A successful case of decreasing the frequency of premature ventricular contraction only by acupuncture / 全日本鍼灸学会雑誌

[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.

The Incidence of Cardiac Arrhythmias is Lower in Isoflurane than Enflurane / 대한마취과학회지

BACKGROUND: There is difference between isoflurane and enflurane in the myocardial sensitization to catecholamines, and their actions on the heart. Enflurane reduces cytoplasmic calcium more than isoflurane. The hypothesis could be suggested that these two volatile anesthetics might cause the different incidences and natures of cardiac arrhythmias. METHODS: The anesthesia was induced by the intravenous injection of thiopental(6 mg, kg-1) and pipecuronium(0.1 mg, kg-1). Two groups were randomly allocated to the patients(n=80) in the maintenance: Group I inhaled isoflurane(1~2%), O2(2 L), and N2O(2 L), Group II, enflurane (1.5~2.5%). Continuous electrocardiographic recordings with Holter monitor were made of those undergoing tympanoplasty during anesthesia. The tapes recorded were scanned using analyzer, and we read out ECG complexes on the screen. Results were categorized as induction, maintenance, and emergence, and inferred from unpaired t-test, and X2-test with p<0.05 considered significant. RESULTS: The results were as follows: 1) The total incidence of cardiac arrhythmias was 65.0%. Isoflurane(52.5%) was lower than enflurane(77.5%) in the incidence. 2) During maintenance and emergence, isoflurane was lower than enflurane in the frequency of supraventicular arrhythmias. 3) Ventricular arrhythmias most frequently occurred in induction. 4) The frequency of supraventricular arrhythmias was more than two times that of ventricular ones. The arrhythmias at the AV junction were the most common, and VPC's the second. CONCLUSIONS: Greatest caution should be paid during peri-induction. It could be suggested that compared to enflurane, isoflurane better be administered for those to whom arrhythmias could be harmful.

Cardiac Arrhythmias under General Anesthesia Using Enflurane / 대한마취과학회지

The large part of pathophysiology of cardiac arrhythmias has been clarified but still arrhythmias have bothered anesthesiologists. This study was done in order to investigate the incidence and nature of arrhythmias using Holter monitor for complete study during enflurane anesthesia. The patients were randomly allocated to two groups. Group I received succinylcholine 1.5 mg/kg, and Group II vecuronium 0.1 mg/kg, intravenously for intubation. Continuous electrocardiographic recordings on magnetic tape were made in 34 patients undergoing tympanoplasty during general anesthesia (thiopental(5 mg/kg)-muscle relaxants induction, and N2O(50%)-O2-enflurane(1.2%)-pancuronium maintenance). After completion of the recordings, the tapes were scanned to detect changes in rhythm using the analyzer. Complexes were further studied by readouts on standard ECG paper. The results were as follows: 1) The number of patients(n=14) who exhibited arrhythmias during anesthetic maintenance was significantly greater than that(n=4) during induction. 2) The incidence of occurrence of cardiac arrhythmias was 64.7%. There was no difference between two groups. If sinus tachycardia included, the incidence reached at 94.1%. 3) The frequency of supraventricular arrhythmias was more than two times that of ventricular ones. The arrhythmias occuning at the AV junction were the most common, and VPCs the second most common 4) There was no effect on the frequency in arrhythmia occurrence, of age, gender, preoperative ECG findings, intraoperative serum K(+), and intraoperative PaCO2 The discrepancy in the incidence of arrhythmia occurrence between complete and incomplete studies tells that great caution should be paid perioperatively, especially to the patients who have cardiovascular disorders.