysis patients

Most of chronic hemodialysis patients are combined with cardiopathies, such as ischemic heart disease, heart failure, and arrhythmia. Heart rate variability as an index of cardiac autonomic activity is falling in many hemodialysis patients, which can have a concern with the arrhythmogenicity. In addition, QT dispersion as an index of an electrical variability in the ventricular repolarization process increases by hemodialysis, which may tightly relate to the occurrence of ventricular arrhythmia. On the other hand, tendency of the magnesium accumulation is observed in renal insufficiency patients. In our study, plasma concentration of ionized magnesium showed a positive correlation with pNN50 and HF, indicating that this ion may enhance the parasympathetic activity resulting in a cardioprotection. Plasma ionized magnesium also showed a negative correlation with QT dispersion, suggesting that magnesium plays a role of maintaining myocardial electrical stability in hemodialysis patients.     

Heart Rate Variability Before Ventricular Arrhythmias in Patients with Coronary Artery Disease and an Implantable Cardioverter Defibrillator

Background: Changes in autonomic regulation of the heart may be responsible for the occurrence of arrhythmias. Although a decrease in 24‐hour heart rate variability is a strong predictor of subsequent arrhythmias in patients with heart disease, many questions remain unanswered concerning changes in heart rate and heart rate variability in the minutes or hours preceding an arrhythmia. The aim of our study was to analyze changes in heart rate and heart rate variability occurring during the 90 minutes preceding an arrhythmia, in patients with coronary heart disease and an implantable defibrillator. Materials and Methods: Thirty‐eight patients, with a total of 93 episodes of ventricular arrhythmia, were included in the study. Heart rate and heart rate variability were measured in three 30‐minute and five 2‐minute periods preceding the arrhythmia. Heart rate variability was assessed using measurements of Poincaré plots. Results: The results show a gradual increase in heart rate before the arrhythmia, from 73 ± 13/min , to 75 ± 14/min , and finally 78 ± 15/min in the 90 minutes preceding the arrhythmia (P < 0.05) . Conclusion: Measurements of Poincaré plots showed a significant increase in their length and no significant change in their width. These results suggest that sympathetic activation is the predominant change in autonomic nervous system before a ventricular arrhythmia in patients with coronary heart disease. This change may occur as early as one hour and a half before the arrhythmia.     

Polymorphous ventricular tachycardia: a side effect of intracoronary papaverine

Polymorphous ventricular tachycardia occurred in 1.3% of patients (5 of 391) who received intracoronary papaverine over a 47 month period. The arrhythmia lasted less than 1 min in all five patients, converting spontaneously in four and requiring electrical cardioversion in one. Ventricular tachycardia occurred in 4.4% of women (4 of 90) and 0.3% of men (1 of 301) (p less than 0.0025). Only one of the patients with ventricular tachycardia had coronary artery disease. To determine whether other clinical or procedural factors predispose patients to this side effect of papaverine, these 5 patients were compared with 25 control patients who were matched for gender and extent of coronary artery disease. The following variables were analyzed: age, baseline serum potassium and calcium levels, left ventricular ejection fraction, baseline heart rate, mean arterial pressure, corrected QT interval, the change in corrected QT interval produced by papaverine and the maximal dose of the drug per kilogram of body weight. Of these variables, only baseline heart rate differed significantly in the two groups of patients. Thus, polymorphous ventricular tachycardia is an infrequent, but important, side effect of papaverine that is usually self-limited. Women with a relatively slow heart rate appear to be predisposed to this side effect.