QT间期延长与肝移植术后近期心律失常的关系

目的总结和探讨肝移植术前心电图提示QT间期延长与肝移植术后近期各类心律失常的关系。方法回顾性分析北京佑安医院2004年6月～2012年1月500例肝移植患者术前心电图的QT间期与术后近期（术后2周内）各种心律失常的发生率及其诊治资料。结果在500例肝移植患者中有82例（16.4％）发生各类心律失常,其中,病态窦房结综合征（包括持续而显著的窦性心动过缓）35例（7．0％）,阵发性室上性心动过速18例（3．6％）,心房颤动21例（4．2％）,室性心动过速8例（1．6％,包括2例尖端扭转性室性心动过速）;82例心律失常患者中心脏骤停4例（0．8％）,由心律失常引起的死亡2例（0．4％）。根据术前心电图检查结果,将患者分为QT间期延长组共103例,QT间期正常组共397例,其中,QT间期延长组中有28例患者发生心律失常,QT间期正常组中有54例患者发生心律失常,肝移植术后近期心律失常的发生与QT间期延长有明显关系（x^2=11．00,P〈0．01）。结论心律失常是肝移植术后常见的并发症．甚至可导致死亡。术前心电图QT间期延长与肝移植术后近期心律失常的发生有明显关系。因此,对于术前QT间期延长的患者应加强监测和评估,并给予预防性措施,如安置临时心脏起搏器,以防止术中及术后心血管意外的发生。     

39例急性百草枯中毒心律失常分析

  目的 探讨急性百草枯中毒时心律失常发生类型及不同类型与死亡率的关系。方法 分析39例急性百草枯中毒患者的入院心律失常心电图,其中男15例,女24例,年龄20-~49岁。结果 25例次发生窦性心动过速;22例次室性早搏（7例室性早搏二、三联律）,3例次室性心动过速（其中1例转为室性扑动及心室颤动）和1例心室停博;8例次ST-T异常及T波、U波改变。发生室性心律失常的中毒患者死亡率高于其它类型心律失常患者发生室性心律失常的中毒患者死亡率高于其他类型心律失常患者。结论 急性百草枯中毒可出现多种心律失常,发生室性心律失常患者伴有较差预后。     

儿童恶性心律失常70例临床分析

目的 探讨儿童不同恶性心律失常的构成比、伴发疾病、药物治疗效果。 方法 回顾性分析2012年1月-2016年12月安徽省立医院儿科诊断的70例恶性心律失常儿童的临床资料。依据不同恶性心律失常及不同伴发疾病统一的诊断标准,分析不同心律失常构成比及伴发疾病。分析不同恶性心律失常年龄分布特征。按照治疗结局,将其分为难治性心律失常组与非难治性心律失常组,运用确切概率法分析不同种类心律失常发生难治性心律失常的概率。 结果 70例恶性心律失常患儿中,男45例,女25例,心房扑动5例,房性心动过速12例,房颤合并房性心动过速1例,Ⅱ度Ⅱ型房室传导阻滞及Ⅲ度房室传导阻滞12例,室上性心动过速40例。不同心律失常各年龄段均有分布,房间隔膨出瘤全部见于新生儿。不同心律失常伴发疾病不相同:室上性心动过速发作多与呼吸道感染相关,房性心动过速多合并心脏明显扩大,心房扑动部分合并房间隔膨出瘤,Ⅱ度Ⅱ型房室传导阻滞及Ⅲ度房室传导阻滞多与心肌炎发生相关。室上性心动过速发生难治性心律失常的概率明显小于房性心动过速及传导阻滞(P<0.01)。心房扑动发生难治性心律失常概率与房性心动过速及传导阻滞组差异无统计学意义(P=0.10)。 结论 不同种类恶性心律失常构成比、伴发疾病不同,室上性心动过速药物治疗效果明显优于房性心动过速及房室传导阻滞。      

Palpitations: reassurance or more?

Palpitations are a common symptom and are caused by forceful or rapid beating of the heart. Palpitations can be caused by a variety of cardiac arrhythmias and careful history is invaluable in deciding appropriate investigations and management. Palpitations caused by anxiety-induced sinus tachycardia are common, but anxiety is also common in patients who have cardiac arrhythmias for which effective treatment is available. Management of palpitations depends on the type of cardiac arrhythmia; almost all arrhythmias can now be effectively treated. Radiofrequency ablation provides an effective cure for most patients with paroxysmal supraventricular tachycardia when the alternative is continuous drug therapy.     

Catheter and surgical treatment of cardiac arrhythmias

Over the past decade, numerous impressive advances have been made using nonpharmacologic methods for control of cardiac arrhythmias. These methods include surgical or catheter ablation of abnormal foci. Current techniques involve catheter ablation of the atrioventricular junction to control supraventricular arrhythmias. In addition, surgical techniques have proved to be remarkably safe and effective for treatment of patients with accessory pathways and those with atrioventricular nodal reentrant tachycardia. Patients with drug-refractory ventricular tachycardia may benefit from surgical resection of the ventricular tachycardia focus. The use of these interventional methodologies has radically altered the approach to management of patients with drug-refractory cardiac arrhythmias.     

76例食道贲门癌术后心律失常的临床分析

目的：探讨食道、贲门癌术后心律失常的特点和规律。方法：从我院1992年5月-2003年5月资料完整的76例食道、贲门癌已行手术治疗的患者中分别对其年龄、术前第1 s用力通气百分率（FEV1%）和术后血氧饱和度、失血量、手术方法等因素进行分析,探讨其对心律失常的影响,并对44例发生心律失常患者的心律失常类型、药物治疗效果和住院时间进行分析。结果：患者年龄、术前FEV1%和术后血氧饱和度、手术方法对心律失常的发生有一定的影响;而且心律失常以窦性心动过速为主（77.27%）,然后依次为室上性心动过速（11.36%）、房颤（9.09%）、室早（2.27%）;药物治疗完全可以控制;窦性心动过速者住院时间大多数为1个月,而室上性心动过速者和房颤者大多数为2个月。结论：食道、贲门癌术后心律失常发生有一定的特点和规律,认识其特点和规律,在临床工作中有重要意义。     

两种心电图监测冠心病心肌缺血与心律失常的效果比较

目的：：研究比较常规心电图与动态心电图在冠心病患者心肌缺血与心律失常监测中的效果。方法：随机选取2012年6月至2015年6月我院收治的冠心病患者50例,均给予常规心电图及动态心电图检查,然后对常规心电图与动态心电图监测心肌缺血与心律失常的结果进行回顾性统计分析。结果：动态心电图监测心肌缺血的阳性率显著高于常规心电图(P<0.05),阴性率显著低于常规心电图( P<0.05);动态心电图监测期前收缩频发、期前收缩二三联律、成对期前收缩室性心律失常、房性心律失常、室上性心动过速、房室传导阻滞的阳性率均显著高于常规心电图( P<0.05),且动态心电图在监测频发期前收缩室性心律失常、房性心律失常的阳性率较高。结论：动态心电图在冠心病患者心肌缺血与心律失常监测中的效果优于常规心电图。     

无创正压通气对冠心病合并OSAHS患者心律失常的影响

目的 探讨无创正压通气对冠心病合并OSAHS患者心律失常的相关影响。方法 本文选择我院2019年10月至2020年10月收治的81例患者随机分为观察组(n=41)和对照组(n=40)。对照组采用单硝酸异山梨酯缓释片、酒石酸美托洛尔片、阿司匹林肠溶片口服治疗,观察组在此基础上联合无创正压通气治疗。观察比较两组AHI、SaO2呼吸参数,左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及室上性心律失常、室性心律失常、心律失常总负荷。结果 治疗后,观察组AHI水平降低,SaO2水平升高(P0.05),对照组AHI、SaO2水平无明显改变(P0.05)。观察组LVESD、LVEDD较治疗前减低,LVEF升高(P0.05),且优于对照组(P0.05)。观察组室上性心律失常、室性心律失常次数均较治疗前减低(P0.05),心律失常总负荷无明显改变(P0.05);对照组室上性心律失常、室性心律失常次数与治疗前比较,差异无统计学意义(P0.05),而心律失常总负荷明显减低(P0.05);且观察组优于对照组(P0.05)。结论 NPPV治疗冠心病合并OSAHS心律失常患者临床疗效显著,可有效改善肺通气功能,肺内结合,减少机体心律失常的发生风险,稳定心血管功能,值得推广应用。     

急性心肌梗死早期溶栓后再灌注心律失常及预后分析

目的：探讨急性心肌梗死早期溶栓后再灌注心律失常对预后的影响。方法：对确诊为急性心肌梗死的30例患者临床诊治资料进行回顾性分析。结果：30例患者中,冠状动脉再通25例,再通率83.33%;未通5例。再通病例中均出现再灌注心律失常,包括室上性心动过速6例,室性早博7例,短阵室速4例,室颤2例。高度房室传导阻滞3例,窦性心动过缓6例,死亡6例均为窦性心动过缓或高度房室传导阻滞。结论：早期溶栓仍然是抢救急性心肌梗死的首选措施,急性心肌梗死再灌注后缓慢心律失常死亡率明显高于快速心律失常（P〈0.05）。     

心律失常引起心脏猝死原因的探讨

心律失常可引起心脏性猝死,70%～80%为快速性心律失常(如长QT综合征、室性心动过速等)和20%左右缓慢性心律失常(如高度房室传导阻滞、病态窦房结综合征等)所致。近年来,心律失常引起的心脏猝死越来越为人们所关注,常规心电图可对心律失常的发生、鉴别及心律失常的变化有重要价值。本文对一些常见的引起猝死的心律失常的分类、病因、电生理及临床表现方面予以探讨。     

慢性肺心病心律失常的临床特征

目的：探讨肺心痛心律失常的临床特征及治疗原则。方法：本组病例总共136例,全部于入院后48h内通过24h心电监护或反复常规12导联心电图检查,及时地发现心律失常类型并加以分析。结果：本组肺心病患者合并心律失常率迭67．64％(92例),其心律失常类型以房性心律失常最多,占42．08％,其次为窭性心动过速及室性心律失常。严重心律失常如室上性心动过速、多源室早、房宣传导阻滞、房扑等也常出现。心律失常的出现及严重程度与患者病情的严重程度相关性明显,如心衰程度、肺部感染、低氧血症、水电解质紊乱等密切相关。结论：肺心病心律失常发生率较高,且与肺心病患者病情严重程度密切相关,而心律失常治疗应通过积极的病因及合并症治疗,使用抗心律失常药物不是最佳办法。     

运用Vereckei四步法对宽QRS波心律失常的临床分析

目的分析宽QRS波心律失常患者的临床鉴别诊断方法。方法收集既往诊断明确的62例宽QRS波心动过速患者的临床心电图,使用Vereckei四步法进行分析诊断。结果 62例宽QRS波心动过速患者中,9例为室上性心动过速伴差异传导,10例为室上性心动过速伴预激旁路前传,43例为室性心动过速。QRS波越宽,则提示为室速的可能性越大。结论 Vereckei四步法分析方法简单,准确度较高,值得临床推广应用。     

Caffeine and ventricular arrhythmias. An electrophysiological approach

Little information is known regarding caffeine's effect on the substrate supporting sustained ventricular arrhythmias. This prospective study evaluated the effect of coffee (275 mg of caffeine) on this substrate with programmed ventricular stimulation in 22 patients with a history of symptomatic nonsustained ventricular tachycardia, ventricular tachycardia, or ventricular fibrillation. Patients underwent electrophysiological testing before and 1 hour after coffee ingestion. Mean (+/- SEM) plasma caffeine level achieved after coffee consumption was 6.2 +/- 0.5 mg/L. Mean plasma catecholamine and potassium values were not altered significantly 1 hour following caffeine ingestion. The number of extrastimuli required to induce an arrhythmia was unchanged in 10 patients (46%), increased in six (27%), and decreased in six (27%). Rhythm severity was unchanged in 17 patients (77%), more severe in two (9%), and less severe in three (14%). In those patients with clinical ventricular arrhythmias, caffeine did not significantly alter inducibility or severity of arrhythmias, suggesting little effect on the substrate supporting ventricular arrhythmias.     

INCIDENCE, ETIOLOGY AND PROGNOSIS OF ARRHYTHMIAS ANALYSIS OF 2,530 HOSPITALIZED CASES

This is a report of 2,5301 cases of hospitalized pediatric arrhythmia patients. There were 793 ectopic arrhythmias with conductrive dist.urb- ances accounting for 23.Wo of all 3,351 electro- cardiograms made during the same period, indicating that arrhythmia is common in hos- pitalized children. The common types of pediatric arrhythmia are A-V block, premature beats of ventricular and supraventricular origin, incomplete right bundle branch block and paroxysmal supraven- tricular tachycardia The common causes of pediatric arrhythmia are infectious toxic myocarditis, theumatic fever, theumatic heart disease and digitalis intoxicatio.n, indicating a close correlation between infection and the developmeint of pediatric arrhythmia. So management of infectious diseases plays an important role in the prevention and treat- ment of the disease. The prognosis is generally good with a death rate of only about lTo. Arrhythmias disappear following control of the primary disease.     

Ventricular arrhythmias in patients undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group.

OBJECTIVE--To determine the incidence, clinical predictors and prognostic importance of perioperative ventricular arrhythmias. DESIGN--Prospective cohort study (Study of Perioperative Ischemia). SETTING--University-affiliated Department of Veterans Affairs Medical Center, San Francisco, Calif. SUBJECTS--A consecutive sample of 230 male patients, with known coronary artery disease (46%) or at high risk of coronary artery disease (54%), undergoing major noncardiac surgical procedures. MEASUREMENTS--We recorded cardiac rhythm throughout the preoperative (mean = 21 hours), intraoperative (mean = 6 hours), and postoperative (mean = 38 hours) periods using continuous ambulatory electrocardiographic monitoring. Adverse cardiac outcomes were noted by physicians blinded to information about arrhythmias. MAIN RESULTS--Frequent or major ventricular arrhythmias (greater than 30 ventricular ectopic beats per hour, ventricular tachycardia) occurred in 44% of our patients: 21% preoperatively, 16% intraoperatively, and 36% postoperatively. Compared with the preoperative baseline, the severity of arrhythmia increased in only 2% of patients intraoperatively but in 10% postoperatively. Preoperative ventricular arrhythmias were more common in smokers (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.2 to 15.0), those with a history of congestive heart failure (OR, 4.1; 95% CI, 1.9 to 9.0), and those with electrocardiographic evidence of myocardial ischemia (OR, 2.2; 95% CI, 1.1 to 4.7). Preoperative arrhythmias were associated with the occurrence of intraoperative and postoperative arrhythmias (OR, 7.3; 95% CI, 3.3 to 16.0, and OR, 6.4; 95% CI, 2.7 to 15.0, respectively). Nonfatal myocardial infarction or cardiac death occurred in nine men; these outcomes were not significantly more frequent in those with prior perioperative arrhythmias, albeit with wide CIs (OR, 1.6; 95% CI, 0.4 to 6.2). CONCLUSION--Almost half of all high-risk patients undergoing noncardiac surgery have frequent ventricular ectopic beats or nonsustained ventricular tachycardia. Our results suggest that these arrhythmias, when they occur without other signs or symptoms of myocardial infarction, may not require aggressive monitoring or treatment during the perioperative period.     

冠心病患者QT间期离散度与程序刺激诱发的室性心动过速相关性研究

目的 :探讨体表心电图QT间期离散度与冠心病患者程序刺激诱发的室性心动过速的关系。方法 :选择 4 0例接受心脏导管手术的患者 ,其中陈旧性心肌梗死患者 2 0例 ,阵发性室上性心动过速患者 2 0例。术前测定患者体表心电图QT间期离散度 ,术中在右心室起搏刺激以诱发持续室性心动过速 ,探讨QT间期离散度与室性心律失常之间的关系。结果 :2 0例陈旧性心肌梗死患者共有 6例诱发出持续室性心动过速 ,2 0例阵发性室上性心动过速患者中无 1例诱发出持续室性心动过速。冠心病患者体表心电图QT间期离散度较阵发性室上速患者明显增大 (85 .7± 2 4 .6msvs 34.8± 11.3ms,P <0 .0 1) ;冠心病患者中诱发出持续室性心动过速者 ,其QT间期离散度较未诱发出持续室性心动过速者亦明显增大 (98.7± 5 6 .2msvs 70 .4± 2 8.5ms,P <0 .0 5 )。取QT间期离散度≥ 110ms,对室性心律失常的预测有一定价值。结论 :体表心电图QT间期离散度与冠心病患者室性心律失常具有相关性 ,取QTd≥ 110ms对室性心律失常有一定的预测价值。     

早期诊断新生儿心律失常56例分析

目的探讨新生儿心律失常的早期诊断及合理治疗。方法分析我科早期诊断的新生儿心律失常及治疗、预后情况。结果新生儿缺氧、感染、先天性心脏病等疾病和药物使用过程中常伴随心律失常的发生,类型以期前收缩(70.2%)、房室传导阻滞(15.8%)、窦性心动过速(3.5%)、窦性心动过缓(3.5%)、室上性心动过速(3.5%)为主,临床上可通过仔细查体、心电监护而早期确诊,经合理治疗后预后较好。结论新生儿心律失常可通过仔细查体、病情观察和监护及早发现,经过合理治疗,大多预后较好,但严重的器质性心脏病合并严重心律失常会引起死亡。     

致心律失常型右心室心肌病伴发心律失常性心肌病1例

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of inherited cardio-myopathy, which is characterized by fibro-fatty replacement of right ventricular myocardium, leading to ventricular arrhythmia. However, rapid atrial arrhythmias are also common, including atrial fibrillation, atrial flutter and atrial tachycardia. Long term rapid atrial arrhythmia can lead to further deterioration of cardiac function. This case is a 51-year-old male. He was admitted to Department of Cardiology, Peking University Third Hospital with palpitation and fatigue after exercise. Electrocardiogram showed incessant atrial tachycardia. Echocardiography revealed dilation of all his four chambers, especially the right ventricle, with the left ventricular ejection fraction of 40% and the right ventricular hypokinesis. Cardiac magnetic resonance imaging found that the right ventricle was significantly enlarged, and the right ventricular aneurysm had formed; the right ventricular ejection fraction was as low as 8%, and the left ventricular ejection fraction was 35%. The patients met the diagnostic criteria of ARVC, and both left and right ventricles were involved. His physical activities were restricted, and metoprolol, digoxin, spironolactone and ramipril were given. Rivaroxaban was also given because atrial tachycardia could cause left atrial thrombosis and embolism. His atrial tachycardia converted spontaneously to normal sinus rhythm after these treatments. Since the patient had severe right ventricular dysfunction, frequent premature ventricular beats and non-sustained ventricular tachycardia on Holter monitoring, indicating a high risk of sudden death, implantable cardioverter defibrillator (ICD) was implanted. After discharge from hospital, physical activity restriction and the above medicines were continued. As rapid atrial arrhythmia could lead to inappropriate ICD shocks, amiodarone was added to prevent the recurrence of atrial tachycardia, and also control ventricular arrhythmia. After 6 months, echocardiography was repeated and showed that the left ventricle diameter was reduced significantly, and the left ventricular ejection fraction increased to 60%, while the size of right ventricle and right atrium decreased slightly. According to the clinical manifestations and outcomes, he was diagnosed with ARVC associated with arrhythmia induced cardiomyopathy. According to the results of his cardiac magnetic resonance imaging, the patient had left ventricular involvement caused by ARVC, and the persistent atrial tachycardia led to left ventricular systolic dysfunction.     

致心律失常型右心室心肌病伴发心律失常性心肌病1例

致心律失常型右心室心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)是一种遗传性心肌病,以右心室心肌被纤维和脂肪组织替代为病理特征,约50％的患者双心室受累[1].西方人群该病患病率约为1/5000 ～1/1000,临床比较少见.在该病发展的不同阶段,先后出现心律失常、右心室结构及功能异常以及全心衰竭等临床表现,是35岁以下人群心脏性猝死(sudden cardiac death,SCD)的重要原因之一[2].该病的心律失常以室性心律失常为特征,但房性心律失常同样很多见,长时间的快速性房性心律失常可以导致心功能进一步恶化.本文报告1例北京大学第三医院收治的ARVC伴发房性心动过速,并导致心律失常性心肌病的病例.     

维持性血透患者频发透析相关心律失常的原因及防治方法

目的探讨维持性血液透析患者在透析期间频发心律失常的原因及防治方法。方法选择131例维持性血透患者,观察3个月,回顾性分析血透过程中频发心律失常（≥6次／3个月）患者的发生情况及其原因,并予以相应处理。结果45例患者频发心律失常,共血液透析1551例次,发生心律失常323例次,发生率20．83％,心律失常类型以室性期前收缩、房性期前收缩、窦性心动过速和心房颤动为多。发现伴有年龄偏大、透析后低血钾、贫血、心肌缺血等因素的透析相关心律失常的发生率更高。结论透析相关心律失常频繁发生与患者年龄偏大、合并贫血、心肌缺血、透析后低血钾等多种因素有关,积极纠正诱发透析相关心律失常的危险因素,可避免或减少透析相关心律失常的频繁发生。