高血压病左室肥厚患者JT离散度与室性心律失常的关系

目的 观察高血压病左室肥厚(LVH)患者JT离散度(JTd)与室性心律失常(VA)的关系及其预后。方法 检测150例高血压病LVH(Ⅰ组)和110例高血压病无LVH患者(Ⅱ组)心电图JTd。结果 Ⅰ组VA检出率为55.33％;VA、复杂VA及室性心动过速(VT)者JTd显著高于无VA者(分别P<0.05、<0.001、<0.001);Ⅰ组JTd显著高于Ⅱ组(P<0.05);并发现Ⅰ组JTd>60ms者VA、复杂VA及VT检出率均显著高于Ⅱ组JTd<60ms者(均P<0.001)。2年随访组Ⅰ中JTd>60ms的68例有9例猝死(9/68,13.2％)。结论 提示JTd对高血压病LVH者发生VA的预测具有一定参考意义。     

高血压病患者左室肥厚与复杂性室性心律失常关系的研究

目的 探讨高血压病患者左室肥厚与复杂性室性心律失常的关系,为临床诊断治疗提供依据.方法 选择高血压病(均符合2005年中国高血压防治指南修订版)患者共432例,依据左室肥厚及年龄,分别分为左室肥厚、非左室肥厚及年龄≥60岁、＜60岁各两组.应用彩色超声心动图[按照美国超声心动图学会(ASE)推荐的方法 测量]和24 h动态心电图进行检查.结果 合并左室肥厚组复杂性室性心律失常的发生率高达33.76%,显著高于非左室肥厚组的9.82%;在≥60岁患者中左室肥厚及复杂性心律失常的发生率高于<60岁患者(P<0.01);有左室肥厚及复杂性心律失常者常合并缺血性ST段改变.结论 高血压病患者早期积极控制血压是减少发生左室肥厚,进而预防复杂性室性心律失常的关键,从而减少心脏事件的发生.     

老年单纯收缩期高血压左室肥厚心律失常研究

目的研究老年单纯收缩期高血压患者左室肥厚与心律失常关系。方法60岁以上老年单纯收缩期高血压患者63例,平均年龄77.67±5.67岁,其中男性49例,女性14例,排除其他继发性高血压、糖尿病、冠心病等疾病,分别测量身高、体重、血脂、血糖、肝肾功能、心脏彩超、24小时动态心电图监测。计算BMI、左室重量(LVM)、左室重量指数(LVMI),根据结果分为左室肥厚组(LVH)及非左室肥厚组(non-LVH),分析其心律失常情况。63例老年单纯收缩期高血压患者,检出左室肥厚患者20例,占31.75%;非左室肥厚患者43例,占68.25%。结果左室肥厚组与非左室肥厚组在年龄、血脂水平、BMI、房性心律失常的检出率等各项指标上无统计学意义。复杂性室性心律失常(Lown3-6级)的发生率与非左室肥厚组比较有统计学意义(P<0.001)。结论左室肥厚可能是引起老年单纯收缩期高血压患者复杂性室性心律失常的一个重要原因。     

高血压病左室肥厚与心律失常的相关性临床研究

目的 探讨高血压病左心室肥厚与心律失常的关系。方法 选择2001-2003年上海交通大学附属第一人民医院心内科246例原发性高血压患者,进行静息同步12导联心电图,动态心电图及超声心动图测定,监测左室重量指数等指标。结果 左心室肥厚组平均左室重量指数水平为(151.6±15.8)g/m~2,和左心室正常者相比差异有显著性(P<0.01)。左心室肥厚组定性心律失常及复杂性定性心律失常的检出率为93.27％和51.92％,明显高于左心室正常组(35.21％,10.56％),差异有显著性(P<0.001)。结论 原发性高血压左心室肥厚相关性心律失常,尤其是复杂性心律失常,与左室肥厚的程度及是否合并左房肥大有明确的规律关系。     

急性心肌梗死QT离散度与恶性室性心律失常关系的探讨

目的 探讨发生急性心肌梗死时QT离散度（Q-Td）与发生恶性室性心律失常的关系.方法 测量45例患者急性心肌梗死时的Q-Td,计算校正的QT离散度（Q-TdC）.分析Q-Td、Q-TdC与恶性室性心律失常之间的关系.根据有无室性心律失常分为观察组（n=28）与对照组（n=17）.根据Q-TdC水平（分别以60ms、80ms为分界）分析其与室性心律失常和恶性室性心律失常发生的关系.结果 观察组Q-Td、Q-TdC[（70.84±29.87）ms、（79.21±33.58）ms]与对照组[（46.19±17.03）ms、（51.64±17.71）ms]相比,差异均有统计学意义（均P＜0.05）.Q-TdC≥60ms者室性心律失常发生概率（92.30%）高于Q-TdC＜60ms者（21.05%）（P＜0.05）.Q-TdC≥80ms者恶性室性心律失常发生概率（100.00%）高于Q-TdC＜80ms者（10.34%）（P＜0.05）.结论 急性心肌梗死随着Q-Td或Q-TdC值的增大,发生恶性室性心律失常的概率增高.     

高血压左室肥厚的QT离散度及左室Tei指数的研究

目的探讨原发性高血压左室肥厚与QT离散度及左室Tei指数的关系。方法高血压病组109例(非左室肥厚组83例,左室肥厚组26例),正常组30例,测定QT离散度及左室Tei指数。结果高血压病组无论有无左室肥厚,其QT离散度及左室Tei指数均显著大于正常组(QTd:43.9±15.1ms,69.2±16.9msvs36.2±11.3ms,p<0.05;Tei指数:0.54±0.06,0.60±0.14vs0.38±0.07,p<0.05)。高血压病左室肥厚组的左室Tei指数及QT离散度较非左室肥厚组有增大的趋势(QTd:69.2±16.4msvs43.9±15.1ms,p<0.05;Tei指数:0.60±0.14vs0.54±0.06,p>0.05)。结论高血压左室肥厚时,QT离散度及左室Tei指数增大,表明高血压左室肥厚可导致QT离散度增大及左室舒张功能不全。     

肥厚性心肌病和高血压病左室肥厚患者QT离散度的对比观察

目的：对比观察原发性肥厚性心肌病与高血压病左室肥厚患者的QT离散度。方法：以体表心电图描测15例肥厚性心肌病及42例高血压病左室肥厚患者的QT离散度（QTd）和经校正的QTd（QTCd），并与高血压无左室肥厚者及正常对照组进行比较。结果：（1）两组心室肥厚患者的QTd和QTcd均明显高于高血压元左室肥厚者及正常对照组（P＜0.01）；（2）两组心室肥厚者间以上诸指标无明显统计学差异；（3）QTd＞60ms的患者中，两组心室肥厚患者的复杂室性心律失常（≥LownⅢ级）发生率间无明显差异，但均高于高血压病无左室肥厚者。结论：无论是原发性或继发性左室肥厚均与QT离散度的增加相关，并可能为复杂室性心律失常潜在病理基础之一。     

原发性高血压左心室肥大伴室性心律失常与心室晚电位关系探讨

为探讨心室晚电位与原发性高血压左心室肥大伴室性心律失常之间的关系,检测66例合并及94例不合并左心室肥大原发性高血压患者的心室晚电位和动态心电图.结果心室晚电位阳性率13.1%,合并或不合并左心室肥大者分别为20.6%和7.6%(P<0.01);室性心律失常检出率为82.3%和38.4%(P<0.01).心室晚电位阳性的左心室肥大伴室性心律失常、复杂室性心律失常及室性心动过速检出率(100%、64.5%、28.5%)均高于心室晚电位阴性的左心室肥大者(76.9%、47.1%、15.4%,P<0.05)及无左心室肥大的心室晚电位阳性者(71.4%、28.6%、14.3%,P<0.05).提示心室晚电位对原发性高血压的室性心律失常,尤其是复杂性室性心律失常有一定预测价值.     

Q—T离散度与室性心动过速的关系探讨

探讨Q—T离散度(Q—Td)与室性心律失常的关系,观察室性心动过速患者(n=22)体表DCG Q—Td.发现室速发作前3天内Q—Td大,Q—Td值室速组为88.0±24.0ms,对照组(n=30)为20.2±12.0ms,两组有非常显著差异(P<0.001),认为Q—Td增大可作为预测室速的发生。     

冠心病室性心律失常与左室功能关系

为了评价左室功能损伤对冠心病室性心律失常的影响.本文将接受选择性冠脉造影和左室造影的85例患者,同步进行24小时动态心电监测,记录24小时内室性早搏数并且按LOWN氏标准分级。按左室射血分数将受检查者划分为心功能正常组(EF≥60％),其中冠脉正常32例.心绞痛20例.心肌梗塞8例;心功能减退组(EF<60％),其中冠脉正常者2例、心绞痛2例和心肌梗塞21例。结果显示:①心功能减退组室性早搏的检出率96％(24/25)明显高于心功能正常组65％(39/60),P<0.005)。②心功能减退组冠心病室性早搏的检出率96％(22/23)同样显著高于心功能正常组71％(20/28).P<0.05。③心功能减退组≥3级的室性心律失常的检出率为29％,而心功能正常组为13％,前者有升高的趋势。初步认为窒性心律失常在人群中有较高的发生率,左心功能减退是影响冠心病室性心律失常的主要原因之     

Selective right ventricular angiography in apparently idiopathic ventricular fibrillation

Summary The definition of underlying heart disease in apparently idiopathic ventricular fibrillation seems to be important in regard to prognosis and choice of therapy. From October 1989, until August 1993, cardiac arrest due to the documented ventricular fibrillation occurred in eight consecutive patients with normal results on clinical examination, normal echocardiography, and normal or apparently nonspecific electrocardiogram (ECG) findings. Complete invasive investigations, including selective right ventricular angiography, were done; regional hypokinesia and segmental bulging of the right ventricle were found in seven patients (88%). Arrhythmogenic right ventricular dysplasia was suspected in these patients, although endomyocardial biopsy was not performed. After the finding of localized right precordial QRS prolongation of more than 110 ms in November 1993 in five patients, a retrospective, a more precise approach to QRS duration in standard ECG supported this diagnosis. Selective right ventricular angiography is of great help in identifying underlying heart disease in patients with apparently idiopathic ventricular fibrillation, and confirms ECG findings.     

特发性右心室流出道室性心动过速/室性早搏的性别、年龄和临床特点

Objective The aim of this study was to clarify gender,age and clinical feature of idiopathic right ventricular outflow tract ventricular tachycardia/premature ventricular complexes(ROVT/PVC). Methods We studied 478 patients[mean age(39. 8 ± 13. 8)years]with idiopathic ROVT/PVC who were admitted to our center consecutively in past 15 years. All of them underwent catheter mapping and radiofrequency catheter ablation (RFCA), and the original sites of ventricular tachycardia/premature ventricular complexes were confirmed by catheter mapping and radiofrequency catheter ablation. Results Of 478 patients, 288 patients (60. 3% )were female, 190 patients(39. 7% )were male, female/male ratio was 1.52. The early onset of symptom was at (41.2 ± 12. 7 ) years for female, and ( 37.6 ± 15. 0) years for male ( P ＜ 0. 05 ). Almost all patients had palpitation in varying degrees. Sixty-seven of 478 patients( 14.2% ) had history of near-syncope,and 13 of 478 patients(2. 7% )had history of syncope. Two hundred and sixty-three patients( 55% )underwent unsuccessful treatment with antiarrhythmic drugs before the radiofrequency ablation. Of them, 110 patients (23%)had received one kind of antiarrhythmic drug, 104 patients (21.8%)had received two types of antiarrhythmic drugs,49 patients( 10. 3% )had received three types of antiarrhythmic drugs. Conclusion ROVT/VPC occur more in female than in male,the early onset of symptom is older for female than for male. Almost all patients have symptom in varying degrees, some of them have near-syncope or syncope.     

特发性右心室流出道室性心动过速/室性早搏的性别、年龄和临床特点

Objective The aim of this study was to clarify gender,age and clinical feature of idiopathic right ventricular outflow tract ventricular tachycardia/premature ventricular complexes(ROVT/PVC). Methods We studied 478 patients[mean age(39. 8 ± 13. 8)years]with idiopathic ROVT/PVC who were admitted to our center consecutively in past 15 years. All of them underwent catheter mapping and radiofrequency catheter ablation (RFCA), and the original sites of ventricular tachycardia/premature ventricular complexes were confirmed by catheter mapping and radiofrequency catheter ablation. Results Of 478 patients, 288 patients (60. 3% )were female, 190 patients(39. 7% )were male, female/male ratio was 1.52. The early onset of symptom was at (41.2 ± 12. 7 ) years for female, and ( 37.6 ± 15. 0) years for male ( P ＜ 0. 05 ). Almost all patients had palpitation in varying degrees. Sixty-seven of 478 patients( 14.2% ) had history of near-syncope,and 13 of 478 patients(2. 7% )had history of syncope. Two hundred and sixty-three patients( 55% )underwent unsuccessful treatment with antiarrhythmic drugs before the radiofrequency ablation. Of them, 110 patients (23%)had received one kind of antiarrhythmic drug, 104 patients (21.8%)had received two types of antiarrhythmic drugs,49 patients( 10. 3% )had received three types of antiarrhythmic drugs. Conclusion ROVT/VPC occur more in female than in male,the early onset of symptom is older for female than for male. Almost all patients have symptom in varying degrees, some of them have near-syncope or syncope.     

Isolated noncompaction left ventricular myocardium and polymorphic ventricular tachycardia

A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.     

Contribution of each ventricular wall to ventricular interdependence

Summary The influences of presure and volume changes in one ventricle on the other ventricle may be determined from the relative compliances of the ventricular free walls and the interventricular septum. If this is correct, then disease states which alter regional compliances should influence the diastolic mechanical coupling between the ventricles. To examine this hypothesis, the hearts of 15 canine dogs were removed and placed in cool cardioplegic solution. Balloons were inserted into each ventricle and the right and left ventricular pressure (P_r, P_l) and volume (V_r, V_l) changes caused by changing the pressure and volume of the other ventricle were recorded. Acute changes in right ventricular free wall (N=5), septal (N=5), and left ventricular free wall (N=5) compliances were induced by glutaraldehyde injections. After injecting glutaraldehyde into the right coronary artery, P_l/V_r, V_l/V_r, P_r/P_l, and P_r/V_l increased significantly (P<0.05). After septal artery injection, pressure and volume transfer between the ventricles was significantly depressed. After left coronary artery injection, P_l/P_r, P_l/V_r, P_r/V_l, and V_r/V_l increased significantly (P<0.05). Thus, selective alterations in the mechanical coupling between the ventricles occurred following changes in right ventricular, septal, and left ventricular free wall compliances. Such changes may be important in diseases which primarily affect one side of the heart.This study was supported in part by NIH Grant No. HL 36068 by a grant from the American Heart Association, New Jersey Chapter.     

Cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach

Disabling monomorphic ventricular bigeminy has not been describedas an indication for surgery. Three young patients with thisarrhythmia sometimes deteriorating into ventricular tachyarrhythmiasand in whom drug therapy failed completely were accepted forsurgical ablation of the arrhythmogenic area. The earliest endocardialsite of origin was located preoperatively by catheter mappingof the spontaneously occuring ventricular bigeminy in the leftand right ventricles. For maximum preservation of myocardialmuscle and function, the peroperative mapping and surgical procedurewere preformed through the aortic root; mapping by transaorticmultipolar balloon was done during normothermic coronary perfusionand cryocoagulation was done during cardioplegic arrest. Cryocoagulationof the endocardial site was performed using the transaorticapproach and epicardial cryocoagulation at the opposite sitewas done afterwards. In the two patients in whom the peroperativemapping results were consistent with those of preoperative cathetermapping, the arrhythmia could be abolished, as documented duringlong-term follow-up. In the only patient in whom the mappingresults were not in agreement, the ventricular arrhythmia reoccurredand was the cause of death at five months after surgery. Postoperativewall-motion studies performed in the two surviving patientsshowed limited scars in the area of cryocogulation and minordamage to the coronary arteries in that area. The transaorticapproach can be considered as a new and important surgical optionfor endocardial mapping and cryocoagulation which prevents thedamaging effects of a left ventriculotomy.     

A case of arrhythmogenic right ventricular dysplasia with ventricular fibrillation

A case of repeated attacks of ventricular fibrillation is described. The patient suffered from an arrhythmogenic right ventricular dysplasia (ARVD) documented by right and left ventriculograms and myocardial biopsies obtained during surgical treatment of the arrhythmia. The histological changes were interpreted as being signs of fresh myocardial damage of unknown origin in addition to a replacement of the normal myocardium by adipose and fibrotic tissue. The repeated attacks of ventricular fibrillation in this patient contrast to the arrhythmia spectrum noted in the available literature on ARVD, mostly stable chronic ventricular tachycardias.     

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。     

Delayed ventricular depolarization -- correlation with ventricular activation and relevance to ventricular fibrillation in acute myocardial infarction

Signal averaging to detect abnormalities in the terminal phaseof ventricular depolarization has been performed in severalgroups of patients with various manifestations of ischaemicheart disease. Late potentials were common in patients withVT and in a group of patients having cardiac surgery. Findingsin the surgical group highlighted the close correlation of latepotentials with delayed, fragmented epicardial activation supportingthe hypothesis that late potentials reflect a myocardial substratewhich would support re-entrant VT. The findings in the surgicalgroup allowed a definition of late potentials which could beapplied to other patients in the study, and also demonstrateda spectrum of late depolarization abnormalities. Signal averaging is technically feasible in the noisy CCU environmentbut late potentials were detected in few patients early in AMI.Late potentials were also rarely seen in patients with VF andtherefore cannot be construed as a predictive index of thisarrhythmia.     

Hoffmayer心电图积分识别ARVC室早／室速

目的探讨应用Hoffmayer心电图积分鉴别致心律失常性右室心肌病（arrhvthmogenic right ventricular cardiomyopathy,ARVC）和特发f生右室流出道室早／室速的临床意义。方法收集2009年9月至2013年5月就诊于北京大学人民医院患者中,心电图表现为右室流出道起源室早／室速患者57例。其中明确诊断为ARVC患者4例,经电生理检查及射频消融治疗成功的特发性右室流出道室早／室速患者53例。由两位电生理医生在不知道确切诊断的情况下,依据Hoffmayer心电图积分对上述患者的心电图进行分析,计算总积分≥5分,各单项积分诊断ARVC伴发的室早／室速的敏感度、特异度、阳性预测值、阴性预测值及诊断符合率。结果Hoffmayer心电图积分≥5分诊断ARVC伴发室早／室速的敏感度75％,特异度96．23％,阳性预测值60％,阴性预测值98％、诊断符合率94．7％。结论Hoffmayer积分≥5可有效鉴别右室流出道室早／室速是ARVC伴发的还是特发性的。应用此项积分具有简单、快速、敏感度及特异度均较高的优点,具较高的临床应用价值。