新生儿律失常56例临床分析

本文报道经临床表现和心电图确诊新生儿心律失常５６例，其中房性早搏１５例，室性早搏１２例，室上阵发性心动过速１０例，先天性传导阻滞６例，窦性心动过缓６例，右束支阻滞６例，新生儿心律失常类型以房性早搏最多；其次是室性早搏，室上性阵发性心动过速，房室传导阻滞。     

慢性肺源性心脏病并发心律失常78例临床分析

目的 探讨慢性肺源性心脏病并发心律失常的临床特点.方法 对本院2006年1月～2008年12月间121例慢性肺心病患者的临床资料进行回顾性分析.结果 经心电图和心电监护时检查发现121例患者中并发心律失常者78例,占64.46%.心律失常表现为窦性心动过速、窦性心动过缓、房性早搏、室性早搏、心房颤动、心房扑动、阵发性房性心动过速(包括紊乱性房性心动过速)、阵发性室性心动过速、一度或二度房室传导阻滞、右束支传导阻滞(完全性或不完全性)、左束支传导阻滞(完全性或不完全性)、左前分支传导阻滞.Ⅰ°心衰22例,心律失常9例(40.9%);Ⅱ°心衰 41例,心律失常25例(60.97%);Ⅲ°心衰58例,心律失常44例(75.86%).三组之间有非常显著差异(P均＜0.01),提示心衰程度越重,并发心律失常率越高.结论 心律失常是慢性肺心病最常见的并发症之一,肺心病并发心律失常是多种多样的、可变的,了解其心电图特点对慢性肺心病的诊断和治疗具有重要的临床意义.     

急性心肌梗塞并发心律失常68例心电图分析

目的:统计分析急性心肌梗塞时心律失常发生的心电图资料,讨论急性心肌梗塞心律失常的发生与梗塞面积的关系。方法:回顾分析我院2006年6月以来68例急性心肌梗塞病人发生心律失常的心电图资料,进行分类总结。结果:窦性心动过缓8例(11.8%),Ⅰ-Ⅲ度房室传导阻滞3例(4.4%),室性早搏36例(52.9%),心房纤颤7例(10.3%),房性早搏5例(7.4%),窦性心动过速9例(13.2%)。结论:大面积急性心肌梗塞较小面积急性心肌梗塞心律失常发生率高,恶性程度高,危险性大。     

老年性充血性心力衰竭合并心律失常的治疗对策

目的分析老年性充血性心力衰谒(简称老年性心衰)伴心律失常发病规律,为临床防治提供依据.方法回顾性分析了78例患者,男49例,女29例,年龄60～88岁,平均69.1岁.结果心律失常发生率为88.4%,以室性早搏(室早)发生率最高(87.2%),其次是房性早搏(房早)79.5%,窦性心动过速46.2%,室上性心动过速(室上速)33.3%,心房纤颤(房颤)25.6%,室性心动过速(室速)20.5%.结论治疗老年性心衰伴心律失常纠正心功能不全是治疗的关键,还要注重老年人生理特点及电解质(尤其是钾和镁)的失调,对于抗心律失常药物应慎用.     

慢性肺源性心脏病并发心律失常78例临床分析

目的探讨慢性肺源性心脏病并发心律失常的临床特点。方法对本院2006年1月-2008年12月间121例慢性肺心病患者的临床资料进行回顾性分析。结果经心电图和心电监护时检查发现121例患者中并发心律失常者78例,占64．46％。心律失常表现为窦性心动过速、窦性心动过缓、房性早搏、室性早搏、心房颤动、心房扑动、阵发性房性心动过速（包括紊乱性房性心动过速）、阵发性室性心动过速、一度或二度房室传导阻滞、右束支传导阻滞（完全性或不完全性）、左柬支传导阻滞（完全性或不完全性）、左前分支传导阻滞。I°心衰22例,心律失常9例（40．90石）;II°心衰41例,心律失常25例（60．97％）;III°心衰58例,心律失常44例（75．86％）。三组之间有非常显著差异（P均〈0．01）,提示心衰程度越重,并发心律失常率越高。结论心律失常是慢性肺心病最常见的并发症之一,肺心病并发心律失常是多种多样的、可变的。了解其心电图特点对慢性肺心病的诊断和治疗具有重要的临床意义。     

avR导联在阵发性室上性心动过速中的鉴别诊断价值

目的探讨avR导联在阵发性室上性心动过速中的鉴别诊断价值。方法回顾性分析146例室上性心动过速患者资料,患者均行射频消融治疗,房室结折返性心动过速82例,房室折返性心动过速64例,比较两组对avR导联QRS波终末部形态异常、ST段抬高检出率的差异。结果与窦性心律相比,avR导联中,房室结折返组QRS波终末部形态异常检出率为72.0%高于房室折返组6.3%,比较具有统计学差异(P0.05),房室结折返组ST段抬高检出率为19.5%高于房室折返组71.9%,比较具有统计学差异(P0.05);结论 avR导联QRS波终末部形态异常、ST段抬高对阵发性室上性心动过速具有较高的诊断意义,与窦性心律相比较,值得临床选择。     

尿毒症血透患者动态心电图改变及其临床意义

目的:探讨动态心电图监测对诊断尿毒症血透患者心脏并发症的临床意义。方法:对60例尿毒症血透患者分别进行ECG与DCG检查,另外对28例来我院进行健康体检者进行DCG检查,分析比较异常心电图检出率,同时比较尿毒症血透患者、健康体检者DCG中HRV观察指标。结果:尿毒症患者房性早搏、室性早搏、室性心动过速、阵发性室上速、房室传导阻滞、房颤房扑的发生率明显高于健康体检者(P<0.05);常规心电图对室性早搏、室性心动过速、阵发性室上速、房室传导阻滞、房颤房扑的检出率明显低于动态心电图(P<0.05);尿毒症患者HRV各项指标均明显低于健康体检者,差异具有统计学意义(P<0.01)。结论:心电图检查,特别是动态心电图能够准确了解尿毒症患者心脏状态,对临床尿毒症患者及时诊断治疗心脏并发症具有重要意义。     

162例病毒性心肌炎动态心电图分析

目的：观察病毒性心肌炎患动态心电图监测情况。方法：对临床拟诊病毒性心肌炎患进行24小时动态心电图监测。结果：162例患中，24小时有室性早搏（VE）82例；室上性早搏（SVE）78例。室性心动过速（VT）2例；室上性心动过速（SVT）8例；二度房室传导阻滞（AVB）18例；二度窦房传导阻滞（SAB）8例，三度房室传导阻滞（AVB）2例；有ST-T改变的32例。结论：动态心电图检查为病毒性心肌炎的诊断，治疗，预后分析提供了重要依据。     

200例老年患者动态心电图心律失常的临床分析

目的通过24h动态心电图(DCG)检测,探讨老年人心律失常与年龄、疾病的关系及其临床特点。方法收集本院心电图科2004年1月~2006年10月住院的经DCG检查存在心律失常的老年患者共200例,其中男性124例,女性76例,年龄60~95岁。按年龄分为3组:60~69岁组(32例,16%),70~79岁组(95例,47.5%),80岁以上组(73例,36.5%);按期前收缩分为:房性早搏(APC)组,室性早搏(VPC)组,房性早搏合并室性早搏(APC VPC)组;按传导阻滞分为:右束支传导阻滞(RBBB)组包括完全性/不完全性右束支传导阻滞(CRBBB/ICRBBB)和左束支传导阻滞(LBBB)组包括左前分支传导阻滞(LAH)左前分支传导阻滞 完全性/不完全性右束支传导阻滞(LAH CRBBB/ICRBBB)并对心律失常进行相关对比分析。结果不同年龄组间比较平均心率、最快及最慢心率无显著差异(P>0.05),期前收缩及室内传导阻滞组间比较有差异(P<0.05)。结论随年龄增加心律失常明显增多的主要原因是器质性心脏病,DCG对老年人心律失常的检出与评估有重要的临床意义。     

动态心电图观察阵发性心房颤动的发生机制

目的:应用动态心电图观察阵发性房颤的发作特征,以探讨阵发性房颤的发生机制。方法:对41例阵发性房颤患者的动态心电图进行分析。男20例,女21例。平均年龄66±13岁。冠心病10例,高血压病8例,糖尿病3例,甲亢性心脏病2例。观察动态心电图中心律失常的特点及与阵发性房颤的关系。结果:41例患者的动态心电图均可见房性早搏。频发者23例,占56.1%(23/41)。伴阵发性心动过速及心房扑动30例,占73.2%(30/41)。伴房性早搏二联律,房性早搏未下传及长R-R间期的35例,占85.3%(35/41)。伴有窦性心动过缓11例,占26.8%(11/41)。结论:阵发性房颤的发生有多种因素,以房性心律失常最常见,其中又以房性早搏居多,早搏的联律间期越短,越容易诱发阵发性房颤。房性早搏二联律,房性早搏未下传及长R-R间期诱发阵发性房颤的原因可能为长短周期机制。部分病例存在窦性心动过缓,与阵发性房颤的关系可能是迷走神经张力增加参与影响的结果。     

Pregnancy Outcomes in Patients with Autoimmune Diseases and Anti-Ro/SSA Antibodies

Anti-Ro/SSA antibodies are associated with neonatal lupus (congenital heart block (CHB), neonatal transient skin rash, hematological and hepatic abnormalities), but do not negatively affects other gestational outcomes, and the general outcome of these pregnancies is now good, when followed by experienced multidisciplinary teams. The prevalence of CHB, defined as an atrioventricular block diagnosed in utero, at birth, or within the neonatal period (0–27 days after birth), in the offspring of an anti-Ro/SSA-positive women is 1–2%, of neonatal lupus rash around 10–20%, while laboratory abnormalities in asymptomatic babies can be detected in up to 27% of cases. The risk of recurrence of CHB is ten times higher. Most of the mothers are asymptomatic at delivery and are identified only by the birth of an affected child. Half of these asymptomatic women develop symptoms of a rheumatic disease, most commonly arthralgias and xerophtalmia, but few develop lupus nephritis. A standard therapy for CHB is still matter of investigation, although fluorinated corticosteroids have been reported to be effective for associated cardiomyopathy. Serial echocardiograms and obstetric sonograms, performed at least every 1–2 weeks starting from the 16th week of gestational age, are recommended in anti-Ro/SSA-positive pregnant women to detect early fetal abnormalities that might be a target of preventive therapy.     

全数据库评估概率密度函数法利用R-R间期检测房颤精度

研究整个MIT-BIH心律失常数据库评估概率密度函数法利用R-R间期检测房颤的精度。研究发现正常窦性心律含较多早搏时[（早搏次数/总心搏次数）>9.3%],识别房颤的精度下降到约70%;左束支传导阻滞含较多早搏时,识别房颤的精度下降到约80%;而房颤心电中频繁早搏对辨别房颤精度影响很小,仍达91%。可见该算法适用于区分关联性强的序列与关联性弱的序列。正常窦性心律和左束支传导阻滞心律相邻R-R间期关联性强,频繁早搏使其相邻R-R间期关联性减弱,从而降低识别房颤的精度;而房颤相邻R-R间期无关联性,频繁早搏对检测精度无影响。尽管数据库中有种类繁多的心律失常,且伴有频繁的早搏,算法全数据库共约110 000次心跳辨别房颤精度达82%~86%。     

Head-up tilt test in complicated neurocardiogenic syncope in children.

To confirm the usefulness of head-up tilt test (HUT) in neurocardiogenic syncope (NCS) with complicating clinical features, retrospective analysis were done on 12 selected children. The age at onset was 12.7 +/- 1.9 (mean +/- SD) years. Associated clinical features were postoperative congenital heart disease (PO CHD) in 3, coexistent arrhythmia in 8 (persistent ventricular arrhythmia during exercise in 3, premature ventricular contractions in 2, ventricular couplets in 1, sinoatrial exit block in 1 and resting sinus bradycardia in 1) and ST segment depression during exercise in 1. Four of them had a history of exercise-related syncope. All 3 patients with PO CHD had arrhythmia (ventricular tachycardia in 1, sinus bradycardia in 1 and atrioventricular block in 1). HUT provoked NCS in 8 (2 during baseline tilt, 6 during isoproterenol infusion). In one each, ventricular tachycardia and loss of consciousness without hypotension and bradycardia were induced. Atenolol was tried in 5 with improvement of NCS in 4 and aggravation of dizziness in 1. During follow-up, 7 became asymptomatic (2 with atenolol) and 5 were stationary. In conclusion, HUT was valuable in diagnosing NCS even in children with complicating clinical features such as arrhythmias or PO CHD. HUT could be done as apart of initial diagnostic tests if the past history suggests NCS, regardless of associated clinical features. In some cases, the unexpected results of the test turned out useful in managing children with syncope or dizziness.     

Investigations into Ro-specific antibody-associated congenital cardiac conduction defects

Summary Forty-two babies with different congenital cardiac conduction defects, and in 12 cases the mothers, were tested for autoantibodies to Ro, La, U₁RNP and Sm. Ro-specific antibodies were detected most frequently. They were to be found in 16 sera from infants and in 8 maternal serum samples. The occurrence of anti-Ro was associated preferentially with several atrioventricular conduction blocks. The sex relation of anti-Ro associated congential heart block did not show a typical preference (6 male/10 female). At the time of giving birth, 5 anti- Ro-positive mothers did not have any clinical symptoms of rheumatic autoimmune diseases. Three of them had a first degree atrioventricular block. Our findings indicate that all pregnant women at risk for anti-Ro like connective tissue disease or cardiac conduction defects should be tested for these autoantibodies because of the suspicion of cardiac conduction abnormalities in the offspring. Anti-Ro-positive infants should be examined for structural heart disease by echocardiography.Abbreviations anti-EBV VCA IgG anti-viral capsid antigens immunoglobulin G - AV atrioventricular - CHB congenital heart block - CIE counter immunoelectrophoresis - EBV Epstein-Barr virus - NLE neonatal lupus erythematosus - SLE systemic lupus erythematosus     

早搏信号的小波模极大多重分形分析

本文运用基于小波模极大值的多重分形分析方法,研究心脏房性早搏(APB)信号、室性早搏(PVC)信号及正常心电(ECG)信号的多重分形特征。通过分析多重分形谱得出:三种信号都具有不同程度的多重分形特性;正常ECG信号的分形程度最强,PVC信号次之,APB信号最弱。t检验结果表明,此方法得出的三种信号分形谱宽度差异具有显著性,对临床医学诊断区分APB、PVC信号有很好的借鉴意义。     

国产与进口封堵器介入治疗小儿室间隔缺损导致的心律失常和残余分流分析

目的 了解进口和国产膜部窜间隔缺损(VSD)封堵器封堵小儿先天性膜周部VSD术后心律失常和残余分流的改变和差异.方法 2003年1月至2008年6月在本院成功封堵的膜周部VSD患儿396例,应用进口膜部VSD封堵器和装置封堵膜周部VSD组186例;国产膜部VSD封堵器和装置封堵膜周部VSD组210例.术中严密监测心电图(ECG)改变,术后常规持续心电监测3～7 d,必要时1～2周.观察ECG各波段的变化,分析各组心律失常和残余分流的发生率及评价重度心律失常病例的临床转归.结果 膜部瘤样VSD较其他类型膜周部VSD更容易发生心律失常和残余分流(48.8%比29.1%,X~2=5.21,P<0.05;12.5%比0.9%,X~2=23.31,P<0.01);进口封堵器封堵膜部瘤样VSD均较封堵其他类型膜周部VSD易于导致心律失常和残余分流(68.2%比28.0%,X~2=14.18,P<0.01;36.4%比1.2%,X~2=40.44.P<0.01);封堵膜部瘤样VSD进口封堵器较国产者更易导致心律失常和残余分流(68.2%比41.4%,X~2=4.60,P<0.01;36.4%比3.4%,X~2=15.60,P<0.01),而封堵其他类型膜周部VSD心律失常和残余分流发生率差异并无统计学意义.国产封堵器封堵膜部瘤样VSD和其他膜周部VSD导致心律失常和残余分流则无差异.进口和国产2组各出现3例Ⅲ度房窜传导阻滞(Ⅲ度AVB)或间歇Ⅲ度AVB.出现Ⅲ度AVB的6例中除1例应用进口封堵器者为膜周部VSD,其他5例均为膜部瘤样VSD.结论 进121和国产封堵器封堵膜周部VSD均可导致Ⅲ度AVB等严重心律失常发生.但国产封堵器封堵膜部瘤样VSD发生心律失常和残余分流较进口封堵器少.术中和术后应密切观察ECG的改变.     

Fetal and neonatal arrhythmia in one of the twins--a case history

There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. Digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in Cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.     

The acute effect of ajmaline on ventricular arrhythmia after cardiac surgery

The acute effect of ajmaline was investigated in the treatment of postoperative ventricular arrhythmias. Ajmaline (Glurytmal--Giulini Pharma GMBH) was applied intravenously in 15 patients suffering from ventricular premature beats (Lown II--IV/b), tachycardia and/or ventricular fibrillation after open heart surgery. Ajmaline infusion produced in 40% of the cases a total suppression and in 100% a significant improvement of malignant ventricular arrhythmia. In patients with recurrent and resistant ventricular tachycardia, ajmaline proved effective even when other antiarrhythmic drugs had failed. It was shown to be effective in reducing ventricular premature contractions and recurrent ventricular tachycardia after heart surgery, without haemodynamic side effects. Because of recurrent ventricular premature beats in 11 patients after acute ajmaline administration further oral application of prajmalium bitartarate (Neo-Gilurytmal) was necessary. The maintenance of these patients on oral ajmaline treatment seemed important.     

心房纤颤病人室性早搏与心室内差异性传导鉴别诊断的新方法及其应用

为了鉴别心房纤颤时出现的室性早搏（ＶＰＢ）与室内差异性传导（ＩＶＡＣ），本文引用了ＱＲＳ空间心电向量模，模导数按时间轴展开的计算机分析描记方法，对９５例患者做了临床测试，得出了六个鉴别指标，两个判别方程，然后对１２名患者做了临床试用诊断，效果极佳。     

Persistent atrioventricular block in Lyme borreliosis

Summary Cardiac manifestations are reported in 0.3%–4.0% of European patients withBorrelia burgdorferi (B.b.) infection. Usually symptoms disappear within 6 weeks. We report a case with persistent impairment of atrioventricular (AV) conduction. Diagnosis was confirmed by demonstration of IgM antibodies and increase of IgG antibody titers against B.b. in serum, by isolation of the spirochete from skin biopsy material and by the typical clinical combination of erythema migrans, Bannwarth syndrome (meningoradiculitis), and complete heart block. Despite immediate antibiotic therapy with ceftriaxone, first degree AV block and second degree block Wenckebach with atrial pacing at 100 beats/minute persisted for 2 years. We conclude, that Lyme carditis can cause long-standing or irreversible AV conduction defects despite adequate and early antimicrobial therapy.Abbreviations AV atrioventricular - AVt atrioventricular time - B. burgdorferi Borrelia burgdorferi - CSF cerebrospinal fluid - ECG electrocardiogram - ESR erythrocyte sedimentation rate - FRG Federal Republic of Germany - I. dammini/ricinus Ixodes dammini/ricinus - IgG immunoglobulin G - IgM immunoglobulin M