Association between ventricular premature contraction burden and ventricular repolarization duration

SUMMARY OBJECTIVE: Premature ventricular contraction is generally known as benign in the absence of structural heart disease; however, premature ventricular contraction-induced left ventricular systolic dysfunction or ventricular arrhythmias are defined in some cases. Ventricular repolarization duration differs between myocardial cells, which causes myocardial electrical heterogeneity and is thought to be responsible for ventricular arrhythmias. In our study, we aimed to evaluate the association of ventricular repolarization parameters including Tp-Te interval, Tp-Te/QT ratio, and QRS-T angle with premature ventricular contraction frequency in patients with premature ventricular contraction burden. METHODS: A total of 80 subjects who were admitted to our cardiology department and underwent 24-h electrocardiography Holter monitoring were included. Patients were divided into two groups: group 1 is defined as premature ventricular contraction burden that had frequent premature ventricular contraction ≥1% in 24-h Holter monitoring, and group 2 is defined as rare premature ventricular contraction <1% in 24-h Holter monitoring. RESULTS: Tp-Te interval and Tp-Te/QT ratio are statistically significantly prolonged in the premature ventricular contraction burden group than in the control group (85.3±13.9 vs. 65.7±11.9, p<0.001; 0.19±0.03 vs. 0.15±0.02, p<0.001, respectively). QRS-T angle was statistically significantly abnormal in the premature ventricular contraction burden group (p=0.024). CONCLUSION: Increased Tp-Te interval and widened QRS-T angle are associated with ventricular arrhythmias and might be used for the prediction of premature ventricular contraction burden in patients with premature ventricular contraction in electrocardiography in the absence of 24-h Holter monitoring.

Primer caso en Colombia de crioablación y mapeo de alta densidad en arritmia ventricular del músculo papilar / First case in Colombia of cryoablation and high-density mapping in ventricular arrhythmia of the papillary muscle

Resumen La ablación con catéter se ha convertido en un enfoque práctico para el tratamiento de las arritmias cardiacas, sobre todo cuando el manejo farmacológico óptimo no logra controlarlas. De esta manera se reduce la readmisión hospitalaria y se mejora la calidad de vida de los pacientes, incluso de aquellos en quienes no se logra la resolución completa de la arritmia. Hasta la fecha se han utilizado varias modalidades entre las que se incluyen la radiofrecuencia y la crioablación. Los principios de la criobiología se establecieron por primera vez con investigaciones sobre la congelación de los tumores y datos actuales sugieren que es necesaria una temperatura entre -30 a -40 °C para inducir muerte celular, ya sea por mecanismos inmediatos, como ruptura celular, lesión hipotérmica o daño vascular, o tardíos, como apoptosis. Se presenta el primer caso en Colombia de mapeo de alta densidad y crioablación como estrategias combinadas para el tratamiento efectivo de un paciente con alta carga de arritmia ventricular sintomática originada en el músculo papilar anterolateral, sin recurrencia de la arritmia en el tiempo de seguimiento.

Abstract Catheter ablation has become a practical approach for the treatment of cardiac arrhythmias, especially when optimal pharmacological management does not achieve adequate control of it, thus reducing hospital readmission and improving quality of life, even in patients in whom the complete resolution of the arrhythmia is not achieved. To date, a variety of modalities have been used, including radiofrequency and cryoablation. The principles of cryobiology were established for the first time with research on the freezing of tumors and current data suggest that a temperature of -30 to -40 °C is necessary to induce cell death either by immediate or delayed mechanisms; immediate as cellular rupture or hypothermic injury as well as vascular damage or apoptosis among the late. The first case in Colombia of high-density mapping and cryoablation is presented as combined strategies for the effective treatment of a patient with a high load of symptomatic ventricular arrhythmia originating in the anterolateral papillary muscle, without recurrence of the arrhythmia at the time of follow-up with symptoms, so it was to successful cryoablation, as the first case with this technique.

Ablación exitosa con radiofrecuencia a través de la cúspide coronariana derecha de un complejo ventricular prematuro parahisiano / Successful radiofrequency ablation through the right coronary cups of a parahisian premature ventricular complexes

Resumen Los complejos ventriculares prematuros (CVP) son hallazgos frecuentes en individuos con o sin enfermedad estructural cardiaca. Los CVP cuyo origen se localiza en la región parahisiana son poco frecuentes y su manejo a través de ablación con catéter de radiofrecuencia es un reto, pues su localización favorece un alto riesgo de desarrollo de bloqueo aurículo-ventricular. Se describen dos casos de pacientes con CVP parahisianos llevados a ablación con catéter de radiofrecuencia.

Abstract Premature ventricular complexes (PVC) are common findings in patients with or without structural heart disease. Parahisian PVC are uncommon and their management through radiofrequency catheter ablation remains a challenge, since their location favors a high risk for developing atrioventricular block. Two cases of patients with parahisian PVC undergoing radiofrequency catheter ablation are described.

Application value of bipolar electrogram with steep and negative initial morphology in right ventricular outflow tract origin ventricular premature ablation / 中国医师杂志

Objective:To explore the value of using bipolar electrogram to guide target selection in patients with frequent premature ventricular contractions in the right ventricular outflow tract (RVOT-PVC).Methods:The clinical data of 115 patients with idiopathic and frequent RVOT-PVC from October 2018 to January June 2020 in Guangzhou First People′s Hospital were retrospectively analyzed. The number of PVCs in Holter 24 h before ablation was 19 802.6±4916.7, and the load was (20.3±5.0)%. The Johnson & Johnson Carto 3.0 system was used to guide RVOT-PVC radiofrequency ablation, and the morphological characteristics of the bipolar electrogram in the cavity of the successful ablation target were observed. According to whether the starting part of the bipolar electrogram of the distal ablation catheter showed a steep negative shape recorded by the Carto 3.0 system, the patients were divided into positive group and negative group. The differences in ablation success rate, effective discharge time, total ablation time and other indicators of the two groups were compared.Results:Steep negative wave was recorded in the initial part of the effective target site of 87 patients (75.7%). The ablation success rate of the patients was 95.4%(83/87) based on the excitation mapping and unipolar morphology combined with the above initial part of the bipolar electrogram. Compared with the negative group, the PVC disappeared faster in patients of positive group [(6.9±2.3)s vs (10.2±2.9)s, P<0.05] and the total ablation time was shorter [(187.5±35.7)s vs (267.3±54.1)s, P<0.05]. Ambulatory electrocardiogram (ECG) was rechecked at 3 months. At 3 months, there was 1 case recurrence in the positive group and 1 case recurrence in the negative group, and there was no significant difference in the long-term recurrence rate between the two groups ( P=0.422). Conclusions:On the basis of traditional mapping, the bipolar electrogram combined with the steep negative shape of the initial part can be used as an alternative RVOT-PVC ablation strategy.

Arrhythmia-induced cardiomyopathy: a specific pediatric dilated cardiomyopathies / 中国小儿急救医学

Arrhythmia-induced cardiomyopathy(AIC) is an reversible dilated cardiomyopathy and appears to occur at any age.The morbidity of AIC is unclear and likely underestimated.The pathophysiology and mechanism of AIC is unknown.It is often difficult to determine whether arrhythmias are the cause or result of cardiac dysfunction.The diagnosis of AIC can be only confirmed after recovery or improvement of cardiac function after elimination of the tachyarrhythmia.Tachycardias, ventricular premature contraction, left bundle branch block and ventricular preexcitation are known to trigger AIC.Appropriate diagnosis and treatment of AIC can reverse cardiac function.However, arrhythmia recurrence can lead to rapid recurrence of AIC and symptoms of heart failure.

Effects of Danhong injection combined with bisoprolol on ventricular arrhythmia in patients with type 2 diabetes mellitus complicated by coronary heart disease / 中国基层医药

Objective:To investigate the efficacy and safety of Danhong injection combined with Bisoprolol on ventricular arrhythmia in patients with type 2 diabetes mellitus complicated by coronary heart disease. Methods:A total of 100 patents with type 2 diabetes mellitus complicated by coronary heart disease who received treatment in Dezhou Second People's Hospital, China between January and December 2019 were included in this study. They were randomly assigned to receive treatment either with bisoprolol (control group, n = 50) or bisoprolol + Danhong injection (treatment group, n = 50) based on routine treatment. Therapeutic effects, arrhythmia improvement, blood glucose index, islet function index, and adverse reactions during treatment were compared between the control and treatment groups. Results:Total effective rate in the observation group was significantly higher than that in the control group (88.0% vs. 70.0%, χ2 = 4.883, P < 0.05). After treatment, there were significant differences in the number of ventricular premature beats [(1 412.52 ± 587.85) beats/24 hours vs. (2 247.96 ± 761.52) beats/24 hours], paroxysmal supraventricular tachycardia [(46.58 ± 10.12) bursts/24 hours vs. (79.45 ± 12.01) bursts/24 hours], and ST segment depression [(1.24 ± 0.19) mm vs. (1.41 ± 0.24) mm] between the observation and control groups ( t = -6.141, -14.799, -3.927, all P < 0.001). After treatment, fasting blood glucose level, 2-hour postprandial glucose value and glycosylated hemoglobin level in the treatment group were (6.58 ± 1.61) mmol/L, (8.35 ± 1.72) mmol/L, and (6.14 ± 1.58)%, respectively, which were significantly lower than those in the control group [(8.24 ± 1.87) mmol/L, (9.69 ± 1.91) mmol/L, (7.68 ± 1.92)%, t = -4.757, -3.686, -4.379, all P < 0.001]. After treatment, islet beta cell function in the observation group was significantly higher than that in the control group [(56.52 ± 10.28) % vs. (47.96 ± 9.72)%, t = 4.278, P < 0.001). Insulin resistance index in the observation group was significantly lower than that in the control group [(2.06 ± 0.32) vs. (2.54 ± 0.35), t = -7.157, P < 0.001]. After treatment, there was no significant difference in the incidence of adverse reactions between the control and observation groups (12.00% vs. 8.00%), χ2 = 0.444, P > 0.05]. Conclusion:Danhong injection combined with bisoprolol is more effective in treating ventricular arrhythmia in patients with type 2 diabetes mellitus complicated by coronary heart disease than Danhong injection and bisoprolol alone. The combined treatment can reduce the incidence of ventricular arrhythmia, regulate blood glucose level, and improve islet function.

Research on inheritance of Professor WANG Jie's Experience in Treatment of Frequent Ventricular Premature Complexes Based on Inheritance Support System of Traditional Chinese Medicine / 中国实验方剂学杂志

Objective:With the aid of the Inheritance Support System of Traditional Chinese Medicine V2.5 （TCMISS V2.5），to study the experience and prescription rules of professor WANG Jie in the treatment of frequent ventricular premature complexes，and inherit his clinical experience in diagnosis and treatment. Method:Professor WANG Jie's medical records and prescriptions for frequent ventricular premature complexes from 2016 to 2020 were collected and sorted out. Improved mutual information method，association rules，complex system entropy clustering，and unsupervised entropy hierarchical clustering were used to analyze the nature and flavor，channel tropism，concerted application rules，pair and combination of herbs for statistics， association rules analysis and discovery of new prescriptions. Result:A total of 122 prescriptions of professor WANG Jie on the treatment of frequent ventricular premature complexes were collected. 110 herbs，mostly with pungent and sweet flavors，were mainly on spleen channel and also on heart，kidney，liver，lung，and stomach channels. Cinnamomi Ramulus，Paeoniae Alba Radix<italic>，</italic>Os Draconis<italic>，</italic>Ostreae Concha<italic>， </italic>Glycyrrhizae Radix<italic>，</italic>and Jujubae Fructus<italic> </italic>had the highest frequency in use. The high-frequency herbal pair was Cinnamomi Ramulus-Paeoniae Alba Radix（116 times， accounting for 95.08%），the commonly used corner drugs were Cinnamomi Ramulus<italic>-</italic>Os Draconis<italic>-</italic>Ostreae Concha<italic> </italic>（108 times，88.52%），Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Ostreae Concha （106 times， 86.89%），Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Os Draconis （106 times，86.89%）. Commonly used herbal pair was<italic> </italic>Aucklandiae Radix-Amomi Villosi Fructus. The core prescription herbs included Cinnamomi Ramulus<italic>-</italic>Paeoniae Alba Radix<italic>-</italic>Os Draconis<italic>-</italic>Ostreae Concha<italic>-</italic>Glycyrrhizae Radix<italic>-</italic>Jujubae Fructus<italic>-</italic>Zingiberis Recens Rhizoma<italic>-</italic>Achyranthis Bidentatae Radix<italic>-</italic>Codonopsis Radix<italic>-</italic>Astragali Seu Hedysari Radix<italic>-</italic>Cistanches Herba-Poria<italic>-</italic>Ziziphi Spinosae Semen. Conclusion:Professor WANG Jie's prescription for the treatment of frequent ventricular premature complexes is Guizhi Jia Longgu Mulitang，and the main herbs are Cinnamomi Ramulus，Paeoniae Alba Radix，Os Draconis，Ostreae Concha，Glycyrrhizae Radix，and Jujubae Fructus. The final prescription could be adjusted according to the diseases and symptoms of patients.

Clinical research of Yangxin-Fulv decoction combined with amiodarone hydrochloride in the treatment of dilated cardiomyopathy complicated with ventricular arrhythmia / 国际中医中药杂志

Objective@#To explore the clinical efficacy of Yangxin-Fulv decoction combined with amiodarone hydrochloride in the treatment of dilated cardiomyopathy (DCM) complicated with ventricular arrhythmia (VA).@*Methods@#According to the random table method, 103 DCM patients with VA were divided into the control group (n=51) and the research group (n=52). The patients in the control group were given amiodarone hydrochloride orally on the basis of routine treatment, while the research group was given Yangxin-Fulv decoction on the basis of the control group. The treatment course of two groups was 3 months. The total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, short-term ventricular tachycardia,left ventricular ejection fraction (LVEF), left ventricular diastolic internal diameter (LVEDD), left ventricular end systolic diameter (LVESV) and left ventricular posterior wall thickness (LVPWT) were recorded by dynamic electrocardiogram analyzer. The Dynamic electrocardiogram was used to monitor QT interphase dispersion (QTd) and calibrate QT interphase dispersion (QTcd) and change of QTc interval. Clinical efficacy was evaluated and adverse reactions were recorded.@*Results@#The total effective rate of the research group was 88.5% while the control group was 62.8%, where the difference between two groups was statistically significant (χ2=6.106, P=0.014). After treatment, the total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, and short-term ventricular tachycardia in the research group were significantly lower than those in the control group (t=-7.005,-4.760,-16.111,-12.059, P<0.001). After treatment, the LVEF of the research group was significantly higher than that of the control group (t=4.024, P<0.01), while the LVEDD, LVESV and LVPWT of the research group were significantly lower than those of the control group (t=-3.913,-6.623,-5.719, P<0.001). After treatment, the changes of QTc interval (402.08 ± 30.14 ms vs. 421.08 ± 32.19 ms, t=-3.093), QTd (65.25 ± 5.63 ms vs. 72.18 ± 5.92 ms, t=-6.089) and QTcd (72.18 ± 10.56 ms vs. 80.53 ± 12.09 ms, t=-3.735) in the research group were significantly lower than those in the control group (P<0.01). During the treatment period, the incidence of adverse reactions in the control group was 7.8% (4/51) and in the research group was 5.8% (3/52). There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.175, P=0.676).@*Conclusions@#The Yangxin-Fulv decoction combined with amiodarone hydrochloride can improve the clinical symptoms and clinical efficacy of DCM patients with VA by inhibiting ventricular remodeling and arrhythmia.

Premature complex-induced chronic cough :case report and literature review / 中华全科医师杂志

The clinical presentation,chest image and electrocardiogram of 4 cases of premature complex-induced chronic cough admitted in the First Affiliated Hospital of Guangzhou Medical University from March 2008 to February 2009,were retrospectively analyzed.And other 6 cases of premature complex-induced chronic cough were retrieved for literature review.In total 10 patients,there were 3 males and 7 females aged 58(36-74) years,with a disease duration of 10.5 (3.0,264.0) months.The main clinical presentations were chronic dry cough with post-sternal thump and premature beats as shown by auscultation and 24 h-electrocardiogram examination.Cough was relieved after the premature beats were controlled with the treatment of arrhythmia drugs or radiofrequency ablation.Premature complex-induced cough is rare but it should be considered when the chief complaint of patients with premature beat is chronic cough.

Study of left ventricular torsional mechanics in patients with premature ventricular complexes from right ventricular outflow tract / 中华超声影像学杂志

Objective To assess alternations in left ventricular( LV) torsion parameters in healthy subjects and patients with premature ventricular complexes ( PVCs) from the right ventricular outflow tract (RVOT) .Methods ThirtypatientswithPVCsfromRVOTand31healthysubjectswereincluded.Two-dimensional speckle tracking imaging( 2D-STI) was applied to evaluate LV torsion parameters ,including LV rotational degrees in basal and apical levels respectively ,LV total torsional degrees ,and time to peak rotational and torsional degrees . All values of patients with PVCs were recorded during both sinus beats ( PVC-S) and premature ventricular beats ( PVC-V) . Results No significant difference was observed in left ventricular ejection fraction(LVEF) between PVC-S group and control subjects( P > 0 .05) ,while LV rotational degrees in apical levels[( 8 .47 ± 3 .54)° vs (9 .50 ± 3 .21)° , P = 0 .042] and LV total torsional degrees [ (11 .25 ± 6 .31)° vs (14 .00 ± 4 .07)° , P =0 .046] were significantly reduced in PVC-S group . In addition to the reduction of LV rotational degrees in apical levels[( 3 .93 ± 7 .23)° vs (9 .50 ± 3 .21)° , P =0 .000] and LV total torsional degrees[ ( 4 .35 ± 9 .62)° vs (14 .00 ± 4 .07)° , P =0 .000] ,lower apical levels[ ( -0 .57 ± 4 .44)° vs ( -5 .26 ± 3 .84)° , P =0 .000] and advanced LV rotational degrees [ ( 40 .5 ± 18 .6)％vs (48 .0 ± 9 .1)％ , P =0 .05] in basal levels were observed in PVC-V group in comparison with the control subjects . Compared with the PVC-S group ,PVC-V group showed lower LV rotational degrees in basal levels [ ( -0 .57 ± 4 .44)° vs ( -4 .57 ± 4 .57)° , P = 0 .000] and advanced time to peak rotational degrees [ (40 .5 ± 18 .6)％ vs (48 .1 ± 12 .6)％ , P =0 .018] ,as well as advanced time to peak and lower LV total torsionaldegrees[(39.3±15.4)％ vs(46.7±13.8)％ ,P =0.007 ;(4.35±9.62)°vs(11.25±6.31)°,P=0 .001] .Conclusions As to RVOT-PVC patients ,LV myocardial torsional motion has changed in PVC-S mainly manifested as a decrease of rotation degrees in apical levels even if the LVEF is still in the normal range . During PVC-V the rotation and twist degree is further reduced ,and the time sequence altered , accompanied with significantly decreased LVEF .

Treadmill test for premature ventricular contraction / 国际儿科学杂志

Premature ventricular contraction is one of the most common arrhythmias in pediatric.Its incidence increases with age.The clinical symptoms of children's premature ventricular beats vary greatly,and the pediatric patients may have no discomforts,while the serious patients may have life-threatening events such as malignant ventricular arrhythmia and cardiac arrest.How to evaluate premature ventricular contraction and to guide the life and activities of children with premature ventricular contraction is of great significance.By adjusting the speed and slope of the plate,the motion of the subject is adjusted to increase the work and increase the heart rate,then the arrhythmia that is absent in the static state can be found or the original arrhythmia can be changed or disappeared.Treadmill test has been carried out in China for more than 30 years.Though some clinical experience has been accumulated,but there are still a lot of problems.This article reviews the present state and precision management of treadmill test's effect on children with ventricular premature contraction.

Effect of ventricular premature catheter ablation on diastolic function in elderly patients / 中国综合临床

Objective To observe whether catheter ablation for ventricular premature complexes (PVC) has an effect on ventricular diastolic function in elderly patients.Methods Elderly patients older than 65 years of age who underwent catheter ablation from March 2012 to May 2015 for idiopathic ventricular premature complexes were enrolled.Preoperative echocardiography was performed using E／e′ for left ventricular diastolic function and venous brain natriuretic peptide (BNP) levels were measured.All patients underwent catheter ablation under the guidance of a three?dimensional mapping system.Cardiac ultrasound and BNP levels were repeated 6 months after ablation, and 24?hour electrocardiogram was performed to confirm ventricular premature complexes.Results There were a total of 89 patients with idiopathic ventricular premature complexes ( PVC) who underwent catheter ablation.81 cases were successed at 6 months,with a success rate of 91.0%.At 6 months after ablation,the E／e′ values were significantly lower ((15.3±5.2) vs ( 10.2± 3.2),( P＜0.001)) and BNP levels were significantly lower (( 202.0 ± 23.2) pg／L vs (94±13.3) pg／L),(P＜0.001).For the unsuccessful subgroup,there was no significant change in E／e′values (16.3±6.3 vs 15.2±5.6) and BNP levels ((223.0±26.8) pg／L vs (245.0±23.9) pg／L), (P＞0.05).Conclusion The number of premature ventricular beats is associated with left ventricular diastolic function,and ventricular premature catheter ablation can improve left ventricular diastolic function in elderly PVC patients.

Study on radiofrequency catheter ablation below tricuspid valve in premature ventricular contraction originating from tricuspid annulus under Carto3 guidance / 中国医师进修杂志

Objective To evaluate the safety and clinical effect of radiofrequency catheter ablation below tricuspid valve using Carto3 system combined with SmartTouch contact force catheter in premature ventricular contraction (PVC) originating from tricuspid annulus. Methods The clinical data of 21 patients with PVC originating from tricuspid annulus from September 2016 to September 2018 were retrospectively analyzed. Radiofrequency catheter ablation below tricuspid valve was performed using Carto3 system combined with SmartTouch contact force catheter. Results The result of intraoperative mapping under Carto3 guidance showed that premature ventricular contraction in 12 cases originated from septal portion of the tricuspid annulus and in 9 cases originated from free wall of the tricuspid annulus. All patients′ ablation were successful, and no operative complications occurred. The patients were followed up for 1 to 23 months, and no recurrence occurred. However, there was 1 patient whose first radiofrequency ablation on the tricuspid valve was immediately successful, and PVC recurred 2 h after operation. Finally, radiofrequency ablation was performed successfully at 12 O′clock below the tricuspid valve 9 months later. Conclusions Radiofrequency catheter ablation below the tricuspid valve using carto3 guidance combined with SmartTouch contact force is safe in PVC originated from tricuspid annulus, and it can improve the success rate.

Clinical research of Yangxin-Fulv decoction combined with amiodarone hydrochloride in the treatment of dilated cardiomyopathy complicated with ventricular arrhythmia / 国际中医中药杂志

Objective To explore the clinical efficacy of Yangxin-Fulv decoction combined with amiodarone hydrochloride in the treatment of dilated cardiomyopathy (DCM) complicated with ventricular arrhythmia (VA). Methods According to the random table method, 103 DCM patients with VA were divided into the control group (n=51) and the research group (n=52). The patients in the control group were given amiodarone hydrochloride orally on the basis of routine treatment, while the research group was given Yangxin-Fulv decoction on the basis of the control group. The treatment course of two groups was 3 months. The total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, short-term ventricular tachycardia,left ventricular ejection fraction (LVEF), left ventricular diastolic internal diameter (LVEDD), left ventricular end systolic diameter (LVESV) and left ventricular posterior wall thickness (LVPWT) were recorded by dynamic electrocardiogram analyzer. The Dynamic electrocardiogram was used to monitor QT interphase dispersion (QTd) and calibrate QT interphase dispersion (QTcd) and change of QTc interval. Clinical efficacy was evaluated and adverse reactions were recorded. Results The total effective rate of the research group was 88.5% while the control group was 62.8%, where the difference between two groups was statistically significant (χ2=6.106, P=0.014). After treatment, the total number of ventricular premature beats, ventricular premature second rhythm, triple rhythm, and short-term ventricular tachycardia in the research group were significantly lower than those in the control group (t=-7.005,-4.760,-16.111,-12.059, P<0.001). After treatment, the LVEF of the research group was significantly higher than that of the control group (t=4.024, P<0.01), while the LVEDD, LVESV and LVPWT of the research group were significantly lower than those of the control group (t=-3.913,-6.623,-5.719, P<0.001). After treatment, the changes of QTc interval (402.08 ± 30.14 ms vs. 421.08 ± 32.19 ms, t=-3.093), QTd (65.25 ± 5.63 ms vs. 72.18 ± 5.92 ms, t=-6.089) and QTcd (72.18 ± 10.56 ms vs. 80.53 ± 12.09 ms, t=-3.735) in the research group were significantly lower than those in the control group (P<0.01). During the treatment period, the incidence of adverse reactions in the control group was 7.8% (4/51) and in the research group was 5.8% (3/52). There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.175, P=0.676). Conclusions The Yangxin-Fulv decoction combined with amiodarone hydrochloride can improve the clinical symptoms and clinical efficacy of DCM patients with VA by inhibiting ventricular remodeling and arrhythmia.

Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions? / Há Alguma Relação entre os Parâmetros de Repolarização do Miocárdio e a Frequência de Contrações Ventriculares Prematuras?

Abstract Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.

Resumo Fundamento: As contrações ventriculares prematuras (CVPs) podem provocar arritmias ventriculares letais em pacientes com doença cardíaca estrutural, no entanto o papel das CVPs em indivíduos saudáveis permanece controverso, já que não há muitos estudos clínicos disponíveis. Recentemente, alguns marcadores de repolarização do miocárdio, tais como o intervalo Tp-e e as relações Tp-e/QT e Tp-e/QTc, foram relatados como úteis para prognosticar arritmias ventriculares letais em diversos transtornos clínicos sem doença cardíaca estrutural. Objetivo: Neste estudo, o objetivo foi investigar a relação entre os marcadores de repolarização do miocárdio e as CVPs frequentes em indivíduos sem doença cardíaca estrutural. Métodos: Este estudo incluiu 100 pacientes com queixas de tonturas e palpitações. Eletrocardiografia de 12 derivações e registros de Holter ambulatorial de 24 horas foram obtidos de todos os pacientes. A carga de CVP foi calculada como o número total de CVPs dividido pelo número de todos os complexos de QRS no tempo de registro total. Foram considerados significativos valores p < 0,05. Resultados: O intervalo Tp-e e a relação Tp-e/QTc foram significativamente mais altos em pacientes com carga de CVP mais alta do que nos pacientes com carga de CVP inferior, e encontrou-se correlação positiva entre esses marcadores e a carga de CVP. Tp-e (β = 1,318, p = 0,043) e Tp-e/QTc (β = -405,136, p = 0,024) na derivação V5 foram identificados como preditores independentes da carga de CVP aumentada. Conclusões: O intervalo Tp-e e a razão Tp-e/QTc foram mais altos em pacientes com um valor mais alto de CVP. Nosso estudo mostrou que CVPs podem ter um efeito negativo na repolarização do miocárdio. Essa interação pode resultar em risco aumentado de arritmias malignas.

Clinical Observation of Metoprolol Combined with Shensong Yangxin Capsule in the Treatment of Ventricular Premature Beat / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of metoprolol combined with Shensong yangxin capsule in the treatment of ventricular premature beat. METHODS:A total of 104 patients with ventricular premature beat during Jan. 2016-Jan. 2017 were analyzed retrospectively,and they were divided into control group(52 cases)and observation group(52 cases)according to medication plan. Control group was given Metoprolol tartrate tablet 25 mg orally,3 times a day. Observation group was given Shensong yangxin capsule 1.2 g orally,3 times a day,on the basis of control group. Both groups were treated for consecutive 28 d. Clinical efficacies of 2 groups were observed. The electrocardiogram P-R interval and Q-T interval,24 h premature beat times,heart rate,the occurrence of palpitation before and after treatment and ADR were observed. RESULTS:Total response rate of observation group(92.30%)was significantly higher than that of control group(76.92%),with statistical significance(P<0.05).Before treatment, there was no statistical significance in electrocardiogram P-R interval and Q-T interval,24 h premature beat times,heart rate or palpitation times between 2 groups(P>0.05). After treatment,electrocardiogram P-R interval and Q-T interval of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group. 24 h premature beat times,palpitation times of 2 groups and heart rate of control group were significantly lower than before treatment;and 24 h premature beat times,palpitation times of the observation group was significantly lower than the control group,with statistical significance(P<0.05);there was no statistical significance in heart rate of observation group before and after treatment(P>0.05). There was no statistical significance in the total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:For ventricular premature beat,metoprolol combined with Shensong yangxin capsule show significant therapeutic efficacy,can reduce the times of premature beat and improve patients'electrocardiogram without increasing the occurrence of ADR.

Radiofrequency catheter ablation of premature ventricular contractions in children under CARTO3 system: a retrospective study from one single center / 中华儿科杂志

Objective@#To evaluate the clinical effect and summarize the experience of radiofrequency catheter ablation (RFCA) for children suffered from premature ventricular contractions (PVCs).@*Methods@#This retrospective study was conducted by descriptive analysis. A total of 108 cases with frequent PVCs from Shanghai Children's Medical Center were treated with RFCA under the guidance of CARTO3 system from January 2011 to December 2016. The immediate success rate of the procedure, the recurrence rate and the perioperative complications were summarized. The constituent ratio of different PVCs origins, the trend of overall procedure time and success rate in recent years were analyzed. Statistical analyses were performed using F test.@*Results@#Immediate success of RFCA was achieved in 104 cases (96.3%, 104/108) and 4 cases (3.7%, 4/108) failed. The PVCs recurred during follow-up of over 6 months in 5 cases (4.8%, 5/104) . There were no severe complications related to the procedure. The sites of PVCs origin, in 52 cases originated from right ventricular outflow track (48.2%, 52/108) , 17 cases originated from left ventricular outflow track (15.7%, 17/108) and 26 cases originated from tricuspid annulus (24.1%, 26/108) . Among the three predilection sites of PVCs, the operation time was (141±46) min for right ventricular outflow track, (155±50) min for left ventricular outflow track, and (166±57) min for tricuspid annulus. However, the difference was not statistically significant (F=1.79, P=0.17) . X-ray exposure time was (14±8) minutes for right ventricular outflow track ablation, (32±14) minutes for left ventricular outflow track ablation and (16±8) minutes for tricuspid annulus ablation respectively. The exposure time for the ablation on left ventricle was significantly longer than the other two sites (F=5.12, P=0.018) .@*Conclusion@#RFCA is safe and effective for PVCs in children with high success rate and low recurrence and complication rates.

Electrocardiographic characteristics of idiopathic ventricular arrhythmias originating from the tricuspid annulus regions / 中华心血管病杂志

Object@#To explore the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating from tricuspid annulus region.@*Methods@#Present study included 169 consecutive patients undergoing catheter ablation of VAs from tricuspid annulus origin in our department from August 2007 to September 2016. Based on the origin sites, the patients were divided into two subgroups, the free wall group (81 cases) and septal wall group (88 cases). Based on the location, patients in the free wall group were classified into anterolateral (22 cases), lateral (26 cases) and posterolateral (33 cases) subgroups. Patients in the septal group were classified into anteroseptal (10 cases), midseptal (71 cases) and posteroseptal (7 cases) subgroups. We analyzed the electrocardiographic features of these patients and in 87 patients with PVCs/VT originating from right ventricular outflow tract.@*Results@#(1) A positive R wave inⅠ, aVL, V5-V6 leads were found among most of patients, only few cases originating from tricuspid annulus anteroseptum group and tricuspid annulus anterolateral group demonstrated qr or qs pattern in aVL lead. 97.53% (79/81) patients demonstrated rS pattern in V1-V3 leads with VAs originating from tricuspid annulus free wall, and 9/10 patients demonstrated rS pattern in V1 lead with VAs originating from anteroseptum, and 97.44% (76/78) patients demonstrated QS pattern in V1 lead with VAs originating from midseptum and posteroseptum. Precordial lead transition zone was on or behind V3 for tricuspid annulus free wall group (96.3%, 78/81), but in front of V3 for tricuspid annulus septum wall group (47.73%, 42/88) (P<0.01). The S wave's amplitude smaller than-1.81 mV in lead V2 can be used as a cutoff value to identify if PVC/VT is originating from free wall or septum of TA. R wave in inferior wall leads was found among 98.85% (86/87) patients with PVCs/VT originating from right ventricular outflow tract.@*Conclusion@#A positive R wave in Ⅰ, aVL, V5-V6 leads was found among most of patients with idiopathic ventricular arrhythmias originating from the tricuspid annulus regions, but VAs originating from different portions of tricuspid annulus area have distinct electrocardiographic characteristics.

Management of Common Arrhythmia in the Neurological Intensive Care Unit

Cardiac arrhythmias are a common problem in the neurological intensive care unit and represent a major cause of ischemic stroke. Significant arrhythmias are most likely to occur in elderly patients. In this review, we focus on three arrhythmias: premature beats, atrial fibrillation, and QT prolongation. The goal of this review is to provide a current concept of diagnosis and acute management of arrhythmias in the neurological intensive care unit.

Reversal of Left Ventricular Function by PVC Ablation in Dilated Cardiomyopathy Patient

Premature ventricular complex (PVC) usually follows a benign course and shows good response to medical therapy. However, high burden of PVC deteriorates cardiac function and is often associated with progression into dilated cardiomyopathy (DCMP). We report a case of a young patient who recovered from DCMP after PVC ablation. The patient complained of palpitations and dyspnea on exertion. Holter examination revealed an isolated PVC burden of 29%. Despite intensive medical therapy for more than a year, symptoms aggravated and PVC burden was not diminished on follow-up Holter examination. Furthermore, the echocardiogram revealed deteriorated systolic function as well as left ventricular enlargement, indicating progression into DCMP. Surface electrocardiogram indicated PVC origin in the left ventricular outflow tract. Detailed mapping at the right ventricle and left ventricle outflow tract with the aid of 3-dimensional mapping system, demonstrated PVC origin from the left ventricular outflow tract area, between the right and left coronary cusps. Radiofrequency ablation successfully abolished all ventricular premature beats. Follow-up Holter examination revealed no PVC, and the echocardiogram showed recovery to normal systolic function and chamber size. In conclusion, ablation of PVC should be considered when it does not respond to medical therapy and is associated with deterioration of cardiac function.