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Premature ventricular extrastimulus without His or ventricular capture: An unexpected response during AV nodal reentrant tachycardia 
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Kevin Hodges Carlos Godoy Rivas José Aguilera Robert Borden Alaa Alashi Eugene H. Blackstone Milind Y. Desai Nicholas G. Smedira 《The Journal of thoracic and cardiovascular surgery》2019,157(6):2289-2299
ObjectivesThis study evaluates operative approach and contemporary surgical outcomes in the management of left ventricular outflow tract obstruction by a single surgeon at a high-volume, specialized hypertrophic cardiomyopathy center.MethodsThis is a retrospective review of 1559 consecutive operations for left ventricular outflow tract obstruction from 2005 to 2015. Demographic profiles, echocardiogram-derived ventricular morphology and hemodynamics, operative data, and in-hospital outcomes were analyzed.ResultsOf the 1559 operations, 586 were isolated septal myectomies, 522 were myectomies with mitral valve or subvalvular apparatus intervention, 422 were myectomies with another concomitant procedure, and 29 were isolated mitral valve interventions without myectomy. Common mitral valve interventions included anterior leaflet shortening (16%), chordae tendineae resection (9.8%), papillary muscle resection (7.2%), and papillary muscle reorientation (7.5%). Ninety-two patients underwent mitral valve replacement, 42 for left ventricular outflow tract obstruction and 50 for intrinsic mitral valve pathology. Patients undergoing mitral interventions had thinner septums (18 ± 0.4 mm vs 22 ± 0.5 mm, P < .001) and less myocardium removed (6.2 ± 3.5 g vs 8.8 ± 3.8 g, P < .001) than patients without a mitral intervention. Prevalence of in-hospital permanent pacemaker insertion was 4.2% (n = 1334) for complete heart block and 1.1% (n = 464) for isolated septal myectomy with normal preoperative conduction. Overall, there were 2 postoperative ventricular septal defects (0.13%) and none for isolated myectomies. Operative mortality was 0.38%.ConclusionsSeptal myectomy can be performed safely with excellent outcomes when the procedure is performed by a highly experienced surgeon in a high-volume, specialized center. A mitral valve intervention is a useful adjunct in patients with moderate hypertrophy. 相似文献
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Antonio Mangieri Giuseppe Lanzillo Letizia Bertoldi Richard J. Jabbour Damiano Regazzoli Marco B. Ancona Akihito Tanaka Satoru Mitomo Stefano Garducci Claudio Montalto Matteo Pagnesi Francesco Giannini Manuela Giglio Matteo Montorfano Alaide Chieffo Josep Rodès-Cabau Fabrizio Monaco Gabriele Paglino Azeem Latib 《JACC: Cardiovascular Interventions》2018,11(15):1519-1526
Objectives
This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR).Methods
Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length.Results
Overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM <48 h after TAVR. The final analysis included 611 patients. Fifty-four patients (8.8%) developed an advanced conduction disturbance requiring PPM ≥48 h following TAVR. Patients who required a late PPM implant had a wider QRS width (113 ± 25 ms vs. 105 ± 23 ms; p = 0.009) and a higher prevalence of baseline right bundle branch block (12.9% vs. 5.3%; p = 0.026) and were more likely to have a self-expandable valve implanted (51.8% vs. 31.9%; p = 0.003). The ΔPR was 40 ± 51 ms (p = 0.0001) and the ΔQRS was 22 ± 61 ms (p = 0.001). Multivariable analysis revealed that baseline right bundle branch block (odds ratio: 3.56; 95% confidence interval: 1.07 to 11.77; p = 0.037) and ΔPR (odds ratio for each 10-ms increase: 1.31; 95% confidence interval: 1.18 to 1.45; p = 0.0001) are independent predictors of delayed advanced conduction disturbances.Conclusions
This analysis showed that baseline right bundle branch block and the amount of increase of PR length after TAVR are independent predictors of late (≥48 h) advanced conduction disturbances requiring PPM replacement after TAVR in this cohort. A simple ECG analysis could help in detecting potentially lethal advanced conduction disturbances that could occur more than 48 h after TAVR. 相似文献15.
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Attila Nemes Willem B Vletter Marcoen F Scholten Folkert J ten Cate 《European journal of echocardiography》2005,6(6):470-472
Right ventricular (RV) cardiomyopathy is a familiar myocardial disease of RV characterized by extensive fatty replacement of the myocardium. Conventional echocardiography is able to show abnormalities in myocardial contractility, but fat on the images appears to be similar to the surrounding tissue or fluid. The present case suggests the clinical role of contrast echocardiography showing perfusion abnormalities in patients with RV cardiomyopathy in the region of the fat depositions. 相似文献
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目的：探讨农村老年人心电图特征及临床意义。方法：从农村65岁以上18 024名体检结果中随机抽取1 208例常规心电图检查资料进行分析。结果：异常心电图827例,占68.46%;正常心电图381例,占31.54%。其主要异常率表现在T波、S-T、ST-T、房性早搏、房颤、RBBB及窦缓,依次为：ST-T 287例,占23.76%;ST压低或抬高190例,占15.73%;T波异常133例,占11.01%;房性早搏160例,占13.25%;房颤136例,占11.26%;RBBB 107例,占8.85%;窦缓94例,占7.78%。主要异常率随年龄增高而增长。结论：农村老年人心电图特征同城市老年人,但农村老年人异常率较高,做好农村老年人健康保健,以简便易行心电图检查结合体筛选心肺器质性病变有更大的意义。 相似文献
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Won-Keun Kim Helge Möllmann Christoph Liebetrau Matthias Renker Andreas Rolf Philippe Simon Arnaud Van Linden Mani Arsalan Mirko Doss Christian W. Hamm Thomas Walther 《JACC: Cardiovascular Interventions》2018,11(17):1721-1729
Objectives
The aim of this study was to perform a comprehensive analysis of factors that affect procedural outcomes of transcatheter aortic valve replacement using the ACURATE neo prosthesis (Symetis/Boston, Ecublens, Switzerland).Background
Predictors of procedural outcomes using the ACURATE neo prosthesis are poorly understood.Methods
A total of 500 patients underwent transfemoral aortic valve replacement with the ACURATE neo prosthesis. Device landing zone calcification was stratified as severe, moderate, or mild. Anatomic and procedural predictors of second-degree or greater paravalvular leakage and permanent pacemaker implantation were assessed.Results
Post-procedural second-degree or greater paravalvular leakage was more frequent with increasing device landing zone calcification (mild 0.8% vs. moderate 5.0% vs. severe 13.0%; p < 0.001), whereas permanent pacemaker implantation was independent of device landing zone calcification. More severe periannular calcification (odds ratio [OR]: 1.007; 95% confidence interval [CI]: 1.003 to 1.010; p < 0.001), less oversizing (OR: 0.867; 95% CI: 0.773 to 0.971; p = 0.014), the presence of annular plaque protrusions (OR: 2.756; 95% CI: 1.138 to 6.670; p = 0.025), and aortic movement of the delivery system after full deployment (OR: 5.593; 95% CI: 1.299 to 24.076; p = 0.02), and sinotubular junction height (OR: 1.156; 95% CI: 1.007 to 1.328; p = 0.04) independently predicted second-degree or greater paravalvular leakage. Predictors of permanent pacemaker implantation were pre-existing right bundle branch block (OR: 3.122; 95% CI: 1.261 to 7.731; p = 0.01) and more oversizing (OR: 1.111; 95% CI: 1.009 to 1.222; p = 0.03).Conclusions
Successful transcatheter aortic valve replacement using the ACURATE neo device predominantly depends on careful patient selection with appropriate oversizing and taking into account the individual anatomy and calcium distribution of the aortic root. 相似文献20.
HAIM SHMUELY SHIMSHON ERDMAN BORIS STRASBERG † JOSEPH B. ROSENFELD 《Pacing and clinical electrophysiology : PACE》1992,15(4):369-372
The case report is presented of a patient in whom an uncomplicated left ventricular transvenous pacing produced right bundle branch block (RBBB). A diagnostic echocardiography, confirmed by cine cardiovascular computed tomography, showed that there was no rupture of the right ventricle and diagnosed a left ventricular pacing, due to malposition of the pacing electrode. The patient was treated with aspirin and dipyridamole during the last 6 years of follow-up, without any complications, including 1 year of pacing, prior to admission. 相似文献