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As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.
Subject(s)
Humans , Arrhythmias, Cardiac , Defibrillators , Heart , Heart Arrest , Ventricular Fibrillation/therapyABSTRACT
OBJECTIVE: To explore the treatment of malignant arrhythmia induced by acute poisoning. METHODS: To analyze the treatment of 11 cases of malignant arrhythmia caused by acute poisoning. The therapeutic effect of malignant arrhythmia treated by drug, electrical cardioversion and detoxification was observed. RESULTS: The arrhythmias in the patients included premature ventricular beats, ventricular tachycardia, ventricular fibrillation, sinus tachycardia, sinus bradycardia, atrial premature beats, and ST-T changes. After treatment with cardioerter drug such as amiodarone, lidocaine, esmolol and other drugs, electric defibrillation, removeing poisons with hemoperfusion and specific antidotes, and multiple organ protection symptomatic treatment, 10 cases were successfully rescued and 1 case died. CONCLUSION: Malignant arrhythmias caused by acute poisoning could be given combined treatment with anti-arrhythmias and relief of etiology.
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Long QT syndrome(LQTS)is a rare and inherited cardiac channelopathy with high lethality,which is characterized by prolonged QTc interval and frequent malignant arrhythmia,the cause of the disease is that mutations of genes coding for cardiac ion channel subunit or channel associated proteins. Since some fetal LQTS may die in utero or neonatal period,thus,prenatal suspicion or diagnosis of fetal LQTS may improve their outcome and prognosis. There-fore,this review prepares to discuss around the prenatal diagnosis and management of fetal LQTS.
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Objective To study the relationship between red blood cell distribution width (RDW) and the malignant arrhythmia event of patients with chronic heart failure (CHF) during hospitalization. Methods A retrospective study was conducted. The clinical data of patients with CHF admitted to Department of Emergency and Cardiology of Peking University Third Hospital from January 2014 to February 2016 were reviewed. The patients with New York Heart Association (NYHA) Class Ⅱ, Ⅲ, Ⅳ at hospital admission and courses lasted at least six months were enrolled. The patients were divided into two groups according to malignant arrhythmia events (ventricular tachycardia, ventricular flutter or ventricular fibrillation) during hospitalization, i.e. malignant arrhythmia group and non-malignant arrhythmia group. The value of RDW and left ventricular ejection fraction (LVEF) were compared between two groups, and correlation of RDW, LVEF and malignant arrhythmia events by Spearman rank correlation analysis were studied, and the predictive value of RDW and LVEF for malignant arrhythmia events in patients with CHF was analyzed with receiver operating characteristic (ROC) curve. Results A total of 226 CHF patients were enrolled with 148 male and 78 female, the average age was (61.52±13.27) years old (range: 26-91 years old), the average hospitalization days were (14.5±3.5) days (range: 14-21 days), and malignant arrhythmia occurred in 102 patients (45.13%) during hospitalization. There were no statistically differences in gender, age, past history, etiology of heart disease, the usage of angiotensin receptor converting enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor inhibitors (ARB) and beta blockers, serum potassium levels and so on between two groups. Compared with non-malignant arrhythmia group, the value of the RDW was significantly increased in malignant arrhythmia group [(13.28±1.07)% vs. (12.87±1.32)%, t = 2.531, P = 0.012], but the levels of LVEF was significantly reduced (0.425±0.116 vs. 0.458±0.104, t = 2.249, P = 0.026), the proportion of patients with NYHA Class Ⅱ was significantly lower (4.90% vs. 19.35%, χ2= 10.451, P = 0.000) and that of NYHA Class Ⅳ was just the opposite (57.84% vs. 41.13%, χ2 = 6.264, P = 0.011). The value of the RDW showed positively correlation with the malignant arrhythmia events (r = 0.758, P = 0.023), while LVEF was negatively correlated (r = -0.719, P = 0.019). The area under the ROC curve (AUC) for predicting the malignant arrhythmia events of RDW and LVEF was 0.882 [95% confidence interval (95%CI) = 0.839-0.925), 0.903 (95%CI = 0.866-0.941), respectively. The sensitivity and specificity for RDW in predicting in-hospital malignant arrhythmia event respectively were 82.0% and 79.0% with the optimal cut-off of 14.20%, and those for LVEF were 78.0% and 85.0% with the optimal cut-off of 0.375. Conclusion RDW can be used to predict the occurrence of malignant arrhythmia in patients with CHF during hospitalization.
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Objective To observe the effects of tanshinone on malignant arrhythmias which occured in rabbit model of myocardi-al infarction,and explore the relationship between tanshinone induced calmodulin(CaM)signal system changes and the incidence of malignant arrhythmias after myocardial infarction.Methods A total of 90 healthy big ear rabbits were selected and randomly divid-ed into 3 groups:myocardial infarction model rabbits(non-intervention group)and myocardial infarction model rabbits with tanshi-none intervention(intervention group)and sham operated rabbits(control group),30 rats in each group.The incidence of malignant arrhythmias,calmodulin(CaM),calmodulin kinaseⅡ(CaMKⅡ),transmural dispersity of repolarization(TDR)and the concentra-tion of Ca2 + in myocardial cells were statistically analysed and compared among the 3 groups.Results The control group did not undergo malignant myocardial infarction,in non-intervention group and intervention group,malignant arrhythmia incidence was higher than that in control group(P 0.05).Serum Ca2 + concentration in non-intervention group was higher than that in control group and intervention group(P <0.05);serum Ca2 + concentration in control group was lower than that in intervention group(P <0.05).The TDR of intervention group is lower than that of non-intervention group,the two groups′TDR were both higher than that of control group(P <0.05).At single cell level,the intracellular calcium concentration of intervention group was lower than that of non-inter-vention group (P <0.05).Conclusion The relevant signal factors of CaM signal transduction system have implications on malig-nant arrhythmia after myocardial infarction.Tanshinone can inhibit CaM signaling system and play an important role in the preven-tion of malignant arrhythmia after myocardial infarction.