Circadian pattern of spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators.

BACKGROUND: Previous studies have reported a circadian variation of ventricular tachyarrhythmias. However, there is no detailed information of the daily distribution of ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes. The purpose of this study was to evaluate the daily distribution of episodes of ventricular tachyarrhythmia in patients with implantable cardioverter defibrillators. MATERIAL/METHODS: We used data stored by last-generation implantable cardioverter-defibrillators (ICD) to retrospectively evaluate the circadian distribution of VT and VF in 70 patients with ICD. The distribution of tachyarrhythmias was categorized into four time zones: zone 1 (06:00-11:59), zone 2 (12:00-17:59), zone 3 (18:00-23:59), and zone 4 (00:00-05:59). RESULTS: During a follow-up of a mean of 3.1+/-1.3 years, a total of 791 ventricular arrhythmias were recorded from which 631 events were VT and 160 VF. A circadian variation of episodes of ventricular tachyarrhythmia was evident. The incidence of ventricular arrhythmia sharply increased in zone 1 (8.82+/-2.13, p<0.0001). Episodes of VT had peaks in zones 1 and 2 (7.44+/-2.03 and 2.70+/-0.65, p<0.001) and episodes of VF had peaks in zones 1 and 4 (1.38+/-0.39 and 1.30+/-0.51, p<0.011). No difference was observed between patients who used betablocker and those who did not. CONCLUSIONS: Malignant ventricular tachyarrhythmias have a circadian distribution. VT peaks occur in the morning and noon hours and VF peaks occurs at the night and morning hours. Betablocker and/or amiodarone usage do not alter this distribution.     

Tp-e间期，Tp-e/QT与ICD一级预防患者发生恶性室性心律失常的关系

目的：探讨心电图T波峰末间期（Tp-e）及T波峰末间期与QT间期的比值（Tp-e/QT）与ICD一级预防患者发生恶性室性心律失常的关系。方法分析我院2011年3月~2014年2月因严重慢性心功能不全（左室射血分数≤35%,纽约心功能分级为Ⅱ/Ⅲ级,且既往从未发生过室速或室颤等恶性心律失常）接受ICD（植入式心脏复律除颤器）一级预防的患者68例,对所有的患者随访18~38个月（平均26个月）。在随访过程中,患者根据是否发生终点事件分为高危组及低危组;本研究以SCD或室颤、室速作为终点事件。术前对所有的患者进行12导联心电图、心脏彩超、24 h动态心电图等检查,并分析Tpeak-Tend间期及（Tpeak-Tend）/QT。结果随访过程中,因ICD识别持续性室速或室颤而引发恰当放电的患者共11例,由ICD发现非持续性室速而不需治疗的患者共7例,故高危组患者共18例。从未发生室速或室颤者共50例为低危组。高危组患者的（Tp-e）105±15 ms明显高于低危组90±17 ms（P=0.003）;（Tpeak-Tend）/QT比值在高危组与低危早组相比有明显的统计学差异（0.27±0.04 vs 0.22±0.05,P=0.002）. TpTe/QT≥0.255预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为72.2%和65.9%;TpTe≥103 ms预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为66.7%和67.9%。结论 Tp-e间期、Tp-e/QT比值与ICD一级预防患者发生恶性室性心律失常的关系密切,Tpeak-Tend间期及Tp-e/QT比值越大,ICD一级预防患者发生恶性室性心律失常如室速、室颤的可能性越大。     

心肌梗塞患者心室晚电位的临床和随访分析

目的：研究心室晚电位（ＬＰ）与梗塞部位、恶性室性心律失常和心功能的关系，以及ＬＰ对心肌梗塞（ＭＩ）后发生室性心动过速／心室颤动（ＶＴ／ＶＦ）和猝死的预测作用。方法：用晚电位记录仪对１６８例ＭＩ患者进行检测和随访分析。结果：本组ＭＩ患者中ＬＰ的阳性检出率为２７％，多壁ＭＩ组ＬＰ阳性率明显高于前（间）壁ＭＩ组（Ｐ＜００５），ＶＴ／ＶＦ和猝死患者的ＬＰ阳性率明显高于无ＶＴ／ＶＦ患者（Ｐ＜００１），ＭＩ伴心功能不全者ＬＰ阳性率明显高于有ＭＩ但心功能Ⅰ级者（Ｐ＜００１）。结论：ＬＰ与ＭＩ范围的大小、心脏的功能状态以及ＶＴ／ＶＦ或猝死有密切关系，但陈旧性ＭＩ发生猝死可能与ＬＰ关系不大     

植入心律转复除颤器患者室性心律失常和放电事件的相关分析

【目的】 分析植入心律转复除颤器(ICD)患者在一级或二级预防中发生室性心律失常和放电治疗情况及相关因素。 【方法】 对2004年3月至2012年9月在中山大学附属第一医院植入了ICD的92例患者进行程控随访,结合患者的临床资料进行回顾性分析。【结果】 92例患者,其中ICD一级预防45例,二级预防47例,共进行了423人次的程控随访,平均随访时间(27.6 ± 21.8)个月。有37.8%的一级预防患者出现了室速/室颤(VT/VF),平均2.53次/人年;28.9%的患者给予了放电治疗,平均0.44次/人年。在二级预防中有59.6%的患者出现VT/VF,平均4.99次/人年,其中有47.9%需要放电治疗,平均为1.41次/人年。所有患者中,有46例ICD发生放电(50.0%),其中恰当放电的35例(38.0%),不恰当放电的11例(12.0%)。总计放电334次,其中恰当的放电治疗198次(59.3%),不恰当的放电治疗136次(40.7%)。不恰当放电原因包括:房颤92次(67.6%),阵发性室上性心动过速32次(23.5%),ICD异常感知12次(8.8%)。有房颤病史的患者发生VT/VF的概率以及误放电的概率均高于无房颤病史的患者,差异有统计学意义(P < 0.05)。【结论】 ICD在心脏性猝死的一级预防能给患者带来获益;房颤既是ICD不恰当放电的主要原因,也是提示VT/VF高发的指标。     

心大静脉不同部位室性心律失常的心电图特征及射频导管消融治疗

目的 探讨心大静脉（GCV）不同部位室性期前收缩（PVCs）和室性心动过速（VT）的心电图特征及射频导管消融治疗的疗效与安全性.方法 4例经GCV标测和消融患者,其中持续及短阵性VT各1例,PVCs2例.经左、右心室流出道（LVOT、RVOT）及二尖瓣环心内膜标测与试消融无效各2例,最后均经GCV标测与消融,并对GCV远端（前室间静脉分支前-二尖瓣环前壁心外膜）及最远端（前室间静脉分支后-LVOT）消融成功者的心电图特征进行分析.结果 首次均采用普通温控导管仅1例消融成功,因阻抗太高无法放电失败3例,其中2例再次经三维标测系统EnSite3000-NavX指导下,采用盐水灌注导管标测与消融均成功,1例放弃再次消融,成功率75.00%.经GCV远端及最远端消融成功各1及2例.激动顺序标测有效靶点心内电图较体表心电图QRS波群起始点提早（36.00±2.65）ms,可见A波及V波（V＞A） 起搏标测的QRS波群与自发PVCs/VT形态12及11导联相同各2例.GCV远端及最远端消融成功者体表12导联心电图特征不同：（1）前者假性＂δ＂波时间≥75ms而后者＜75ms （2）前者V1呈R型无S波群而V4～V6有S波（呈Rs型）,后者则相反.结论 部分体表心电图特征符合LVOT或二尖瓣环前壁起源的PVCs/VT,经上述部位标测与消融无效者,应考虑经GCV采用盐水灌注导管进行标测与消融,且安全有效.     

特发性右室流出道室速的昼夜发作规律及临床意义

目的：探讨特发性右室流出道室速的昼夜发作规律及临床意义,方法：对12例特发性右室流出道室速患者在基础状态进行动态心电图（Holter)监测,分别记录24h中每小时内心律失常发作频数及平均心率,了解室速,室早发作的昼夜规律,结果：基础状态下,室速,连发室早,平均心率在24h内呈不均一分布（P＜0．001）,其发作规律呈白天多,夜间少,单个室呈不均一分布,但整个差异无显著性,平均心率与室速,连发室早互正相关,单个室早与平均心率无相关性,结论：左室流出道室速患者24h内室速,连发病早呈明显的昼夜节律变化,提示特发性右室流出道室速的发生与交感迷走神经平衡失调有关。     

Effects of alpha adrenergic blockade during stellate ganglion stimulation on arrhythmias induced by acute myocardial ischemia in pigs

Summary The effects of α-adrenergic receptor blockade during stellate ganglion stimulation on arrhythmias induced by repeated coronary artery occlusion in pigs under spontaneous breathing were studied. Prazosin, α₁-receptor blocker, did not have any effect on the early ischemic dysrhythmia. Yohimbin, which selectively blocks α₂-receptor, significantly increased the number of premature ventricular complexes (19±3→ 32±2 PVC;P<0.01), but produced no effects on the percentage of appearance of ventricular fibrillation (VF) and ventricular tachycardia (VT). However, nonselective α-receptor blocker phentolamine significantly reduced the number of premature ventricular complexes (30.5 ± 4.5→ 11 ±3 PVC;P<0.05), but did not affect the frequency of occurrence of VF and VT. The above results show that α-adrenergic mechanisms do not play any important role in the genesis of arrhythmias during ischemia in the pig model.     

Life-threatening arrhythmias after intravenous lidocaine alone or with magnesium in myocardial infarction complicated by ventricular fibrillation

To compare the effects of Lidocaine (LID) alone or with Magnesium Sulfate (M) on life-threatening ventricular arrhythmias which followed cardioverted prolonged ventricular fibrillation (VF) during an acute myocardial infarction (AMI), we studied 34 (24.63%) out of 138 patients aged from 52 to 83 years (mean: 66.92 + 8.82) with an anterior AMI, who had cardioverted prolonged VF. Twenty patients (58.8%)--Group A--received LID 2 mg/min at constant-rate infusion through a subclavian catheter following a bolus of LID 100 mg, whereas 14 patients (14.2%)--Group B--received LID at the same dose + M 2.5 mg/min. All the patients had continuous monitoring and LID serum level was measured daily by means of immunofluorescent method (TDX Abbot; range 1.5-5 micrograms/ml). Group A had the following mean serum levels of LID; 250 + 0.9; 1.52; 245 +/- 0.9; 3.20 + 1.1. Group B showed: 2.65 + 1.2; 2.80 + 1.8; 3.10 + 1.2; 3.25 + 1.1. Continuous monitoring displayed the following arrhythmias respectively for Group A and Group B: VT 37 times vs 16(P less than 0.05, significant), transiently cardioverted VF during therapy 17 times vs 6(p less than 0.01, significant), 8 deaths from VF vs 6 - 3 from VF and 3 from asystole - (p = NS). LID + M treatment seemed to be more effective than LID alone to reduce life-threatening arrhythmias following cardioverted prolonged VF of AMI but not the deaths. In addition, M would raise moderately LID serum level and this fact, not yet well known, needs further investigation.     

急诊大剂量静脉应用胺碘酮治疗顽固性室性心动过速和／或心室颤动的疗效观察

目的：探讨急诊大剂量静脉应用胺碘酮治疗顽固性室性心动过速和／或心室颤动的用药经验和临床疗效。方法：选择急救中心56例急性心肌梗死后顽固性室性心动过速和／或心室颤动患者,男36例,女20例,年龄37～73岁,平均46．2岁。在心律失常发作时或电除颤后静脉注射胺碘酮负荷剂量150mg,随后前6h以1．0～1．5mg／min泵入胺碘酮,6h后以0．5～1．0mg／min维持;若心律失常控制不满意,间隔30min再注射75～150mg;同时口服胺碘酮片剂,每次200mg、每日3次,逐渐减至每日1次口服维持。结果：静脉用药（2．56±0．59）d,第一个24h静脉用量（1351±192）mg,心律失常控制率69．6％（39／56）;第二个24h静脉用量（759±38）mg,心律失常累计控制率82．1％（46／56）;第三个24h静脉用量（726±21）mg。心律失常累计控制率91．1％（51／56）。用药期间有7例患者出现缓慢型心律失常,药物减量后恢复正常;72h内有6例患者因病情恶化临床死亡。结论：急诊大剂量静脉应用胺碘酮对急性心梗后顽固性室性心动过速和心心室颤动动安全有效。     

心律转复除颤器植入术中避免常规 除颤阈值测试的随访观察

目的：探讨心律转复除颤器（ICD）和心室再同步心脏转复除颤器（CRT-D）植入术中未进行除颤阈值测试的患者,治疗恶性室性心律失常的有效性和安全性。方法：收集1999年10月至2008年8月间ICD植入术中未进行除颤阈值测试的21例ICD/CRT-D患者临床资料,应用体外程控仪获取存取信息并结合随访资料进行分析。结果：17例室性心动过速（室速）或心室颤动（室颤）患者植入ICD,4例心肌病合并严重心力衰竭患者植入CRT-D,术中均未进行除颤阈值测试。8例术后1周进行除颤阈值测试,其中3例（37.5%）未诱发出室速/室颤。程控随访1~7(4.2±1.9)年,21例未进行除颤阈值测试的患者中16例记录到室速或室颤事件,ICD成功除颤89阵（成功率100%）,抗心动过速起搏（ATP）终止室速120阵次（成功率51.1%）,低能量同步转复22阵次（成功率59.2%）。术后大多数患者联合应用抗心律失常药物,无恶性室性心律失常相关死亡病例。结论：ICD/CRT-D植入术中不常规进行除颤阈值测试可避免相关并发症发生,术后随访可有效治疗恶性室性心律失常,预防心脏性猝死。     

山羊急性心肌缺血时恶性心律不齐的发生和...

The coronary collateral circulation of goat is very spare, so myocardiac ischemia model of goat can simulate the patient previously with normal coronary circulation and suddenly developing complete occlusion of coronary arteries. In this study 80 Chengdu goats were used, and the branches of their left coronary artery were ligated. Ventricular tachycardia (VT) developed in 23 goats and ventricular fibrillation (VF) in 39 goats. VT and VF both occurred in the early phase of acute myocardial ischemia, and both had 6 min as the median time of onset. In 71 cases data on the weight of myocardiac ischemic area were collected, in which the weight percentage of ischemic area relating to the ventricles of 34 goats with VF was significantly higher than that of 37 goats without VF (35.4 +/- 2.4% vs 19.5 +/- 1.9%). After coronary ligation, 9 cases directly precipitated into VF which could not be defibrillated. In the remaining 62 cases, the weight percentage of ischemic area of 21 cases with VT was higher than that of 41 cases without VT (32.9 +/- 2.8% vs 20.9 +/- 2.1%). The relationships between the incidence of VT or VF and the weight percentage of ischemic area were fitted with logistic curve. The likelihood of occurrence of VT or VF is increased as the weight percentage of ischemia area goes up.     

The Effect of Xin'an Capsule(心安胶囊) on Ventricular Arrthythmia in Animals

ＴｈｅｒｅｃｉｐｅｏｆＸｉｎ＇ａｎｃａｐｓｕｌｅ（ＸＡＣ）ｗｉｔｈｔｈｅｍａｉｎｅｆｆｅｃｔｏｆｉｎｖｉｇｏｒａｔｉｎｇＱｉａｎｄｎｏｕｒｉｓｈｉｎｇＹｉｎｗａｓｄｅｓｉｇｎｅｄｓｐｅｃｉａｌｌｙｆｏｒｔｒｅａｔｍｅｎｔｏｆｖｅｎｔｒｉｃｕｌａｒａｒｒｈｙｔｈｍｉａ（ＶＡ）,ａｎｄｉｔｓｄｅｃｏｃｔｉｏｎｆｏｒｍｗａｓｃｏｎｆｉｒｍｅｄｔｏｂｅｅｆｆｅｃｔｉｖｅｉｎｃｌｉｎｉｃａｌｐｒａｃｔｉｃｅ．Ｔｈｉｓｓｔｕｄｙｕｓｅｄａｎｉｍａｌａｒｒｈｙｔｈｍｉｃｍｏｄｅｌｓｔｏｓｔｕｄｙｔｈｅｅｆｆｅ…     

The effect of Xin’an capsule on ventricular arrthythmia in animals) on ventricular arrthythmia in animals

Objective: To observe the effects of Xin’an capsule (XAC) on experimental ventricular arrhythmia (EVA) in animals and to explore the possible mechanism.Methods: Three types of animal arrhythmic model (ventricular arrythmia in guinea pigs induced by Ouabin, in rats caused by reperfusion after ligation of descending anterior branch of coronary artery and by CaCl₂) were used to study the effects of XAC on ventricular arrhythmia (VA).Results: After XAC treatment, the dosage of Ouabin needed for inducing ventricular premature beat (VPB), ventricular tachycardia (VT) and ventricular fibrillation (VF) increased in guinea pigs. The sustaining time of reperfusion induced VT and total occurrence of ventricular arrhythmias decreased. XAC also showed an effect in increasing CaCl₂ dosage needed to cause VA, and decreased the occurrence of VF and death in rats     

血小板激活因子受体拮抗剂BN50739对大鼠早期再灌注心律失常的作用

采用SD大鼠心肌缺血再灌注模型观察新的PAF受体拮抗剂BN50739对早期再灌注心律失常的保护作用,并探讨PAF在早期再灌注心律失常形成机制中的意义。结果显示:BN50739能降低再灌注性室性早搏、室速、室颤的发生率,室颤的发生率与对照组相比差别显著(P<0.01)。BN50739还可缩短室速+室颤时间以及总的心律失常时间(P<0.05),并可降低由室颤导致的大鼠死亡数(P<0.05)。证实BN50739对大鼠早期再灌注心律失常具有保护作用,提示PAF在早期再灌注心律失常的发生机制中有重要作用。     

Incidence and causes of inappropriate detection and therapy by implantable defibrillators of cardioversion in patients with ventricular tachyarrhythmia

Background Implantable cardioverter defibrillator （ICD） is the only effective therapy in patients with life threatening ventricular arrhythmias. Inappropriate detection and therapy by ICDs are the most common causes of side effects that affect the quality of life in ICD recipients. This study evaluated the incidence and causes of inappropriate detection and therapy by ICDs in patients in our hospital. Methods From January 2000 to December 2005, fifty patients who received ICD implantation for ventricular arrhythmias for prevention of sudden cardiac death were evaluated in this study. Each ICD was programmed using clinical arrhythmic and cardiac data of the patient before discharge. Patients were followed up by standard schedule after implantation and all data retrieved from each device were collected and saved for further analysis. Results No arrhythmic event was detected in 12/50 （24%） patients during the period of follow-up. Among the remaining patients, 11 （22%） experienced inappropriate detections and therapies during follow-up in this study. ICD detected 383 ventricular tachyarrhythmia （VT） and 108 ventricular fibrillation （VF） episodes and delivered 678 therapies. In VT group, ICD delivered 413 antitachycardiac pacings （ATPs） and 118 shocks, among which 78 ATPs and 9 shocks were initiated by 55/383 （14.3%） inappropriate detections. In VF group ICD delivered 147 shocks, among which 56 shocks were initiated by 28/108 （26.9%） inappropriate detections. Overall, more than 50% of these episodes were caused by atrial fibrillation （AF） with rapid ventricular response, followed by electromagnetic or myopotential interference. In addition, most inappropriate therapies occurred within one year after ICD implantation. Conclusions About one fifth of patients experienced ICD inappropriate detection and therapy after implantation. The main cause was AF with rapid ventricular response, followed by electromagnetic or myopotential interference.     

不同部位急性心肌梗塞QT间期离散度变化的意义

目的 研究急性心肌梗塞不同梗塞部位QT离散度变化的意义。方法 对126例不同部位急性心肌 梗塞(AMI)患者的QT间期离散度(QTd)进行分析,并对其发生恶性心律失常的情况进行比较。结果 前壁梗塞 组患者的QTd明显大于下后壁梗塞患者(P<0.05),且随着梗塞面积不同各亚组间的QTd值也不同(P<0.05);有 室性心动过速(VT)、室颤(Vf)及猝死者的QTd明显大于无VT、Vf及猝死者(P(0.01)。提示:QTd有助于评估急 性心肌梗塞的病情,反映患者的预后。     

重症室性心律失常的探讨

本文对１１４例重症室性心律失常患者的病因及心电图演变规律进行了分析。结果表明：室早频率、提前指数、易激指数等指标对重症室性心律失常的诊断和预测具有重要意义；抗心律失常药可加重心律失常。     

大花红景天对室性心律失常防治的初步研究

目的：探讨大花红景天对实验性快速室性心律失常的防治作用。方法：采用氯化钙、乌头碱致大鼠，哇巴因致豚鼠及肾上腺素致大白兔心律失常模型。观察大花红景天对上述模型的影响。结果：口服红景天水提液后，显著减少氯化钙致大鼠室速、室颤的发生率及死亡率，并显著提高氯化钙致大鼠室性心律失常的阈剂量；显著提高乌头碱致大鼠室速、室颤的阈剂量；显著推迟肾上腺素致大白兔室性心律失常开始发作的时间、缩短发作持续时间及窦性心律恢复时间；未能显著减少哇巴因致豚鼠室速、室颤的发生率，未能显著提高哇巴因致豚鼠室性心律失常的阈剂量。结论：大花红景天水提液对多种实验性快速室性心律失常有良好的防治作用。     

单导管射频消融治疗主肺动脉干室性早搏／室性心动过速临床观察

目的探讨起源于主肺动脉干（MSPA）室性早搏（PVCs）/室性心动过速（VT）的心电图特征、标测方法及单导管射频消融治疗的疗效与安全性。方法选取经肺动脉造影证实起源于MSPA的PVCs／VT患者12例（MSPA组）以及右心室流出道（RVOT）前间隔起源的PVCs／VT患者59例（RVOT组）,均采用单导管常规标测技术进行标测、消融。比较分析两组患者心电图特征,随访MSPA组患者的疗效。结果MSPA组患者体表心电图具有下壁导联R波振幅高以及胸前导联移形较早（多位于V2～V3）的特点,其有效靶点高电压（8V）可起搏心室,并与自发PVCs/VT的QRS波形12导联完全相同,有效靶点心室电位较PVCs／VT体表心电图QRS波起始点提早（33.91±3.69）ms,10例可记录到远场A、V波,6例可记录到融合或分离的尖峰或碎裂电位。所有消融治疗均成功,无并发症发生,随访期间无复发病例。结论起源于MSPA的PVCs／VT并非罕见．单导管标测及消融安全、有效．     

STEMI 冠脉病变程度与恶性心律失常的关系

目的：观察急性ST段抬高型心肌梗死（ STEMI）行直接经皮冠状动脉介入治疗（ PCI）患者冠脉病变程度与恶性心律失常的关系,指导临床防治。方法采用回顾性分析的方法连续收集2008年1月至2010年12月中国医科大学附属第一医院心内科诊断为STEMI并行直接PCI的住院患者418例。入院后均给予心电监护观察,根据是否发生恶性心律失常[定义为持续性室速（ sVT）或室颤（ VF）]分为无sVT/VF和sVT/VF两组。在发生sVT/VF的患者中,按sVT/VF发生时间分为2组：术前sVT/VF组,术后sVT/VF组。计算STEMI患者的冠脉病变程度,统计Gensini评分＜60分、Gensini评分≥60分且＜120分、Gensini评分≥120分患者的sVT/VF发生情况。观察STEMI行直接PCI患者冠脉病变程度与恶性心律失常的关系。结果共有47例（11.2％）患者发生sVT/VF,直接PCI术前发生sVT/VF 22例（44.8％）,术后发生25例（53.3％）。 sVT/VF组Killip分级＞I级、心率快、血压低、射血分数低（ P ＜0.05）,Gensini评分分组间总sVT/VF及术前sVT/VF的发生率差异有统计学意义（7.1％vs 10.8％vs 20.5％, P ＝0.012;2.1％vs 5.9％vs 9.6％, P ＝0.045）;直接PCI Gensini评分分组间术后sVT/VF的发生率差异无统计学意义（5.0％vs 4.9％vs 11.0％, P ＝0.142）;用年龄（ x±2）、性别、高血压、糖尿病1∶2配对Logistic回归分析显示心率≥80次/min（ P ＝0.04, OR：2.667,95％CI：1.043-6.815）是术前发生sVT/VF的独立危险因素, Gensini评分不是术前发生恶性心律失常的独立危险因素。结论 STEMI行直接PCI患者中,冠脉程度越重术前恶性心律失常的发生率可能越高,但是术后的恶性心律失常发生率无明显差异。