心肌病患者心室晚电位检测意义

心肌病患者心室晚电位检测意义云南省昆明市第一人民医院翟彪，田青，王纬心室晚电位（ＶＬＰ）检测有助于预报恶性快速室律异常，其与心肌梗塞发生恶性室律异常的关系已有很多报道，而与心肌病发生恶性室律异常的关系报道不多。本文对正常人、心肌梗塞及心肌病分组进行信...     

心室晚电位与室性心律失常关系的探讨

心室晚电位(VLP)常见于缺血性心脏病病人,与恶性室性心律失常的发生密切相关。为探讨VLP与室性心律失常的确切关系,我们应用美国ART1200EPX型晚电位分析仪,对心肌梗塞、冠心病心绞痛、心肌炎等222例患者进行了VLP检查,并与143例正常健康人作对照,现报告分析如下。     

体表记录心室晚电位对冠心病室性心律失常临床意义

本文应用体表记录心室晚电位的方法,对220人(正常人78名);急性心肌梗塞92例;陈旧心肌梗塞50例;心绞痛10例进行了检测。正常人无一例晚电位阳性,而陈旧心肌梗塞合并室性心动过速(室速)者晚电位阳性率高达66.7%。心肌梗塞部位、室壁瘤及左室射血分数与晚电位缺乏相关性。体表记录心室晚电位对于冠心病室性心律失常的检测不失为一种有价值的非创伤性手段。     

369例急性心肌梗塞患者信号叠加心电图的临床分析

通过对369例急性心肌梗塞患者的临床观察,分析了心室晚电位在心肌梗塞患者和并发室速/室颤(VT/VF)患者中的发生率以及梗塞部位、左心功能与心室晚电位的关系。     

冠心病及心肌梗塞体表心室晚电位的定量分析及临床意义

心室晚电位,本文通过冠心病及心肌梗塞体表心室晚电位的检测定量分析,了解其在临床上的实用价值,1991—1992年本院住院及门诊病例作为观察对象,心电图,心电向量图,酶学检查及病史,临床诊断为冠心病及心肌梗塞321例,其中:冠心病(除外心肌梗塞)组,包括心绞痛278例,心肌梗塞43例,采用WEX公司的WLP—1800型心室晚电位检测仪,叠加150—300个心动周期,频率为40—250Hz,背景噪声0.20—0.50μV,冠心病体表心室晚电位阳性率为21.8％,心肌梗塞心室晚电位阳性率     

105例老年人心室晚电位初步观察

对3组105例60岁以上老人进行了心室晚电位测定,结果显示心肌梗塞伴有复杂心律失常组与心肌梗塞无复杂心律失常组相比,晚电位阳性率有非常显著的差异(P<0.001),前者明显高于后者。复杂心律失常组的晚电位发生率明显高于对照组(P<0.05)。并就17例复杂室性心律失常者未记录到心室晚电位、而1例“正常”人则记录到心室晚电位的现象予以讨论。     

药物干预心室晚电位研究进展

药物干预心室晚电位研究进展湖北中医学院黎启华综述，屈松柏，审校国内外一系列研究表明，心室晚电位（ＶｅｎｔｒｉｃｕｌａｒＬａｔｅＰｏｔｅｎｔｉａｌ，ＶＬＰ）与折返性室性快速性心律失常关系密切［１，２］，且与猝死密切相关［３］，其检出率在心肌梗塞、扩张型...     

心肌梗塞后持续性室性心动过速患者隐匿型心室晚电位的发生率及其意义

近年来,信号叠加心电图作为一种无创性检查方法,用来检查疑似病人有无折返性室性心律失常的基础。检出的心室晚电位多出现于QRS终末部分,但少数出现更晚,振幅更低,在ST段中,称隐匿型心室晚电位。本文研究这种隐匿型心室晚电位的特征并探讨其临床意义。方法:心肌梗塞后发生持续性室性心动过速病人48例,其中前壁心肌梗塞20例(42%),下壁心肌     

心室晚电位与室壁运动的相关性研究

心肌梗塞后患者绝大多数都有室壁运动异常.而室壁运动异常对心室晚电位是否有影响,各家报道不一.本文旨在研究室壁运动与心室晚电位的相互关系.1 临床资料随机选择陈旧性心肌梗塞患者50例,男46例,女4例;平均年龄57(40～73)岁.2 检查方法     

QT离散度、心室晚电位对心肌梗塞患者临床事件发生的预测价值（摘要）

我们通过测定50例急性心肌梗塞(AMI)患者和50例陈旧性心肌梗塞(OMI)患者的QT离散度(QTcd)及心室晚电位(VLP)两项指标，并与40例正常人进行了对照分析，以探讨QTed、VLP对心肌梗塞患者临床事件发生的预测价值。现报告如下。     

Ventricular premature beats on Holter monitoring in patients admitted with chest pain, in whom acute myocardial infarction is not confirmed. The prognostic value and relationship to scars or ischemia on thallium-201 scintigraphy

Ambulatory 24-h Holter monitoring was carried out in 198 patients who had been admitted because of suspected acute myocardial infarction (AMI) due to chest pain, but in whom AMI was not confirmed. During a follow-up period of 12-24 months (median 14 months) 16 cardiac events (i.e., nonfatal AMI or cardiac death) occurred. Ventricular premature beats (VPBs) were found in 65.2% of the patients, complex VPBs in 28.8%. Pairs of VPBs which were seen in 10.0% of the patients were the only important type of VPBs significantly related to an impaired prognosis. Thallium-201 scintigraphy was performed in 144 of the patients. VPBs were significantly related to scar formation (i.e., to permanent defects, but not to ischemia, specifically, to transient defects). It is concluded that ventricular arrhythmias in this patient category indicate presence of chronic ischemic heart disease, and that pairs of VPBs seem to identify patients at risk for cardiac events.     

1- and 7-year risk of cardiac events in relation to Holter monitoring in patients admitted with chest pain in whom AMI is not confirmed

The prognostic value of ventricular premature beats (VPBs) was evaluated in 198 patients with chest pain (non-AMI patients) in whom the diagnosis of acute myocardial infarction was ruled out after admission to hospital. VPBs were registered at the time of discharge during a 24-hour Holter monitoring. The amount of cardiac events (CEs) were analyzed after 1 and 7 years follow-up. After 1 year, CEs were seen in 9% of the non-acute myocardial infarction (AMI) patients. After 7 years, 51 CEs (20 nonfatal AMIs and 31 cardiac deaths) had occurred (25%). After 1 year, only pairs of VPBs were associated with an increased risk of CEs. CEs were seen in 25% of the patients with pairs of VPBs and in 6% of the patients without pairs (p<0.01). The occurrence of CEs after 7 years was related to the presence of pairs of VPBs and multiform VPBs. Fifty-five percent of the patients with pairs of VPBs had CEs during the long-term follow-up, compared with 22.5% without pairs (p<0.0005). CE was seen in 48.9% of the patients with multiform VPBs, compared with 19.0% without multiform VPBs (p< 0.0001). Thus, Holter monitoring seems to be of better value for predicting long-term prognosis than for predicting short-term prognosis in non-AMI patients. The presence of multiform VPBs or pairs of VPBs is strongly associated with an increased risk of CE after 7 years. Non-AMI patients with pairs of VPBs or multiform VPBs should be considered as high-risk patients.Presented at The 35th World Congress, International College of Angiology, Copenhagen, Denmark, July 1993     

Comparative study of the ECG exercise test and ambulatory ECG monitoring after recovery from acute myocardial infarction

Early ECG exercise tests (EET) and ambulatory ECG monitoring (AEM) were performed in 42 patients surviving AMI in order to determine the sensitivity of the two methods for detecting ST-segment deviation and arrhythmias. 23 patients had ST changes during EET and AEM. Of them, 21 patients had ST changes induced by EET and 10 were recorded by AEM. The more the ECG leads used for monitoring during and after EET, the higher the percentage of patients with ST changes will be. There were 2 cases with ST changes found in AEM only. All the 6 patients who had ST elevations during EET had an anterior infarction and echocardiograms did show that they had left ventricular aneurysms or abnormal ventricular wall movement. AEM recorded ventricular premature beats (VPBs) in 37 cases (88.0%), while EET induced VPBs in 8 patients. The 42 patients were followed up for an average time of 6 +/- 1.7 m. (3.4 to 9.3 m.) Cardiac death occurred in 2 cases. One of them had horizontal ST depression of 3 mm during EET, the other had a negative EET but multifocal VPBs during AEM. It is concluded that for detecting ST changes EET is more sensitive than AEM, while VPBs are more frequently found in AEM than in EET. The authors are of the opinion that for better, prediction of the prognosis of patients after AMI, it is preferable to have early EET in combination with AEM.     

Correlation of signal-averaged electrocardiograms with the threatening ventricular arrhythmia during recovery period of experimental acute myocardial infarction]

Body surface signal-averaged ECGs were recorded in 24 dogs during recovery period of AMI. The correlation of VLP with ventricular arrhythmias induced by programmed electrical stimulation was studied. VLPs were positive in 12 dogs between 7 and 14 days after AMI. VLPs were all positive in 6 dogs with induced VT(100%). In 15 dogs with induced VF, however, VLPs were positive in only 5 (33.3%). The difference between two groups was significant (P = 0.01). Propafenone 2 mg/kg was injected intravenously in 21 dogs. Among the VF group no VF was induced after administration of the drug. In VT group propafenone increased the cycle length of VTs although it could not prevent the induction of the arrhythmias. The drug had no significant influence on VLPs, but it might provide some antifibrillation effect. There was no proarrhythmic effect observed when propafenone was used in this study.     

Patients at risk for cardiac death late after aortic valve replacement.

A total of 100 patients aged 24 to 78 years were screened prospectively a mean of 71 months after aortic valve replacement for the presence of left ventricular hypertrophy (LVH) on the ECG (Estes scores greater than or equal to 5.0) and for repetitive ventricular premature beats VPBs greater than or equal to 2 couplets/24 hr) during 24-hour Holter monitoring. During the subsequent 41-month follow-up (range 10 to 50 months), the yearly cardiac mortality rate was 1.3% in patients with LVH, 2.9% in patients with VPBs, and 8.0% in patients with LVH plus VPBs but only 0.6% when none of these factors was present (p less than 0.05 chi 2 test). The patient groups did not differ with regard to age, time elapsed since operation, underlying valve lesion, and coronary artery disease. Both LVH and VPBs occurred more frequently in patients with left ventricular dysfunction. We conclude that after aortic valve replacement cardiac mortality is markedly increased in patients with LVH and repetitive VPBs, since they are noninvasive markers of left ventricular dysfunction.     

再灌注对急性心肌梗死左室舒张与收缩功能影响的实验研究

本文用急性心肌梗死（ＡＭＩ）犬模型对左室舒张与收缩功能及再灌注后的变化特点进行了观察。结果发现，ＡＭＩ后２、３和７２小时左室舒张与收缩功能均明显下降，在ＡＭＩ后７２小时再灌注组左室舒张与收缩功能明显优于未再灌注组（Ｐ＜０．０５和Ｐ＜０．０１）。     

The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction.

BACKGROUND: Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ventricular tachycardia and sudden cardiac death in acute myocardial infarction (AMI). In the present study, we investigated the effect of glucose-insulin-potassium (GIK) solution on the VLPs and HRV in AMI. METHODS: Seventy-two consecutive patients with first Q wave AMI were randomized to GIK solution and placebo. HRV analysis and ambulatory electrocardiographic recordings were taken in all patients between 24 and 48 h. Sub-maximal exercise testing and echocardiography were performed and signal-averaged electrocardiography (SAECG) was recorded before discharge. RESULTS: Total filtered QRS duration (FQRS: 102 +/- 7 versus 108 +/- 11 ms; P < 0.05), low-amplitude signal (LAS: 25 +/- 8 versus 32 +/- 11 ms; P < 0.01) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be significantly lower while root-mean-square voltage of the terminal 40 ms of QRS (RMS-40: 45 +/- 18 versus 36 +/- 20 microV; P < 0.05), and left ventricular ejection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantly higher in the GIK group when compared to placebo. During the hospital period, the presence and frequency of post-myocardial infarction angina were significantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an insignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference between two groups in either time domain (SD, SDNN, RMS-SD) or frequency domain (HF, LF, LF/HF ratio) parameters. CONCLUSION: GIK solution may be beneficial to VLPs, ischaemic events, and left ventricular systolic performance in the early period of AMI. This therapy has no significant effect on HRV in AMI patients.     

Predictive value of ventricular premature beats for subsequent ischaemic heart disease in apparently healthy subjects.

From 1978 to 1980, 260 healthy subjects, 40-79 years of age, underwent 24 h ambulatory electrocardiography in order to determine the prevalence and complexity of ventricular premature beats (VPBs) in adults without apparent heart disease. The number of types of VPBs seem in 5% or less were considered 'abnormal' and the present follow-up study undertaken in order to assess the significance of such 'abnormal' VPBs as predictors of subsequent ischaemic heart disease (IHD). Information concerning cardiac events within the follow-up period was available in 237 subjects. Nine were lost to follow-up and 24 refused clinical examination. IHD was documented in 13 (eight myocardial infarction, five angina pectoris). 'Abnormal' VPBs occurred in six out of 13 (46%) who later developed IHD compared to only 24 out of 213 (11%) without IHD (P less than 0.001). The presence of either more than 900 VPBs 24 h-1 or ventricular tachycardia of more than three beats, identified five out of 13 patients with IHD (sensitivity 38%), whereas 210 out of 213 with no evidence of IHD at follow-up were identified (specificity 98%). Four out of seven who initially had more than 900 VPBs 24 h-1 had IHD on follow-up. Our results have demonstrated a strong positive association between 'abnormal' VPBs observed in a random 24-h electrocardiographic recording of apparently healthy subjects 40-79 years of age and subsequent IHD. They also suggest that a 24-h ECG may be useful for the assessment of coronary risk even in asymptomatic subjects.     

顽固性室性早搏的导管标测与射频消融治疗

采用射频导管消融术对症状明显、药物无效的１０例顽固性室性早搏（简称室早）进行治疗。将消融电极送至右室流出道区域，以Ｓ１Ｓ１或ＲＳ２早搏刺激标测到与体表１２导联心电图记录的自发室早ＱＲＳ波群图形完全相同，并且激动标测时自发室早的局部电图较体表心电图ＱＲＳ波群提前３０ｍｓ以上的部位为消融靶点。以室早在放电后１０ｓ内消失，维持稳定窦性心律３０～６０ｍｉｎ为即刻成功标准。９例患者经１０～２０Ｗ、消融６０～１８０ｓ，早搏和短阵室速完全消失；１例失败。平均随访１１个月，未服任何抗心律失常药物症状消失，复查心电图和动态心电图，９例中８例无早搏、１例为偶发室早，均无并发症。提示射频导管消融术是治疗某些右室流出道早搏的可行方法。     

Clinical and prognostic significance of hyperkinetic ventricular arrhythmias

Ventricular arrhythmias, mainly ventricular premature beats (VPBs) are omnipresent in the general population. They may be detected or induced by means of different techniques such as routine ECG, ambulatory ECG-monitoring, exercise testing and ventricular stimulation during an intracavitary electrophysiologic study. The prevalence and clinical-prognostic significance of VPBs are highly related to the presence and severity of an underlying heart disease. Simple and complex (bigeminal, multiform, repetitive or R on T) VPBs are much more frequent in cardiac patients than in normal subjects. Acute myocardial infarction (AMI), chronic coronary heart disease (CCHD), cardiomyopathies and mitral valve prolapse are the most common clinical conditions in which VPBs occur. In apparently healthy persons, the presence of VPBs does not seem to indicate a greater risk for the future development of cardiac disease. In patients with AMI frequent, and complex VPBs often precede primary ventricular fibrillation and appear to be directly related to the size of the infarct. In the posthospital phase of AMI, as well as in CCHD, the occurrence of high-grade VPBs usually indicates more advanced degrees of both coronary and left ventricular disease as well as the possibility of cardiac and/or sudden death. In cardiomyopathies and mitral valve prolapse the VPBs do not correlate with either clinical, electrocardiographic, echocardiographic or hemodynamic parameters but their complex patterns appear to be a good indicator of patients with high sudden death risk.