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Objective:To investigate the clinical effect of Tiaomai mixture combined with metoprolol tartrate on premature ventricular contraction in coronary heart disease （CHD） due to Qi-Yin deficiency and stagnated heat in blood vessel. Method:A total of 95 patients with CHD complicated with premature ventricular contraction were randomized into a treatment group and a control group. Four cases dropped out， leaving 91 cases （45 in the treatment group and 46 in the control group） included in the follow-up. On the basis of routine treatments for CHD， patients in the control group were further treated with metoprolol tartrate， while those in the treatment group received metoprolol tartrate plus Tiaomai mixture. Such curative effect and safety indexes as traditional Chinese medicine （TCM） syndrome score， electrocardiogram （ECG）， and 24 h dynamic ECG were observed before and after four-week treatment. Result:After treatment， the therapeutic effect on arrhythmia in the treatment group was better than that in the control group（<italic>P</italic><0.05）. The treatment group was superior to the control group in reducing the frequency of premature ventricular contraction （<italic>P</italic><0.05）， improving the Lown grade （<italic>P</italic><0.01）， increasing the heart rate variability index （<italic>P</italic><0.05）， and ameliorating the QT dispersion in ECG （<italic>P</italic><0.05）， hypersensitive C-reactive protein， and homocysteine（<italic>P</italic><0.05）. As revealed by comparison with those before treatment， both interventions improved TCM syndrome， with better outcomes observed in the treatment group （<italic>P</italic><0.01）， manifested as the alleviation of shortness of breath， fatigue， dry mouth with desire to drink， and tongue and pulse manifestations （<italic>P</italic><0.01）. Conclusion:Tiaomai mixture improves the clinical efficacy against arrhythmia in CHD patients by regulating the heart rate variability index， inhibiting inflammatory cytokines， lowering homocysteine， and relieving clinical symptoms， which is worthy of clinical promotion and application.
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RESUMEN Se presenta el caso de una paciente de 43 años, con antecedentes de salud aparente, hasta varias semanas previas a su ingreso, cuando comenzó a presentar síncopes precedidos de palpitaciones. Se realizó estudio electrofisiológico y se demostró precocidad en la porción distal del electrodo de registro de seno coronario, que corresponde a la vena cardíaca magna (interventricular anterior) y techo (summit) del ventrículo izquierdo. A pesar del excelente registro precoz se estudiaron estructuras vecinas como el tracto de salida del ventrículo izquierdo en la cúspide coronaria izquierda, aquí el mapeo eléctrico (pace mapping) no fue concordante total. En el sitio de la precocidad obtenida dentro del sistema venoso cardíaco se realizó mapeo concordante 100%, con una precocidad del catéter de ablación de -30 milisegundos. Se decidió ablación con incrementos progresivos de temperatura y potencia con corte de impedancia (termomapping) y se logró el éxito de la ablación sin reproducibilidad de la arritmia y excelente evolución posterior.
ABSTRACT The case of a 43-year-old female patient is presented, with an apparent history of good health, up to several weeks prior to admission, when she began to present syncopes preceded by palpitations. An electrophysiological study was performed and prematurity in the distal portion of the coronary sinus recording electrode was demonstrated, which corresponds to the great cardiac vein (anterior interventricular vein) and summit of the left ventricle. Despite the excellent early registration, neighboring structures were studied, such as the left ventricular outflow tract in the left coronary cusp, here the pace mapping was not totally concordant. At the site of the precocity obtained within the cardiac venous system, a 100% concordant mapping was achieved, with an ablation catheter's precocity of -30 milliseconds. The ablation was decided with progressive increases in temperature and power with thermomapping and the success of the ablation was achieved without reproducibility of the arrhythmia and excellent subsequent evolution.
Subject(s)
Electrophysiologic Techniques, Cardiac , Tachycardia, Ventricular , Atrial Premature Complexes , Radiofrequency AblationABSTRACT
[Objective] Premature ventricular contraction (PVC) causes arrhythmia, and it most frequently occurs in healthy individuals. It has been recently reported that a combination of medical therapy and acupuncture has an effect on arrhythmia. Herein, we report on the use of acupuncture in a patient with PVC.[Case] A 41-year-old male complained of arrhythmia and stiff shoulders. According to the Lown grading system, he was diagnosed with a grade 1 condition using Holter monitor in a hospital for internal diseases. Acupuncture was applied for decreasing the PVC count and discomfort in the chest region.[Methods] Acupuncture was applied at points PC6, BL15, HT7, ST36, GV20, CV17, and KI3. Manipulation involved twirling the stemless needle (30 mm in length, 0.20 mm in diameter) at a low amplitude and high frequency, and the needle was then retained for 10 min. The treatment was applied twice a day for four weeks. Measurements were obtained using a visual analog scale, SF-36v2, and Holter monitor.[Results] After four weeks of treatment, discomfort in the chest region decreased and quality of life improved. Additionally, the PVC count decreased after two weeks of treatment.[Conclusion] Our findings suggest that acupuncture is effective for treatment of PVC.
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Abstract Introduction Premature Ventricular Contraction (PVC) is among the most common types of ventricular cardiac arrhythmia. However, it only poses danger if the person suffers from a heart disease, such as heart failure. Hence, this is an important factor to consider in heart disease people. This paper presents an ECG real-time analysis system for PVC detection. Methods This system is based on threshold adaptive methods and Redundant Discrete Wavelet Transform (RDWT), with a real-time approach. This analysis is based on wavelet coefficients energy for PVC detection. It is presented also a study to find the most indicated wavelet mother for ECG analysis application among the following wavelet families: Daubechies, Coiflets and Symlets. The system detection performance was validated on the MIT-BIH Arrhythmia Database. Results The best results were verified with db2 wavelet mother: the Sensitivity Se = 99.18%, Positive Predictive Value P+ = 99.15% and Specificity Sp = 99.94%, on 80.872 annotated beats, and 61.2 s processing speed for a half-hour record. Conclusion The proposed system exhibits reliable PVC detection, with real-time approach, and a simple algorithmic structure that can be implemented in many platforms.
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BACKGROUND AND OBJECTIVES: Electroanatomical mapping using a three-dimensional (3D) system has high accuracy and improves the results of the ablation of outflow tract (OT) premature ventricular contraction (PVC) or ventricular tachycardia (VT) but imposes a considerable economic burden. Here, we compared detailed diagnostic catheterization and 3D mapping system for the ablation of OT PVC/VT. MATERIALS AND METHODS: Between June 2012 and February 2017, patients with symptomatic OT PVC/VT underwent radiofrequency ablation. Group 1 underwent detailed diagnostic catheterization (using circular and linear multielectrodes) without a 3D mapping system, while group 2 underwent diagnostic catheterization using a conventional 3D mapping system. Procedural success of PVC reduction, remaining symptoms, need for post-operative medications, and procedural time were evaluated. RESULTS: Ninety-eight OT PVC/VT cases were consecutively enrolled. The mean follow-up period was 17.7±14.5 months. Neither acute success rate (95% vs. 82%, p=0.06) nor a PVC reduction > 80% (84% vs. 87%, p=0.74) differed significantly between the two groups. The recurrence rates of PVC-related symptoms were similar (12% vs. 7%, p=0.06) between the groups, but the medication requirement for symptomatic PVC differed (12% vs. 29%, p < 0.01). The total procedure time of group 1 was shorter than that of group 2 (132±42 min vs. 157±47 min, p=0.01) and fluoroscopy time (24±15 min vs. 38±22 min, p < 0.01) and ablation time (528±538 sec vs. 899±598 sec, p < 0.01) were also significantly shortened. CONCLUSION: Detailed electrode catheter positioning is a safe and cost-effective method for the ablation of OT PVC/VT.
Subject(s)
Humans , Arrhythmias, Cardiac , Catheter Ablation , Catheterization , Catheters , Electrodes , Fluoroscopy , Follow-Up Studies , Methods , Recurrence , Tachycardia, Ventricular , Ventricular Premature ComplexesABSTRACT
Our objective is to evaluate the accuracy of three algorithms in differentiating the origins of outflow tract ventricular arrhythmias (OTVAs). This study involved 110 consecutive patients with OTVAs for whom a standard 12-lead surface electrocardiogram (ECG) showed typical left bundle branch block morphology with an inferior axis. All the ECG tracings were retrospectively analyzed using the following three recently published ECG algorithms: 1) the transitional zone (TZ) index, 2) the V2 transition ratio, and 3) V2 R wave duration and R/S wave amplitude indices. Considering all patients, the V2 transition ratio had the highest sensitivity (92.3%), while the R wave duration and R/S wave amplitude indices in V2 had the highest specificity (93.9%). The latter finding had a maximal area under the ROC curve of 0.925. In patients with left ventricular (LV) rotation, the V2 transition ratio had the highest sensitivity (94.1%), while the R wave duration and R/S wave amplitude indices in V2 had the highest specificity (87.5%). The former finding had a maximal area under the ROC curve of 0.892. All three published ECG algorithms are effective in differentiating the origin of OTVAs, while the V2 transition ratio, and the V2 R wave duration and R/S wave amplitude indices are the most sensitive and specific algorithms, respectively. Amongst all of the patients, the V2 R wave duration and R/S wave amplitude algorithm had the maximal area under the ROC curve, but in patients with LV rotation the V2 transition ratio algorithm had the maximum area under the ROC curve.
Subject(s)
Humans , Male , Female , Middle Aged , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Algorithms , Heart Ventricles/physiopathology , Retrospective Studies , ElectrocardiographyABSTRACT
Objective To evaluate the accuracy of the new and old electrocardiographic algorithms for differentiating the origins of outflow tract ventricular arrhythmias. Methods The clinical data of 202 patients treated between 2010 and 2013 were retrospectively reviewed for the investigations of the four algorithms including the transitional zone index, the V2 transition ratio, V2 R-wave duration and R/S-wave amplitude indices and the Sv2/Rv3 index. Results Regardless of rotation, the V2 transition ratio had the highest sensitivity (93.5%), while the Sv2/Rv3 index had the highest specificity (93.8). The maximal area under the ROC curve of four was more than 0.8, while the transitional zone index had the minimal area (0.804) with statistical significance (P 0.05). Conclusion Regardless of rotation, the Sv2/Rv3 index has the highest specificity and equal diagnostic value, with equal diagnostic value of the V2 transition ratio and V2 R-wave duration and R/S-wave amplitude indices. Compared with other algorithms, the Sv2/Rv3 index is simple and can be a complement as well for the direction of ablation therapy.
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OBJECTIVE: The aim of this study was to evaluate whether frequent premature ventricular contractions originating from the right ventricular outflow tract remodel the cardiac structure and function in patients with a “seemingly normal heart” and whether radiofrequency ablation can reverse this remodeling. METHODS: Sixty-eight patients with idiopathic frequent premature ventricular contractions originating from the right ventricular outflow tract and normal heart structure and function were enrolled in this study. The patients were divided into three groups according to the therapeutic method: radiofrequency ablation group (24 cases), anti-arrhythmia drug group (26 cases), and control group (18 cases without any treatment). Clinical Registration number: ChiCTR-ONRC-12002834 RESULTS: The basic patient characteristics were comparable between the three groups, except for the premature ventricular contraction rate, which was significantly lower in the control group. After six months of follow up, the premature ventricular contraction rate was significantly reduced in the radiofrequency ablation group, which was accompanied by a significant decrease in the following cardiac cavity inner diameters, as determined by echocardiography: right atrium (33.33±3.78 vs. 30.05±2.60 mm, p = 0.001), right ventricle (23.24±2.40 vs. 21.05±2.16 mm, p = 0.020), and left ventricle (44.76±4.33 vs. 41.71±3.44 mm, p = 0.025). These results were similar in the anti-arrhythmia drug group, although this group exhibited a smaller extent of change (right atrium: 33.94±3.25 vs. 31.27±3.11 mm, p = 0.024; right ventricle: 22.97±3.09 vs. 21.64±2.33 mm, p = 0.049; left ventricle: 45.92±6.38 vs. 43.84±5.67 mm, p = 0.039), but not in the control group (p>0.05). There was a tendency toward improvement in the cardiac functions in both the radiofrequency ablation and anti-arrhythmia drug groups. However, ...
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Catheter Ablation/methods , Ventricular Function, Right/physiology , Ventricular Premature Complexes/surgery , Ventricular Remodeling/physiology , Analysis of Variance , Anti-Arrhythmia Agents/therapeutic use , Heart Atria/physiopathology , Reference Values , Reproducibility of Results , Time Factors , Treatment Outcome , Ventricular Premature Complexes/physiopathologyABSTRACT
Objective To observe the changes in cardiopulmonary exercise test (CPET) variables of children with frequent premature ventricular contraction (PVC)before and after creatine phosphate treatment,to examine the difference of CPET results between PVC patients and healthy children,and to evaluate the effect of frequent PVC on the cardiac reserve function in children.Methods One hundred and nine frequent PVC children and 98 healthy children underwent treadmill exercise test and CPET respectively,the changes of CPET variables were observed among patients before and after treatment as well as among the healthy children.CPET variables include maximal oxygen consumption/kg (VO2max/kg),maximal oxygen consumption/heart rate( VO2max/HR),HR( at different time point),anaerobic threshold ( AT),and AT/VO2 maximum prediction (AT/VO2max pred).Results Before creatine phosphate treatment,VO2max/kg,VO2max/HR and AT/VO2max in frequent PVC children were ( 22.9±7.4 ) ml/( kg·min),( 9.3 ± 1.5 ) ml,( 15.5 ±2.7 ) ml/( kg· min).After creatine phosphate treatment,VO2 max/kg,VO2 max/HR and AT/VO2 max were (26.4 ± 6.0) ml/( kg· min),( 11.4 ± 3.3 ) ml,and ( 17.4 ± 3.8 ) ml/( kg· min).These CPET variables after creatine phosphate treatment in frequent PVC children were obviously higher than those before treatment and there was a significant difference [ VO2 max/kg ( t =2.11,P ＜ 0.001 ),VO2 max/HR ( t =4.02,P ＜ 0.001 ),AT( t =10.2,P ＜ 0.001 )].Control group of 98 healthy children had negative CPET results.Conclusion Cardiac reserve function decreases in frequent PVC children.After treatment,the exercise capacity and cardiac reserve function can be improved.CPET can reflect cardiac functional reserve changes in PVC children.
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Objective To discuss curative effect about radio frequently catheter ablation(RFCA) in frequently single originating premature ventricular beats.Methods 19 patients with frequently single original premature ventricular beats.The site of orgin was determined by activation mapping for the earliest endocardial activation,and by pace mapping for the exact QRS pacing site.Results 18 patients operation obtained immediate success,1 patient was failure,but no complication happened.After RFA in 2 weeks 24 hour Hoter ECG was used to examine arrhythmia condition,and all cases were follow up for 6～24 months after RFA,there were 17 patients who had no recurrence or phenomenon of premature beats augument,1 patient showed other type premature ventricular bearts.Conclusion It is safe and effective about RFA in frequently single origin premature ventricular beats of outflow lane.
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BACKGROUND: Although electrocardiographic manifestations of idiopathic dilated cardiomyopathy (DCMP) are usually nonspecific, several studies have suggested that electrocardiogram (ECG) might be used to predict the prognosis. METHODS: The present study was performed to determine the role of standard 12-lead ECG variables as a prognostic factor of patients with idiopathic DCMP. We retrospectively analyzed the ECG findings at the time of the diagnosis in 89 patients with DCMP during a mean follow-up period of 53.2+/-37.1 months. RESULTS: Twenty-eight (31.5%) of the 89 patients died and the cumulative survival rate was 87% at 2 years and 68% at 5 years. By univariate life table analysis, premature ventricular contraction, left bundle branch block, and age were proved as significant predictors. Multivariate analysis using Cox proportional hazards model identified premature ventricular contraction (p=0.014) and left bundle branch block (p=0.02) as an independent predictor for cardiovascular mortality in DCMP. The presence of a premature ventricular contraction increased the mortality 2.8 times and left bundle branch block 2.6 times. CONCLSUION: The present study demonstrates that independent ECG predictors for prognosis of idiopathic DCMP are premature ventricular contraction and left bundle branch block and ECG may be useful in predicting the prognosis of idiopathic dilated cardiomyopathy.
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Humans , Bundle-Branch Block , Cardiomyopathy, Dilated , Deoxycytidine Monophosphate , Diagnosis , Electrocardiography , Follow-Up Studies , Life Tables , Mortality , Multivariate Analysis , Prognosis , Proportional Hazards Models , Retrospective Studies , Survival Rate , Ventricular Premature ComplexesABSTRACT
BACKGROUND: In general, pulse pressure of a VPC depends on its prematurity and the site of origin. The pulse pressure of a VPC with a short coupling interval or originating from the left ventricle tends to be smaller. However, the hemodynamic change of a VPC originating from the right ventricular outflow tract (RVOT) is not well elucidated. In addition to their prematurity and the site of the origin of VPCs, the left ventricular filling profile (Ei/Ai ratio) during preceding control beats may affect the occurrence of a subsequent pulse deficit. The purpose of this study is to evaluate the hemodynamic change of different coupling intervals of VPCs originating from the RVOT. Furthermore, this study evaluates whether the left ventricular filling profile during preceding control beats significantly affects the occurrence of pulse deficits by VPCs. METHODS: In 12 open-chest dogs anesthetized with a -chloralose, sinus node crushing was done, and then a single bipolar ventricular pacing using sutured epicardial electrodes was done at 3 different sites: left ventricular apex (LVA), right ventricular apex (RVA), RVOT. At each site, a single bipolar pacing was done with a different coupling interval: 500 msec, 450 msec, 400 msec, 350 msec, 300 msec. During the production of VPCs, the mitral filling flow velocity and aortic TVI (time-velocity integral) using pulsed wave Doppler echocardiography, the femoral arterial pressure, the pulmonary arterial pressure, the electrocardiogram, and the intracardiac electrocardiogram were simultaneously recorded. RESULTS: The arterial pressure during VPC with a short coupling interval was significantly smaller regardless of the site of origin (p<0.05). The arterial pressure with VPCs originating from the RVOT was significantly more reduced than those from the RVA at a same coupling interval (p<0.05). However, the arterial pressure with originating from the LVA was insignificantly reduced than those from the RVOT. The pulmonary arterial pressure with originating from the RVOT was significantly reduced more than those from the LVA at a same coupling interval, except at the coupling interval of 500 msec (p<0.05). However, the pulmonary arterial pressure with VPCs originating from the RVA was insignificantly reduced than those from the RVOT. The aortic TVI during VPCs originating from the LVA was significantly reduced than those from the RVA or the RVOT at a same coupling interval (p<0.05). However, when the aortic TVI during VPCs originating from the RVOT was compared to that during VPCs from RVA, the former was significantly reduced at certain coupling interval (450 msec, p<0.05). A significant positive correlation was observed between the Ei/Ai ratio of preceding control beats and the pulse deficit coupling intervals during VPCs (p<0.05). CONCLUSION: The above results show that the origin of the site and the coupling interval of VPCs play a major role in determining hemodynamic outcomes during the occurrence of VPCs. The hemodynamic changes during VPCs originating from the RVOT seem to be similar with those during VPCs originating from the RVA. Furthermore, there is a positive correlation between the left ventricular filling pattern (Ei/Ai ratio) of preceding sinus beats and the pulse deficit coupling intervals of VPCs.
Subject(s)
Animals , Dogs , Arterial Pressure , Blood Pressure , Echocardiography, Doppler , Electrocardiography , Electrodes , Heart Ventricles , Hemodynamics , Sinoatrial Node , Ventricular Premature ComplexesABSTRACT
BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Subject(s)
Animals , Dogs , Anesthesia , Arrhythmias, Cardiac , Epinephrine , Halothane , Hemostasis , Myocardium , Ventricular Premature ComplexesABSTRACT
Twenty four hours ambulatory monitoring of electrocardiogram and exercise stress testing were performed in 60 children who were refered to our hospital because of isolated premature ventricular contractions (PVCs) .<BR>Complex ventricular ectopy was found in 28 out of 60 PVC children. Out of 28 subjects with complex ventricular ectopies 21 had PVCs originated from the right ventricle.<BR>Frequency of PVCs per day was high in primary ventricular tachycardia and low in ventricular tachycardia with organic heart disease and there was statistical significance (p<0.01) between these two groups.<BR>There was no characteristics in coupling interval, prematurity index and vulnerability index which could specify ventricular tachycardia, couplets PVCs and isolated PVC.<BR>VT rate in exercise stress testing was higher than that in twenty four hours ambulatory monitoring of electrocardiogram (Holter recording) . Both exercise stress testing and twenty four hours monitering of electrocardiogram should be done to control VT school children.