R-on-T室早致多形性室速1例

患者男、67岁。因间断头昏、眼花、黑矇3年入院。患者自诉曾两次无明显诱因出现黑矇,意识丧失,数秒钟后神志自行恢复,意识恢复后自测脉搏缓慢。入院时查体:神志清,左侧颈动脉可闻及杂音,余无特殊。既往患高血压病,2型糖尿病等。门诊心电图(图1)示:窦性心律;陈旧性下壁心肌梗死;室内传导延迟;ST-T改变。心脏超声示:心脏扩大,心尖室壁瘤形成,左室节段性室壁运动异常,左室收缩功能减退。冠脉造影示:冠脉三支病变,前降支近段次全闭塞,回旋支远段狭窄85%,右冠近段狭窄70%,     

室早指数

临床医生常用室早指数评价联律间期不同的室早的临床意义。[定义]早搏指数（prematurity index，PI）最早由Buechner和Effer于1968年提出，分为室早指数和房早指数。随后，临床更加重视、     

室早指数(46)

临床医生常用室早指数评价联律间期不同的室早的临床意义。     

动态心电图中室早的临床意义分析

动态心电图(DCG)检查中,室性早搏(PVS)的出现频率最高,现将我院1996年12月-2004年10月的2000例PVS者的临床资料和DCG分析如下。     

插入性室早伴不同程度心室预激1例

患者女,68岁.2019年12月17日因"高血压病"复诊.入院时患者无明显头晕、胸痛等不适,有时胸闷、心悸.患者神志清,血压140/82mmHg,心率75次/分,心律不齐,可闻及早搏.血清肌酸激酶、肌酸激酶同工酶、高敏肌钙蛋白、D-二聚体、钾离子和血常规均正常范围.临床诊断:高血压病;心律失常.当日常规心电图(图1)示...     

RonT与RonP型室性早搏诱发室性心动过速一例

ＲｏｎＴ与ＲｏｎＰ型室性早搏诱发室性心动过速一例林加锋ＲｏｎＴ型室性早搏（室早）和ＲｏｎＰ型室早诱发室性心动过速（室速）已有不少报告，但同一患者同时存在上述两种室早，而且均诱发出室速者罕见，现报告一例如下。患者，男性，５１岁。因心悸、胸闷一周入院。临...     

动态心电图检出短阵室性心动过速的临床和心电图分析

一般认为器质性心脏病发生Lown分级Ⅲ级以上的室性心律失常易引发心室颤动而致猝死,故属恶性心律失常.本文收集经24h动态心电图检出的短阵室性心动过速32例,就其临床和心电图作一初步分析,旨在探讨动态心电图检出短阵室性心动过速的临床意义和发生机制.临床资料本组32例均为住院患者.用英国牛津公司产 Prima型动态心电图仪24h监测,其中男性23例,女性9例,年龄43～84(65.41±8.02)岁,经询问病史及各项检查明确诊断.基础心脏病为冠心病23例,高血压心脏病5例,肺源性心脏病3例,扩张型心肌病1例.其中3例为急性心肌梗死,6例为陈旧性心肌梗死,11例合并脑出血或脑梗死.X线胸片、超声心动描记术提示20例有不同程度心房、心室或全心扩大,5例有     

特发性室性心动过速及室性期前收缩的射频消融治疗

目的探讨射频导管消融(radiofrequency catheter ablation,RFCA)治疗特发性室性心动过速(idiopathic ventricular tachycardia,IVT)和室性期前收缩(premature ventricualr contraction,PVC)可行性、必要性和疗效。方法回顾性分析16例IVT、PVC患者采用激动顺序标测和起搏标测法确定室性心动过速(ventricular tachycardia,VT)、PVC的起源部位并行RFCA治疗的资料。结果 3例IVT中2例起源于左室间隔部左后分支的蒲肯野系统,1例起源于右心室流出道(right ventricular outflow tract,RVOT)游离壁,同时合并另一种游离壁起源的PVC,3例消融均成功,1例复发。13例PVC中7例起源RVOT间隔部,3例起源于RVOT游离壁,1例同时存在两种形态PVC(分别起源于ROVT间隔部和游离壁),2例起源于左心室流出道,13例消融成功,1例复发。结论 RFCA治疗IVT及特定部位的PVC是安全、有效且成功率高的一种方法。     

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。     

动态心电图对房性早搏诱发的阵发性心房颤动的诊断价值

目的探讨阵发性心房颤动与房性早搏的关系。方法对26例经动态心电图诊断为阵发性房颤的病人,统计房早个数、房颤的发作阵数,诱发房颤的房早联律间期、房早前周期,未诱发房颤的房早联律间期、房早前周期等。结果26例阵发性房颤患者中,24h平均房早11126±2018个,阵发性房颤248±56阵。其中22例(84.6%)由房早诱发,2例(7.68%)由短阵房速诱发,2例(7.68%)由房扑诱发。能够诱发房颤的房早联律间期及房早前周期分别为361.8±42.9ms和828±101ms,未诱发房颤的房早联律间期及房早前周期分别为426.6±43.5ms和728±107ms,诱发房颤的房早联律间期明显短于未诱发房颤的房早联律间期,呈PonT现象,诱发房颤的房早前周期比未诱发房颤的房早前周期长(p<0.01)。结论阵发性房颤主要由房早始动,其与房早的联律间期及前周期有关。     

Ventricular tachycardia in myocardial infarction: Relation to heart rate and premature ventricular contractions

Analysis of monitored electrocardiograms, recorded in 77 patientsduring the first 48 hours following the onset of myocardialinfarction, revealed 492 episodes of ventricular tachycardiawith rates of 90–220 min^–1. Characteristics of theventricular tachycardia episodes were correlated with heartrate and with the rate and complexity of ventricular arrhythmiasin the 10-min period preceding ventricular tachycardia. Ventriculartachycardia with rates of 140–180 min^–1 and witha QS configuration was the most frequent event. The first ectopiccomplex of VT was R-on-Tin only 17.2%. Sinus tachycardia wasassociated with significantly fewer episodes of VT with ratesof 110–140min^–1 than when the sinus rate was normal.However episodes of ventricular tachycardia with rates of 181to 220 beats min^–1 were more frequent during sinus tachycardia.Analysis of the frequency of premature ventricular contractionsin the 10-min period immediately preceding ventricular tachycardiarevealed no premature ventricular contractions in 24.4% of cases.Multiple premature ventricular contractions with a frequencyof >5 min^-1 were observed in 8.4% of cases, multifocal in30.3%, couplets in 24% and early PVCs in 12.2%. In the minutebefore ventricular tachycardia, only 40.2% of cases displayedpremature ventricular contractions. In that minute, complexpremature ventricular contractions were distributed as follows:multifocal in 10%, couplets in 8.7% and early PVCs in 2.6% ofcases. Out of the total of 492 runs of ventricular tachycardia,5 cases (1%) resulted in ventricular fibrillation. The frequencyand complexity of premature ventricular contractions as wellas the characteristics of ventricular tachycardia were foundto be of little predictive value for the immediate developmentof ventricular fibrillation in patients with acute myocardialinfarction.     

Idiopathic malignant premature ventricular contractions

The presence of premature ventricular contractions (PVCs) in patients with structurally normal hearts was once considered a benign phenomenon. However, in susceptible patients, these “benign” or idiopathic PVCs may develop malignant potential and trigger ventricular fibrillation and result in sudden cardiac death. Alternatively, idiopathic PVCs can also induce cardiomyopathy. Clinical recognition of these entities can lead to effective targeted therapy. In the first instance, treatment consists of ablating the PVC source and implanting a defibrillator, whereas in the second scenario, ablating the PVC origin can normalize left ventricular function.     

动态心电图评价房性早搏诱发阵发性心房颤动的研究

目的用24h动态心电图观察房性早搏所诱发的房颤,探讨其发生的机制及与长短周期现象的关系。方法对100例常规心电图检查发现有房性早搏的患者进行动态心电图监测,观察房性早搏诱发房颤时的长短周期时间及特点。结果100例房性早搏患者动态心电图监测出现阵发性房颤21例(21.0%)、短阵房速26例(26.0%),动态心电图监测发现阵发性房颤100%由房性早搏诱发。结论通过动态心电图监测发现房性早搏患者房颤发生率较高,加强对房性早搏的认识,减少房颤的发生。     

索他洛尔治疗中老年室性早搏的疗效观察

目的　观察索他洛尔对中老年患者室性早搏的治疗效果。方法　根据治疗前后动态心电图监测室性早搏减少的百分比判定疗效 ,同时观察对最快心率、最慢心率、平均心率及 Q- Tc间期的影响 ;对治疗前后的心功能变化进行了监测。结果　索他洛尔治疗中老年人室性早搏总有效率为 65.2 % ;对冠心病合并室性早搏疗效显著 ,并且可减慢窦性心律及延长 Q- Tc间期 ;1 60～ 2 4 0 mg/d治疗 3～ 4w对心功能无影响。结论　索他洛尔是一种有效的治疗室性早搏的抗心律失常药物 ,对冠心病合并的室性早搏效果明显 ,极少数人因心率下降及 Q- Tc间期延长而停止治疗     

射频消融治疗室性早搏触发特发性室性心动过速／心室颤动的病例分析

目的探讨射频消融治疗在室性早搏（室早）触发特发性室性心动过速／心室颤动（室速／室颤）中的作用。方法总结3例由室早触发室速／室颤的治疗经验,1例对室早进行射频消融（RF—CA）并植入心律转复除颤器（ICD）,另1例经射频消融未完全消除室早而选择植入ICD,第3例经射频消融成功消除室早,未再发室颤。结果随访2年,3例患者均存活,ICD未再记录到室速／室颤。结论在室早触发室速／室颤病例中,应分析室早与室速／室颤的相关性,给予个体化治疗,射频消融室早可以消除／减少晕厥和室颤的发作。     

Cardiac magnetic resonance imaging findings in patients with right ventricular outflow tract premature contractions

AIMS: To assess prospectively the value of cardiac magnetic resonanceimaging in patients with apparently idiopathic premature contractionsarising from the right ventricular outflow tract. METHODS: We compared magnetic resonance imaging scans in 19 patients(13 males and six females, mean age 44 years) with frequent(>100 per hour), monomorphic (left bundle branch block andinferior axis morphology) extrasystoles, and in 10 volunteers(four males and six females, mean age 36·7 years) withoutstructural heart disease. Magnetic resonance imaging studies(1 or 1·5 Tesla) included spinecho and gradient-echosequences in the standard planes. The presence of structuraland dynamic abnormalities of the right and left ventricles,such as reduced wall thickness, systolic bulging, and decreasedsystolic thickening, were evaluated. In addition, end-diastolicdiameters of the right ventricular outflow tract were measuredin the transverse plane. RESULTS: The dimensions of the right ventricular outflow tract were widerin patients with extrasystoles compared to the control group.Mean anteroposterior and transverse diameters were 39·6±4·6mm vs 29·9±4·8 mm (P<0·01) and27·5±3·8 mm vs 20·5±2·5mm (P<0·01), respectively. Wall motion and morphologicalabnormalities were present in 16/19 (84%) patients, and wereconfined to the anterolateral wall in 15/16 cases. All normalsubjects had normal magnetic resonance imaging findings (P=0·008). CONCLUSIONS: Cardiac magnetic resonance imaging revealed that in patientswith idiopathic right ventricular outflow tract premature contractionsthere was a higher rate of morphological and functional abnormalitiesof the right ventricular outflow tract than in the normal subjects.Large studies and long follow-up are needed to confirm whetherthese findings could help identify a localized form of arrhythmogeniccardiomyopathy, and its clinical significance.