在射频消融患者中室性期前收缩诱发性心肌病的发生及影响因素分析

目的:观察射频消融患者中的室性期前收缩诱发性心肌病(PVC-ICM)发生情况和影响因素,以及患者术后心脏结构和功能的变化。方法:连续选取2011年1月至2014年2月于北京安贞医院住院,并拟行射频消融术治疗的频发室性期前收缩患者322例。登记患者的年龄、性别、室性期前收缩病程、有无室性期前收缩相关症状,登记术前心电图(ECG)、24小时动态心电图(Holter)及超声心动图(UCG)的相关指标。心内电生理检查及射频消融术后,记录早搏起源部位。所有患者在术后6个月时行Holter及UCG检查。入选患者分为PVC-ICM组(n=54)及无心肌病组(n=233),比较两组患者的术后左心室舒张末径(LVEDD)及左心室射血分数(LVEF)的变化,并用多因素二元Logistic逐步回归分析PVC-ICM的影响因素。本研究PVC-ICM的诊断标准:射频消融术前LVEDD增大,消融成功后(室性期前收缩数目减少>80%)LVEDD恢复正常。结果:共287例患者符合入组标准并完成随访,PVC-ICM组54例(18.8%)。多因素分析显示,室性期前收缩负荷(%)(OR=1.040,P=0.007)、病程(年)(OR=1.057,P=0.015)、室性期前收缩QRS波时程(ms)(OR=1.021,P=0.034)及无症状室性期前收缩(OR=2.379,P=0.046)为PVC-ICM的独立危险因素。射频消融术前PVC-ICM组的LVEDD值明显大于无心肌病组[(55.8±3.7)vs.(47.7±3.5)mm,P<0.001],LVEF值明显低于无心肌病组[(58.6±8.0)vs.(63.1±5.1)%,P<0.001];术后PVC-ICM组患者的LVEDD[(47.1±2.8)vs.(46.9±3.1)mm,P=0.685]及LVEF[(62.0±3.9)vs.(63.2±5.0)%,P=0.086]均达到与无心肌病组一致的水平;两组间手术前后比较显示,PVC-ICM组患者的LVEDD(P<0.001)及LVEF(P<0.001)值均得到改善,而无心肌病组患者术后两项指标均无显著改变(LVEDD:P=0.053;LVEF:P=0.066)。结论:存在较大的室性期前收缩负荷、较长的病程、较长的室性期前收缩QRS波时程以及无症状的室性期前收缩患者更易发生PVC-ICM,射频消融术对PVC-ICM患者的心脏结构及心功能均有明显改善效果。     

二维斑点追踪成像技术评价频发室性期前收缩患者的左心室功能的应用

目的:探讨二维斑点追踪成像技术评估特发性频发室性期前收缩患者的左心功能。方法:研究纳入50例特发性频发室性期前收缩患者以及20例健康人群对照。两组对照进行基线的普通超声心动图、二维斑点追踪成像技术及24h动态心电图检查。结果:病例组与对照组的左心室射血分数、左心室舒张末内径、左心室收缩末内径的差异无统计学意义(P0.05);病例组的左心室短轴应变、左心室圆轴应变及左心室长轴应变显著低于正常对照组(P0.001)。结论:二维斑点追踪成像技术能够识别频发室性期前收缩患者早期隐匿的左心室功能损害。     

不同负荷室性期前收缩与心脏结构及心功能的相关性研究

目的:探讨不同负荷室性期前收缩与心脏结构及心功能的相关性。方法:选择我院收治的220例室性期前收缩患者,根据室性期前收缩数量与24h总心率的比值,分为低负荷组(10%,50例)、中负荷组(10%~20%,108例)、高负荷组(20%,62例),同时选择68例无室性期前收缩的体检者作为正常对照组,记录各组患者的心功能参数指标,同时检测其血清N末端脑钠肽(NT-proBNP)水平,并分析其相关性。结果:与正常对照组相比,中负荷组及高负荷组的QT间期、QRS波时限明显增宽,矫正QT间期明显延长(P0.05或0.01)。与正常对照组相比,中负荷组、高负荷组的左心房内径(LAD)、左心室流出道内径(LVOT)、左心室舒张末期内径(LVEDd)、右心室舒张末期内径(RVEDd)、左心室舒张末期容积(LVEDV)、每博心输出量(SV)、左心室心肌质量指数(LVMI)、NT-proBNP水平均明显升高,左室射血分数(LVEF)显著降低(P0.05或0.01)。双变量直线相关分析显示,室性期前收缩负荷与QRS波时限、矫正QT间期、LVEDd、RVEDd、NT-proBNP呈直线正相关(r=0.42~0.65,P均0.01);与LVEF呈直线负相关(r=-0.62,P=0.001)。结论:随着室性期前收缩负荷的增加,左室的结构及功能可发生改变,因此应注意监测相关指标,及早进行临床干预。     

频发性室性早搏伴心脏扩大患者行射频消融术的预后特点分析

目的频发性室性早搏(premature ventricular contractions, PVCs,简称"频发室早")是临床上常见疾病之一。部分频发室早患者出现心脏扩大,此类患者行射频消融术的效果及术后心脏大小的变化有待进一步明确。本文旨在研究频发室早伴心脏扩大患者射频消融术后心脏大小的变化及预后。方法回顾分析2012年1月至2013年1月因频发室早行射频消融术的300例患者。术前常规行超声心动图检查,男性左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)55.0 mm,女性50.0 mm的患者作为研究对象,排除合并有器质性心脏病者。患者行室性早搏射频消融术后3、6、12个月复查超声心动图观察频发室早被消除后心脏大小的变化。结果共21例频发室早伴心脏扩大患者纳入本研究。平均术前LVEDD为(57.5±3.1)mm。术后17例患者LVEDD在一年内恢复正常。术后LVEDD均值为(52.4±3.5)mm,术前及术后LVEDD的差值为(-5.1±3.7)mm(P0.0001)。术前及术后左室射血分数(left ventricular ejection fraction, LVEF)分别为57.5%±6.5%和61.2%±4.9%,两者差值为3.3%±4.7%,差异均具有统计学意义(P=0.0054)。起源部位(左室或右室)对射频消融术后的心脏大小和功能变化并无明显影响。结论射频消融术对频发室早伴心脏扩大患者的心脏结构有明显改善作用。     

室性期前收缩性心肌病

频发的室性期前收缩导致心脏结构改变和左心室射血分数下降,称为室性期前收缩性心肌病。消除室性期前收缩后心脏结构和功能可恢复正常。回顾性研究显示,病程长及室性期前收缩负荷高是室性期前收缩性心肌病主要易患因素。其发生机制可能与室性期前收缩发生时心脏无法有效充盈及左右室收缩不同步导致心室腔扩大,心功能下降相关。射频消融术已成为根治室性期前收缩、逆转室性期前收缩性心肌病的唯一方法。     

慢性心房颤动患者消融术后左心房和左心室结构远期变化

目的观察维持窦性心律(窦律)对慢性心房颤动(房颤)射频消融术后患者左心房和左心室结构的影响。方法入选38例慢性房颤行射频消融术的患者,分别于术前、术后1年行超声心动图检查,测量的超声心动图指标为左心房前后径、左心房上下径、左心房左右径、左心房最大容积、左心室舒张末内径、左心室收缩末内径,左心室射血分数,评估房颤有无复发对左心房及左心室重构的影响。结果 31例慢性房颤患者完成随访,随访时间为(13.45±1.46)个月,将其按消融效果分为复发组(15例)和非复发组(16例)。随访结果如下:(1)消融术前复发组与非复发组超声指标的基线资料比较,差异无统计学意义(P0.05)。(2)复发组术后12个月左心房前后径、左心房上下径、左心房左右径、左心房最大容积、左心室舒张末内径、左心室收缩末内径、左心室射血分数与术前比较,差异无统计学意义(P0.05);(3)非复发组消融术后12个月左心房前后径较术前减小[(38.73±3.77)mmvs.(41.86±4.73)mm,P0.01],左心房上下径较术前减小[(58.03±4.31)mmvs.(61.70±3.80)mm,P0.01],左心房左右径较术前减小[(43.93±6.06)mmvs.(46.08±6.62)mm,P0.01],左心房最大容积较术前减小[(75.78±22.27)mLvs.(83.18±24.29)mL,P0.01],左心室舒张末内径较术前减小[(45.85±4.98)mmvs.(48.26±5.36)mm,P0.01]、左心室收缩末内径较术前减小[(28.74±4.27)mmvs.(31.44±5.32)mm,P0.01],左心室射血分数较术前增加[68.03%±4.58%vs.62.75%±7.23%,P0.01],差异有统计学意义。结论维持窦律能使射频消融术后12个月的慢性房颤患者左心房及左心室逆向重构,左心室收缩功能改善。     

肥厚型梗阻性心肌病化学消融术后N末端B型利钠肽原水平的变化特点

目的:探讨肥厚型梗阻性心肌病化学消融术后N末端B型利钠肽原(NT-proBNP)水平的变化规律。方法:选取我院化学消融患者82例,术前采用酶联免疫的方法测定NT-proBNP水平,对患者进行超声心动图检查,测定左心室舒张末内径,左心房内径,室间隔厚度、左心室射血分数、左心室流出道压力阶差。50例完成1年门诊或住院随访的患者术后2天及1年时复查超声心动图及NT-proBNP水平,分析超声心动图各项指标中影响NT-proBNP水平的因素,比较术前,术后2天及随访1年时NT-proBNP变化特点。结果:82例患者术前测定NT-proBNP水平,41例高NT-proBNP水平患者的室间隔厚度[(23.66±6.46)mm vs(20.79±4.56)mm,P=0.035],左心室后壁厚度[(12.79±2.99)mm vs(11.50±2.35)mm,P=0.048],最大左心室厚度[(28.03±5.66)mm vs(25.18±4.81)mm,P=0.027],左心房内径[(40.73±4.86)mm vs(38.08±6.17)mm,P=0.049]均显著高于41例低NT-proBNP水平患者。50例完成1年随访的患者术后2天NT-proBNP水平较术前升高[(1841.79±1310.88)fmol/ml vs(1552.15±951.57)fmol/ml,P=0.066],1年随访时NT-proBNP水平较术前显著下降[(1038.46±714.03)fmol/ml vs(1552.15±951.57)fmol/ml,P=0.000]。结论:肥厚型梗阻性心肌病患者NT-proBNP水平受心房大小及心室肥厚程度影响,长期随访NT-proBNP水平显著下降。     

造影超声心动图评估肥厚性心肌病患者左心室收缩功能

目的比较常规超声心动图、造影超声心动图及心脏磁共振成像技术对肥厚性心肌病患者左心室收缩功能的测定。方法纳入2014年9月至2016年9月在四川大学华西医院同时完成上述3种影像学检查的48例肥厚性心肌病患者,其中女性20例,男性28例,分别对左心室舒张末期容积(LVEDV)、收缩末期容积(ESV)、每搏输出量(SV)及左心室射血分数(LVEF)进行比较。结果 3种技术所测LVEDV比较,心脏磁共振成像测值大于造影超声心动图和常规超声心动图[(151.43±70.94)ml比(123.45±44.37)ml和(99.62±35.91)ml,均为P<0.05];所测LVEF比较,造影超声心动图测值大于常规超声心动图和心脏磁共振成像(74.38%±8.87%比68.97%±10.63%和64.46%±11.41%,均为P<0.05);而常规超声心动图所测左心室ESV与造影超声心动图比较差异无统计学意义[(36.21±22.32)ml比(34.13±35.54)ml,P>0.05],但均小于心脏磁共振成像测值[(59.69±70.13)ml,均为P<0.05];造影超声心动图所测左心室SV与心脏磁共振成像比较差异无统计学意义[(92.73±22.99)ml比(92.74±23.77)ml,P>0.05],但均大于常规超声心动图测值[(63.40±22.24)ml,均为P<0.05]。造影超声心动图与心脏磁共振成像在测定左心室EDV(r=0.91)、ESV(r=0.98)、SV(r=0.42)及LVEF(r=0.75)时相关(均为P<0.05);常规超声心动图与心脏磁共振成像在测定左心室EDV(r=0.83)、ESV(r=0.90)及LVEF(r=0.59)时相关(均为P<0.05),而二者在测定SV时无明显相关性(r=0.18,P>0.05)。结论相对于常规超声心动图,造影超声心动图与心脏磁共振成像技术对肥厚性心肌病患者左心室容积及收缩功能测定的相关性更好。     

频发室性期前收缩的频次及负荷对患者心脏结构及功能的影响

目的探讨频发室性期前收缩(PVC)患者的期前收缩频次及负荷与心脏结构及心功能的关系。方法选择PVC患者67例,根据期前收缩频次及负荷,采用四分位数间距法分为频次A组和负荷A组17例,频次B组和负荷B组17例,频次C组和负荷C组17例,频次D组和负荷D组16例;另选择无PVC患者20例为对照组。分析期前收缩频次及负荷与心功能的关系。结果与对照组比较,期前收缩频次C组、频次D组左心房内径、左心室心肌重量、左心室舒张末内径(LVIDD)、期前收缩负荷C组LVIDD、负荷D组LVIDD、左心室舒张末容积和收缩末客积、每搏心输出量明显升高(P<0.05,P<0.01),LVEF明显降低(P<0.05)。期前收缩负荷与左心室心肌重量、LVIDD、左心房内径呈正相关(r=0.41 5、r=0.426、r=0.269,P<0.05,P<0.01);期前收缩频次与LVEF呈负相关(r=-0.432,P<0.01),与LVIDD呈正相关(r=0.390,P<0.01)。结论期前收缩频次与PVC心脏结构及左心室收缩功能显著相关,提示随着期前收缩频次增加其功能下降、左心室扩大;随着期前收缩负荷增大,左心室肥厚程度增加。     

氮末端脑钠素前体评价急性心肌梗死后左心室功能及重构

目的:研究血浆氮末端脑钠素前体(NT-proBNP)对心肌梗死后近期左心室功能及重构评价的临床应用价值.方法:研究对象为61例首次确诊急性心肌梗死的患者(分为A组n=30,B组n=31)和20例正常人(对照组).所有患者于发病后第48～96小时采血测定血浆NT-proBNP水平,并行Killip分级及超声心动图检查.分析左心室功能及左心室容积参数与血浆NT-proBNP水平的关系.结果:急性心肌梗死患者的血浆NT-proBNP水平明显高于对照组.NT-proBNP水平与左心室收缩末容积指数呈正相关(r=0.5551,P<0.001),与同期左心室射血分数呈负相关(r=-0.5538,P<0.001).NT-proBNP＜235 pmol/L诊断左心室射血分数＞0.55的敏感性、特异性和准确性分别是84.6%、65.5%和77.7%.多元逐步回归法分析影响NT-proBNP的因素有Killip 分级,室壁节段运动指数.结论:急性心肌梗死后患者血浆NT-proBNP 浓度显著升高,血浆NT-proBNP水平与左心室壁受累范围和心功能分级之间存在相关.     

不同负荷特发性室性早搏对心脏结构和功能的影响

目的探讨不同负荷特发性室性早搏(简称室早)对心脏结构和功能的影响。方法入选102例特发性室早患者,根据室早数量与24 h总心搏的比值,将入选患者分为室早负荷<10%组(低负荷组),10%～20%组(中等负荷组),>20%组(高负荷组)。采用二维心脏超声分别测量左室射血分数(LVEF),左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)值,并检测以上患者血清N-末端脑钠肽(NT-proBNP)水平。结果室早负荷与LVEDD(r=0.27,P=0.003)、LVESD(r=0.31,P=0.001)大小、血清NT-proBNP水平呈正相关(r=0.21,P=0.02),和LVEF呈负相关(r=0.21,P=0.02);高负荷组与低负荷组、中等负荷组相比,LVEDD、LVESD值明显增大,LVEF值明显降低(P<0.05),而NT-proBNP的升高无显著性。结论随着室早负荷的增大,左室的结构与功能出现重构性变化。     

Characteristics of premature ventricular complexes as correlates of reduced left ventricular systolic function: study of the burden, duration, coupling interval, morphology and site of origin of PVCs

PVCs and Left Ventricular Dysfunction. Background: Frequent premature ventricular complexes (PVCs) can cause a decline in left ventricular ejection fraction (LVEF). We investigated whether the site of origin and other PVC characteristics are associated with LVEF. Methods: We retrospectively studied 70 consecutive patients (mean age 42 ± 17 years, 40 [57%] female) with no other cause of cardiomyopathy undergoing ablation of PVCs. We analyzed the association of a reduced LVEF, defined by LVEF <50% on echocardiography, with features of PVCs obtained from electrocardiography, 24‐ or 48‐hour Holter monitor and electrophysiology study. Results: Patients with reduced LVEF (n = 17) as compared to normal LVEF (n = 53) had an increased burden of PVCs (29.3 ± 14.6% vs 16.7 ± 13.7%, P = 0.004), higher prevalence of nonsustained ventricular tachycardia (VT) [13 (76%) vs 21 (40%), P = 0.01], longer PVC duration (154.3 ± 22.9 vs 145.6 ± 20.8 ms, P = 0.03) and higher prevalence of multiform PVCs [15 (88%) vs 31 (58%), P = 0.04]. There was no significant difference in prevalence of sustained VT, QRS duration of normally conducted complexes, PVC coupling interval, or delay in PVC intrinsicoid deflection. Patients with fascicular PVCs (n = 5) had higher mean LVEF compared to others (66.2 ± 4.0% vs 53.0 ± 10.0%, P = 0.002). There was no association of LVEF with other PVC foci or with left‐bundle versus right‐bundle branch block morphologies. The threshold burden of PVCs associated with reduced LVEF was lower for right as compared to left ventricular PVCs. Conclusion: In addition to the PVC burden, other characteristics like a longer PVC duration, presence of nonsustained VT, multiform PVCs and right ventricular PVCs might be associated with cardiomyopathy. (J Cardiovasc Electrophysiol, Vol. 22, pp. 791‐798, July 2011)     

Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: Comparison with a control group without intervention

BACKGROUND: Idiopathic premature ventricular complexes (PVCs) usually are considered benign, even when frequent. However, case reports have demonstrated a possible link between frequent PVCs and left ventricular (LV) dysfunction. In addition, frequent PVCs recently were demonstrated to be associated with increased LV dimensions and cardiomyopathy. METHODS: Among 60 consecutive patients with idiopathic, frequent PVCs (>10/hour), a reduced LV ejection fraction (EF; mean 34% +/- 13%) was present in 22 (37%) patients. Patients with decreased LV function had a greater PVC burden on a 24-hour Holter monitor than patients with normal EF (37% +/- 13% vs. 11% +/- 10% of all QRS complexes; P <.0001). There was a significant inverse correlation between the PVC burden and the EF before ablation (r = 0.73, P <.0001). RESULTS: The PVCs originated in the right ventricular outflow tract in 31 (52%) of 60 patients, the LV outflow tract in 9 (15%) of 60 patients, and in other sites in 13 (22%) of 60 patients. The site of PVC origin could not be determined in seven patients. Ablation was completely successful in 48 (80%) patients. In patients with an abnormal EF before ablation, LV function normalized in 18 (82%) of 22 patients from a baseline of 34% to 59% +/- 7% (P <.0001) within 6 months. In the four patients in whom ablation was ineffective, the EF further declined from 34% +/- 10% to 25% +/- 7% (P = .06) during follow-up. In a control group of 11 patients with a similar PVC burden (30% +/- 8%) and a reduced EF (28% +/- 13%) who did not undergo ablation, the EF remained unchanged in 10/11 patients over 19 +/- 17 months of follow-up and one patient underwent heart transplantation. CONCLUSION: LV dysfunction in the setting of frequent, idiopathic PVCs may represent a form of cardiomyopathy that can be reversed by catheter ablation of the PVCs.     

Chronic frequent premature ventricular complexes originating from right and non-right ventricular outflow tracts

Frequent premature ventricular complexes (PVCs) from the right ventricular outflow tract (RVOT) have recently been reported to be a cause of dilated cardiomyopathy. We studied the clinical impact of the elimination of PVCs from RVOT and non-RVOT.Thirty-six patients with symptomatic PVCs that were treated with radiofrequency catheter ablation (RFCA) were studied. The patients were assigned to one of two groups according to the origin of the PVCs (group I, RVOT-origin, n = 24; group II, non-RVOT-origin, n = 12) and observed for 10.5 ± 7.1 months.The burden of PVCs at baseline was 19.7 ± 10.6% and 18.7 ± 8.7% in group I and group II, respectively (P = 0.779). In group II, hypertension was more common (16.7% versus 58.3%, P = 0.020) and LV diastolic function was worse (Em, 8.7 ± 3.0 versus 6.4 ± 1.8 cm/second, P = 0.018). The LV end diastolic volume index (LVEDVI) decreased in both groups (59.7 ± 14.6 to 50.9 ± 9.6 mL/m(2), P = 0.004 in group I; 60.0 ± 19.9 to 51.6 ± 12.4 mL/m(2), P = 0.044 in group II), while the left atrial volume index (LAVI) decreased only in group I (36.7 ± 11.7 to 31.7 ± 10.0 mL/m(2), P = 0.002 in group I; 35.6 ± 11.9 to 33.8 ± 10.3 mL/m(2), P = 0.317 in group II). The left ventricular ejection fraction (LVEF) significantly improved in both groups (51.1 ± 6.6 to 59.8 ± 7.2 %, P < 0.01 in group I; 49.9 ± 6.9 to 59.0 ± 5.9 %, P < 0.01 in group II).RFCA of PVCs leads to a reduction of LV volume and improvement of LV systolic function regardless of the origin of the PVCs. Conversely, a non-RVOT-origin as well as an RVOT-origin of the PVCs can cause DCM-like changes in the left ventricle.     

Tachycardia-induced cardiomyopathy in patients with idiopathic ventricular arrhythmias: the incidence, clinical and electrophysiologic characteristics, and the predictors

Idiopathic Ventricular Arrhythmias and Cardiomyopathy. Introduction: Idiopathic ventricular arrhythmias in the form of monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) can cause tachycardia‐induced cardiomyopathy (TICMP). The aim of this study was to determine the incidence, clinical and electrophysiologic characteristics, and the predictors of TICMP in patients with idiopathic ventricular arrhythmias. Methods: Study population consisted of 249 consecutive patients (148 F/101 M, 45 ± 20 y/o) with frequent PVCs and/or VT. All patients underwent transthoracic echocardiography and 24‐hour Holter monitoring. TICMP was defined as left ventricular ejection fraction (LVEF) of ≤50% in the absence of any detectable underlying heart disease and improvement of LVEF ≥15% following effective treatment of index ventricular arrhythmia. Results: Seventeen (6.8%) patients had TICMP. Patients with TICMP compared to patients with preserved LVEF were more likely to be male (65% vs 39%, P = 0.043) and asymptomatic (29% vs 9%, P = 0.018), and were more likely to have higher PVC burden (29.4 ± 9.2 vs 8.1 ± 7.4, P < 0.001), persistence of PVCs throughout the day (65% vs 22%, P = 0.001), and repetitive monomorphic VT (24% vs 0.9%, P < 0.001). PVC burden of 16% by ROC curve analysis best separated the patients with TICMP compared to patients with preserved LVEF (sensitivity 100%, specificity 87%, area under curve 0.96). Conclusions: TICMP was relatively common (～1 in every 15 patients) in our study population. The predictors of TICMP were male gender, absence of symptoms, PVC burden of ≥16%, persistence of PVCs throughout the day, and the presence of repetitive monomorphic VT . (J Cardiovasc Electrophysiol, Vol. 22, pp. 663‐668, June 2011)     

Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract in patients with left ventricular dilation and/or dysfunction

Left ventricular (LV) dysfunction caused by frequent premature ventricular complexes (PVCs) can be reversed by suppression of PVCs with antiarrhythmic agents or radiofrequency catheter ablation (RFA). However, there is a paucity of data on the efficacy and safety of RFA among the local population. We aimed in this study to evaluate the effect of RFA of frequent PVCs originating from right ventricular outflow tract (RVOT-PVCs) on cardiac function in patients with depressed cardiac function and/or LV dilation. The study included sixteen patients with monomorphic RVOT-PVCs without overt underlying structural heart disease. Frequency of PVCs by 24-h Holter monitoring, left ventricular ejection fraction (LVEF), end-diastolic diameter (LVEDD), end-systolic diameter (LVESD), mitral regurgitation (MR) by echocardiogram and NYHA functional class were evaluated before and 3 and 6 months after RFA. All patients underwent RFA.ResultsThe higher the number of PVCs/24 h, the bigger the LVESD and the lower the EF. Procedural success was achieved in 13 (81%) of the patients with no complications. Six months follow-up after successful ablation, LVEDD decreased significantly (from 56.62 ± 5.87 to 49.23 ± 5.31 mm; p = 0.002), LVESD decreased significantly (from 41.85 ± 7.82 to 33.69 ± 4.66 mm; p = 0.002), LVEF increased significantly (from 46.69 ± 4.92% to 60.54 ± 5.39%; p < 0.001) and NYHA functional class improved in all patients after successful ablation.ConclusionRF catheter ablation of frequent RVOT-PVC has a beneficial effect on cardiac function in patients with depressed cardiac function.It carries a high degree of success and safety. Frequent RVOT-PVCs are burden on LV function even in patients without overt underlying structural heart disease.     

右室心尖部起搏患者起搏QRS波时限与左室结构和功能关系探讨

目的评价起搏QRS波时限与左心结构和功能的关系。方法入选106例右室心尖起搏患者,分成左室射血分数(LVEF)<0.55的病例组(n=48)和LVEF>0.55的对照组(n=58)。通过常规体表心电图测得起搏QRS波时限,行超声心动图检查获取左房内径(LAD)、收缩末期左室内径(LVESD)、舒张末期左室内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及LVEF,评价患者的纽约心功能分级,同时检测患者的N端-B型利钠肽前体(NT-proBNP)水平,分析起搏QRS波时限与以上各指标的关系。结果①起搏QRS波时限与LVEDD(r=0.577,P<0.001)、LVESD(r=0.627,P<0.001)、LAD(r=0.241,P=0.013)、IVST(r=0.345,P<0.001)、LVP-WT(r=0.349,P<0.001)均呈正相关,与LVEF负相关(r=-0.570,P<0.001),与纽约心功能分级正相关(r=0.527,P<0.001),与NT-proBNP对数正相关(r=0.265,P=0.024)。②以起搏QRS波时限≥200ms诊断左室收缩功能不全,灵敏度和特异度分别为85.42%和70.69%。结论对于右室心尖部起搏的患者,起搏QRS波时限是一个简便而实用的初步判断心脏结构和功能的指标。     

射频导管消融治疗特发性室性期前收缩触发的心室颤动／多形性室性心动过速

目的：探讨特发性室性期前收缩（早搏,PVC）触发心室颤动和（或）多形性室性心动过速（VF／PVT）的临床特点及射频导管消融治疗效果。方法：313例无器质性心脏病接受射频导管消融治疗的特发性PVC患者,其中6例发生了由PVC触发的VF／PVT,分析该6例患者的临床资料及射频导管消融治疗效果。结果：该6例患者动态心电图可记录到频发PVC[（16303±5854）次／d],PVC联律间期及基础QT间期分别为（412±44）ms和（407±10）ms。这些参数值在另外307例特发性PVC患者中分别为（15570±4743）次／d、（419±36）ms和（404±8）ms,两组间无显著性差异。313例患者中,有88例记录到由PVC触发的单形态室性心动过速（VT）。PVC触发VF／PVT患者中晕厥发生率（3／6）高于由PVC触发的单形态VT患者（4／88,4．5％,P〈0．05）,PVT的周长[（235±22）ms]则短于单形态VT组[（324±29）ms,P〈0．05]。针对触发VF／PVT的PVC消融后随访的10～36个月期间,所有6例患者未再发生晕厥、VF及心脏骤停。结论：恶性VF／PVT可能由一些特发性PVC诱发,射频导管消融PVC治疗可作为一项有效的治疗选择。     

Reversal of premature ventricular complexes induced cardiomyopathy. Influence of concomitant structural heart disease

BackgroundWe examined the effect of radiofrequency (RF) catheter ablation of premature ventricular complexes (PVCs) on left ventricle (LV) function recovery in patients with LV dysfunction, regardless the presence of structural heart disease (SHD).MethodsSeventy seven patients with impaired LV ejection fraction (EF) (37.1 ± 9.4), suspected to have PVCs cardiomyopathy (PVC-CM) (>10% PVCs burden), referred for RF ablation were enrolled, and divided into 2 groups according to the presence of SHD. SHD was ruled out by echocardiography, coronary angiography or MRI. CARTO 3 mapping system was used employing activation mapping in the majority of cases. Initial success was defined as complete elimination or residual PVCs ≤ 10 beats/30 min. Long term success was defined as reduction in PVCs burden >80% on follow-up holter. Echocardiography was done after 6 months. Improvement of EF >5% was considered significant.ResultsForty two (55.8%) cases had SHD. PVCs burden was 28.4 ± 9.8%. EF improved to 48.6 ± 10.3. Initial success, overall success, post procedural PVCs burden and EF were comparable in both groups. EF improved in 47(75%) of successful cases with no significant differences between both groups. Post-MI Patients were the least category to improve. PVCs burden before and after ablation were the independent predictors of LVEF recovery by multivariate analysis. Cutoff values of >18%, <8% had 100% sensitivity and 85%, 87% specificity, respectively.ConclusionsPVCs elimination by RF ablation results in significant improvement even restoration of LV function regardless of PVC origin, or the presence of concomitant SHD. PVCs burden before and after ablation are the main predictors of LVEF recovery.