Premature ventricular beats in healthy adult subjects 20 to 79 years of age

111 healthy subjects, 57 males and 54 females, 20–79 yearsof age, randomly selected among the participants of the CopenhagenCity Heart Study were tested for ventricular ectopic activityusing ambulatory 24-h ECG recording.One or more premature ventricularbeats (PVBs) appeared in 68 subjects (61%), 35 males and 33females (61% of each group). The prevalence of PVBs increasedsignificantly with age: 31, 68 and 84% in the respective agegroups: 20–39, 40–59 and 60–79 (P<0.05). The number of PVBs per 24 h was <24 in 88 (79%), <300in 105 (95%), and <500 in 107 (96%). More than 1000 PVBsper 24 h appeared in 3 (2.7%), one of whom had 11 669. The numberof PV Bs per 24 h increased with age, but the increase was notstatistically significant. The number of PV Bs per 100 000 recordedQRS-complexes did not differ significantly from the number ofPV Bs per 24 h. The number of PV Bs h^-1 was highest in daytime, and apparentlyhigher in males than in females. However, the difference betweenthe two sexes was not statistically significant. Multiform PV Bs appeared in 4 subjects, interpolated PV Bs in2, a run of 5 PV Bs in 1, dropped beats in 3, two pauses of1900 ms duration in 1, and several post-acceleration pausesof 1300 ms duration in 1.     

Premature beats in healthy subjects 40-79 years of age

In order to determine the prevalence and complexity of prematurebeats (PBs) in an adult population without apparent heart disease,260 healthy subjects 40–79 years of age had a 24 h ambulatoryECG recording performed. A total of 221 subjects (87%) had one or more atrial prematurebeats (APBs) in the 24 h period, which was statistically significantlymore than the number of subjects (179 or 69%) with ventricularpremature beats (VPBs). Only 19 subjects (7%) had no PBs. Morethan 200 VPBs/24 h were seen in only 5% of the subjects, anda similar percentage had more than 200 APBs/24 h. There wasa statistically significant increase in the number of VPBs aswell as APBs with an increase in age. Multiform VPBs, VPB pairs,multiform APBs and atrial tachycardia (AT) were ‘normal’findings(seen in more than 5% of the subjects), whereas > 2 differentVPB configurations, > 2 episodes of VPB pairs, ventricularbigeminy, R-on-T VPBs, ventricular tachycardia, > 2 episodesof AT and AT with more than 10 beats per episode were ‘abnormal’findings (seen in less than 5% of the subjects). The number of VPBs was almost identical in two 24 h ECG recordingsobtained at a mean interval of 22 months in 17 out of 22 subjectsstudied. Only two out of 22 had a significant change in thenumber of VPBs/24 h over the 22 month period. As a ‘normal’ range for the number of APBs as wellas VPBs per 24 h a figure of 200 is proposed, and it is concludedthat most complex types of PBs may occur as incidental findingsin healthy adult subjects, but usually in small numbers.     

Rest Premature Ventricular Contractions on Routine ECG and Prognosis in Heart Failure Patients

Background: Premature ventricular contractions (PVC) at rest are frequently seen in heart failure (HF) patients but conflicting data exist regarding their importance for cardiovascular (CV) mortality. This study aims to evaluate the prognostic value of rest PVCs on an electrocardiogram (ECG) in patients with a history of clinical HF. Methods and Results: We considered 352 patients (64 ± 11 years; 7 females) with a history of clinical HF undergoing treadmill testing for clinical reasons at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) (1987–2007). Patients with rest PVCs were defined as having ≥1 PVC on the ECG prior to testing (n = 29; 8%). During a median follow‐up period of 6.2 years, there were 178 deaths of which 76 (42.6%) were due to CV causes. At baseline, compared to patients without rest PVCs, those with rest PVCs had a lower ejection fraction (EF) (30% vs 45%) and the prevalence of EF ≤ 35% was higher (75% vs 41%). They were more likely to have smoked (76% vs 55%).The all‐cause and CV mortality rates were significantly higher in the rest PVCs group (72% vs 49%, P = 0.01 and 45% vs 20%, P = 0.002; respectively). After adjusting for age, beta‐blocker use, rest ECG findings, resting heart rate (HR), EF, maximal systolic blood pressure, peak HR, and exercise capacity, rest PVC was associated with a 5.5‐fold increased risk of CV mortality (P = 0.004). Considering the presence of PVCs during exercise and/or recovery did not affect our results. Conclusion: The presence of PVC on an ECG is a powerful predictor of CV mortality even after adjusting for confounding factors. Ann Noninvasive Electrocardiol 2010;15(1):56–62     

射频导管消融治疗室性早搏的研究进展

室性早搏的治疗,以往学者不主张对其进行药物处理,只是出现较明确的临床症状、患者精神上受较大的影响、且药物效果不好或不愿用药的情况,才推荐导管消融治疗。随着科技进步和人对高水平生活的追求,导管消融治疗室性早搏的适应证也相应调整了,现将在回顾文献的基础上,对经射频导管消融治疗室性早搏的现况作一概述。     

Premature ventricular contraction-induced concealed mechanical bradycardia and dilated cardiomyopathy:

Left ventricular (LV) dysfunction due to frequent isolated premature ventricular contractions (PVCs) has been rarely reported. LV dysfunction and concealed mechanical bradycardia resolved in a patient with idiopathic dilated cardiomyopathy after the focal source of PVCs in the LV was eliminated by radiofrequency ablation (RFA). The patient remained free from PVCs and maintained normal LV function over 36-month follow-up. In a subset of patients with idiopathic dilated cardiomyopathy with frequent isolated PVCs, RFA of the arrhythmic focus restores normal LV function that can be long lasting.     

稳心颗粒治疗老年人冠心病室性期前收缩的临床疗效

目的观察稳心颗粒对老年人冠心病合并室性期前收缩的临床疗效。方法将120例病人随机分为两组,治疗组口服稳心颗粒,对照组口服普罗帕酮(心律平)。4周为1个疗程。两组病人治疗前后各做心电图、Holter、血尿常规、肝肾功能1次。结果治疗组治疗后心电图总有效率为73.33%,显效率53.33%;对照组心电图总有效率为71.67%,显效率为51.67%,两组心电图疗效相近(P>0.05)。Holter改变情况:治疗组总有效率为66.67%,显效率为30.00%;对照组总有效率为65.00%,显效率为31.67%,两组比较无统计学意义(P>0.05)。治疗组临床症状改善总有效率为86.67%,显效率为51.67%;对照组总有效率为73.33%,显效率为41.67%。结论稳心颗粒抗老年人室性期前收缩的作用与心律平相当,还可改善冠心病临床症状。     

Premature ventricular contraction‐induced concealed retrograde penetration: Electrocardiographic manifestations on anterograde ventricular preexcitation

In patients with manifest anterograde ventricular preexcitation, the electrocardiographic manifestation of the anomalous conduction through the simultaneous conduction over the atrioventricular (AV) node and the accessory pathway (“delta wave”); depends on several factors, the most representative being the conduction velocity over one or another connection. Occasionally, ventricular ectopic beats may present with retrograde penetration over one or both conduction pathways (AV node and/or accessory pathway), impacting on the morphology of the next immediate anterogradely conducted QRS. We present a case of a young patient with WPW syndrome and ectopic ventricular beats with different manifestations on the postectopic QRS due to concealed penetration of different conduction pathways.     

Remote magnetic navigation to map and ablate left coronary cusp ventricular tachycardia

Background: Premature ventricular contractions (PVCs) and ventricular tachycardia may arise from the coronary cusps. Navigation, mapping, and ablation in the coronary cusps can be challenging. Remote magnetic navigation may offer an alternative to conventional manually operated catheters.
Objective: We report a case of left coronary cusp ventricular tachycardia ablation using remote magnetic navigation.
Methods: Right ventricular outflow tract and coronary cusp mapping, and ablation of the left coronary cusp using a remote magnetic navigation and three-dimensional (3-D) mapping system was performed in a 28-year-old male with frequent, symptomatic PVCs and ventricular tachycardia.
Results: Successful ablation of left coronary cusp ventricular tachycardia was performed using remote magnetic navigation.
Conclusions: Remote magnetic navigation may be used to map and ablate PVCs and ventricular tachycardia originating from the coronary cusps.     

Acute childhood hemiplegia

A 10-year-old child presented to the emergency department with a sudden onset of right hemiparesis and dysphasia. A thorough evaluation, including CT scan of the brain and cerebral angiography, resulted in a diagnosis of acute childhood hemiplegia. The diagnosis of acute childhood hemiplegia depends on characteristic cerebral angiographic findings. The treatment of this particular entity is supportive, often with incomplete recovery.     

心脏summit区的解剖及室性早搏的心电图特点

心脏summit区包括位于心外膜部和心内膜部的心大静脉(great cardiac vein,GCV)和前室间静脉(anterior interventricular vein,AIV)区、主动脉窦-二尖瓣连接处(aortomitral continuity,AMC)、左冠窦(left coronary cusp,LCC)以及右室流出道(right ventricular outflow,RVOT)后部区。起源于心脏summit区的室性早搏心电图有其特殊性,术前通过体表心电图定位可能的室性早搏起源,对手术策略的选择具有一定的指导意义。     

益心舒胶囊联合普罗帕酮治疗室性早搏136例

目的观察益心舒胶囊联合普罗帕酮治疗室性早搏的临床疗效。方法将204例室性早搏患者按照2∶1随机分为治疗组(136例)与对照组(68例)。治疗组口服普罗帕酮与益心舒胶囊,对照组口服普罗帕酮。观察治疗前及治疗4周后两组临床症状、常规12导联心电图、24h动态心电图等变化情况。结果用药后室性早搏总有效率88.97%,临床症状缓解率为91.18%;对照组分别为75.00%、76.47%,两组比较有统计学意义(P<0.05)。结论益心舒胶囊联合普罗帕酮治疗室性早搏较单独使用普罗帕酮疗效显著,且避免了普罗帕酮用量过大引起心律失常等不适。     

Premature ventricular contractions arising from the pulmonary artery: the use of multielectrode array mapping and cryoablation

Premature ventricular contractions with a left bundle branch block-like morphology and inferior axis typically originate from the right ventricular outflow tract; however, they can also originate from the pulmonary artery. We report two patients with frequent premature ventricular contractions who underwent successful cryoablation of ectopics arising from the posterolateral region of the pulmonary artery. The safe and effective use of cryoablation within the pulmonary artery is discussed. We recommend the use of noncontact mapping with multielectrode array catheter in facilitating the technique and providing a more accurate localization of the ectopic focus within the pulmonary artery, compared with conventional pace mapping methods.     

室性期前收缩对无器质性心脏病患者心功能的影响

室性期前收缩是最常见的室性心律失常,不伴有器质性心脏病的室性期前收缩,通常被认为是良性的,但近10年的研究发现,频发室性期前收缩在某些条件下可导致左室重构,甚至诱发心力衰竭症状.这些条件包括患者年龄、病程长短、室性期前收缩负荷及室性期前收缩的起源部位和室性期前收缩QRS波的宽度.诱发心力衰竭的机制可能与室性期前收缩时左右心室失同步、心肌细胞能量储备耗竭、心内膜下至心外膜下血流比失调导致心肌缺血、钙平衡失调、氧自由基损伤,以及β受体密度下调、反应性下降等多种病理生理因素有关.近来有学者提出“室性期前收缩诱发的心肌病”的概念,和心动过速性心肌病一样,也可能成为一种独立的未分类心肌病.     

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。     

室性早搏性心肌病

长期频发室性早搏(尤其是>10 000次/24 h)可引起心肌病,其临床特征类似于扩张型心肌病,消除室性早搏后心肌病变可以逆转,称为室性早搏性心肌病。这类心肌病的发病机制尚不清楚,可能与室性早搏导致心脏机械性收缩、电激动不同步,心室负荷过大,激活神经体液机制,心脏有效泵血量减少及舒张功能减退等有关。室性早搏的负荷是心肌病的重要影响因素。目前诊断室性早搏性心肌病,多是回顾性诊断。如消除室性早搏后心肌病变可逆转,即可确诊。恰当的药物或导管射频消融治疗能清除或减少室性早搏,改善心功能。     

Effects of intravenous dofetilide in patients with frequent premature ventricular contractions: a clinical trial

BACKGROUND: Although suppression of premature ventricular contractions (PVCs) is not a predictor of mortality over the long term, the extent of PVC suppression is an important characteristic of any antiarrhythmic drug. HYPOTHESIS: This study was undertaken to determine whether intravenous (i.v.) dofetilide has the ability to suppress PVCs in patients who have frequent occurrences. METHODS: Subjects were men and women, aged 18 to 75 years, with > 30 PVCs/h on two consecutive 24-h Holter recordings while drug free, and > 50 PVCs/h during a 2-hour telemetric electrocardiogram. The study was randomized, double-blind, and placebo controlled. Subjects received a single-blind, i.v. infusion of placebo and were randomized (3:1) to receive a double-blind second infusion of placebo or an infusion of dofetilide (a 15-min loading infusion of 4 g/kg followed by a 60-min maintenance infusion of 3.5 g/kg, for a total dose of 7.5 g/kg). RESULTS: Dofetilide produced an 82.6% and placebo a 2.9% median reduction in PVCs. Drug responder rate, defined as 80% reduction in PVCs, was 50% in the dofetilide group and 0% in the placebo group. CONCLUSION: Intravenous dofetilide significantly reduced PVCs in patients who had > 30 PVCs/h at baseline, and it produced > or = 80% reduction in PVCs in 50% of all subjects.     

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.