A Young Healthy Woman with Supraventricular Tachycardia Reveals an Underlying Left Ventricular Non-compaction Cardiomyopathy: A Rare Case Report

LVNC (left ventricular non-compaction) is a rare congenital cardiomyopathy with a reported incidence of 0.05% in adults. It can occur in isolation or affect both ventricles. It’s characterized by prominent LV trabeculae and deep intertrabecular recesses which are filled with blood from the ventricular cavity without evidence of communication to the epicardial coronary artery system. Frequent premature supra ventricular tachycardia as unique finding in LVNC cardiomyopathy is rare manifestation of this disease. We report a case of a frequent persistent supraventricular tachycardia as first manifestation of a patient with LVNC cardiomyopathy in a young healthy woman who despite radio frequency ablation therapy of the supraventricular tachycardia remains symptomatic. The patient was later placed on medical therapy based on a non-cardio selective beta-blocker with a good clinical outcome without recurrent of supra-ventricular arrythmias.

The relationship between premature ventricular complexes and index of cardiac-electrophysiological balance

SUMMARY OBJECTIVE: Premature ventricular complexes are common in healthy individuals' ambulatory monitoring. The index of cardiac-electrophysiological balance may predict malignant ventricular arrhythmias. This study investigated the relation between Premature ventricular complex burden and index of cardiac-electrophysiological balance in 24-h Holter monitoring. METHODS: A total of 257 patients who were admitted to a cardiology outpatient clinic without structural heart disease and underwent 24-h Holter monitoring were included in the study. Demographic features, laboratory parameters, and electrocardiographic and echocardiographic values of all patients were obtained from the hospital database. Patients were categorized into the following four groups according to their premature ventricular complex burden: ≤5% premature ventricular complexes as group 1, >6 and ≤10% premature ventricular complexes as group 2, >11 and ≤20% premature ventricular complexes as group 3, and >20% premature ventricular complexes as group 4. QRS, QT, and T peak to end interval were measured by resting electrocardiography. QT interval was corrected using Bazett's formula. T peak to end interval/QT, T peak to end interval/corrected QT interval, index of cardiac-electrophysiological balance, and corrected index of cardio-electrophysiological balance ratios were calculated. RESULTS: There was no significant difference between groups regarding cardiovascular risk factors. In group 4, beta-blocker usage was significantly higher, and the serum magnesium levels were significantly lower than in other groups. There was no difference in QT duration or index of cardiac-electrophysiological balance values; however, corrected index of cardio-electrophysiological balance was significantly lower in the highest premature ventricular complex group (5.1, 5.1, 4.8, 4.7, p=0.005). In multivariate backward logistic regression analyses, it was found that lower corrected index of cardio-electrophysiological balance, lower serum magnesium levels, lower serum creatinine levels, larger left atrium size, and higher T peak to end interval were associated with higher premature ventricular complexes. CONCLUSION: Corrected index of cardio-electrophysiological balance is a novel and noninvasive marker that can predict premature ventricular complex burden in patients with structurally normal hearts.

Clinical Effect of Tiaomai Mixture on Premature Ventricular Contraction in Coronary Heart Disease Due to Qi-Yin Deficiency and Stagnated Heat in Blood Vessel / 中国实验方剂学杂志

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.

Papel del sistema Purkinje y del tracto de salida del ventrículo derecho en las arritmias ventriculares malignas y la muerte súbita / Role of the Purkinje system and right ventricular outflow tract in malignant ventricular arrhythmias and sudden death

RESUMEN El sistema Purkinje y el tracto de salida del ventrículo derecho tienen un papel trascendente en relación con las arritmias ventriculares malignas (taquicardia y fibrilación ventriculares, torsión de puntas) y con la muerte súbita cardíaca. Se discuten su fisiopatología, participación en el origen (extrasístoles desencadenantes) y mantenimiento de estas arritmias, y las posibilidades ablativas para disminuir las recurrencias y los episodios de tormenta eléctrica. Se expone el diagnóstico diferencial entre variantes benignas y malignas de la taquicardia ventricular relacionada con el tracto de salida del ventrículo derecho y la relación entre factores genéticos, estructurales, electroanatómicos y funcionales (inflamación, fibrosis), con los eventos clínicos y la vulnerabilidad a las arritmias. Se necesita reclasificar algunas de estas enfermedades, vistas ahora en su carácter orgánico-funcional (síndrome de Brugada, por ejemplo), lo cual implica cambios revolucionarios en algunos conceptos clásicos y una nueva visión en cuanto a la estratificación de riesgo y la conducta terapéutica.

ABSTRACT The Purkinje system and the right ventricular outflow tract play a pivotal role in relation to malignant ventricular arrhythmias (ventricular tachycardia and fibrillation, torsades de pointes) and sudden cardiac death. Details such as their pathophysiology, origin involvement (triggering extrasystoles) maintenance of such arrhythmias, and ablative possibilities to reduce recurrences and electrical storm events are discussed herein. The differential diagnosis between benign and malignant ventricular tachycardia related to the right ventricular outflow tract, and the relationship between genetic, structural, electroanatomical and functional factors (inflammation, fibrosis) with clinical events and vulnerability to arrhythmias are presented. Some of these diseases need to be reclassified as they are now seen in their organic-functional character (Brugada syndrome, for example), and this implies radical changes in some classical concepts as well as a new perspective on risk stratification and therapeutic management.

Mapeo y ablación exitosa, desde el interior de la vena cardíaca magna, de extrasístoles ventriculares originados en el techo (summit) del ventrículo izquierdo / Mapping and successful ablation, from within the great cardiac vein, of premature ventricular contractions originating from the summit of the left ventricle

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.

Arritmias y muerte súbita en la falla cardíaca: estratificación eléctrica de grupos de riesgo / Arrhythmias and sudden death in heart failure: electrical stratification of risk groups

RESUMEN Se presenta una panorámica de la falla cardíaca ligada a las arritmias y a la muerte súbita, que pueden coexistir, agravarse, o ser causa o consecuencia una de otra. Se discuten los signos eléctricos premonitorios que permiten estratificar riesgo en pacientes con eventos previos, con posible acercamiento a la realidad, y en quienes no los han presentado (la mayoría, los no protegidos), y resulta muy difícil o imposible establecer un pronóstico. Estos signos son numerosos, esquivos, de baja especificidad y sensibilidad, ninguno es absoluto ni despreciable, para interpretarlos se requiere una visión integral. Se discuten las extrasístoles ventriculares como predictoras y desencadenantes de arritmias, de muerte súbita y de miocardiopatía, y la utilidad de los procedimientos ablativos frente a los medicamentosos. Los signos eléctricos son buenos para identificar grandes grupos de riesgo pero no lo son tanto para, dentro del gran grupo de bajo riesgo (la mayoría), identificar los individuos de alto riesgo.

ABSTRACT In this research is presented an overview of heart failure related to arrhythmias and sudden death, which can coexist, worsen, or be cause or consequence of one another. Here are discussed the premonitory electrical signs that allow to stratify risk in patients with previous events, with a possible approach to reality, and in those who have not presented them (most of them, the unprotected ones) and where a prognosis is very difficult, or impossible, to be established. These signs are numerous, elusive, with low specificity and sensitivity, none is absolute or negligible, in order to interpret them, a comprehensive vision is required. Premature ventricular contractions are discussed as predictors and triggers of arrhythmias, sudden death and cardiomyopathy, as well as the usefulness of ablative procedures versus medications. Electrical signs are good for identifying large risk groups but not for identifying high risk individuals inside the large low risk group (the majority).

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.

Real-time premature ventricular contractions detection based on Redundant Discrete Wavelet Transform

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.

Lead aVL in combination with lead V1:A new method for identifying premature ventricular contractions originating from aortic sinus cusp / 中国介入心脏病学杂志

Objective To explore the validity of lead aVL in combination with lead V1 for identifying idiopathic outflow tract premature ventricular contractions(PVCs)originating from aortic sinus cusp(ASC).Methods This study consecutively enrolled 102 idiopathic outflow tract PVCs patients who underwent radiofrequency catheter ablation at the Second Xiangya Hospital,Central South University between January 2015 and August 2017.We compared the QRS wave amplitudes in the surface twelve leads electrocardiography between PVCs originating from ASC and right ventricular outflow tract(RVOT).Results(1)The origin sites of PVCs were ASC(n=28,27.5％)and RVOT(n=74,72.5％).The lead V1R/S wave amplitude ratio and lead aVL S wave amplitude were significantly higher in the ASC group than in the RVOT group[(1.14±1.32)vs.(0.16±0.18),P＜0.001;(0.99±0.36)mV vs.(0.56±0.26)mV,P＜0.001].The areas under the receiver operating characteristic curve(AUCs)and 95％confidence intervals of V1R/S wave amplitude ratio and aVL S wave amplitude had relatively larger AUCs which were 0.894(0.824-0.964)and 0.831(0.749-0.912),with the cut-offs of 0.25 and 0.80 respectively.(2)The sensitivity,specificity and accuracy of the lead V1R/S wave amplitude ratio＞0.25 to identify ASC originating PVCs were 78.9％,83.7％and 82.4％,respectively.The sensitivity,specificity and accuracy of the lead aVL S wave amplitude＞0.80 mV were 78.6％,85.1％and 83.3％,respectively.The lead aVL S wave amplitude＞0.80 mV in combination with the lead V1R/S wave amplitude ratio＞0.25 was applied to developed a new diagnostic approach and the sensitivity,specificity and accuracy were 60.7％,93.2％and 84.3％,respectively.Conclusions Lead aVL in combination with lead V1 could be applied to develop a more accurate method for identifying ASC originating PVCs.

Ventricular arrhythmias originating from left ventricle posterior papillary muscle:electrocardiographic characteristics and catheter ablation / 中国介入心脏病学杂志

Objective To investigate the clinical characteristics, electrocardiography, electrophysiological features and the eff ectiveness of catheter ablation of ventricular arrhythmias originating from left ventricle posterior papillary muscles. Methods Clinical features and electrocardiography of 16 patients with ventricular arrhythmias arising from left ventricular posterior papillary muscles underwent catheter ablation were retrospectively analyzed. Activation mapping and/or pace mapping were performed to identify the site of origin and transthoracic echocardiography were used to demonstrate ablation catheter position and contact. The immediate success and recurrence rates were evaluated. Results During arrhythmias, QRS wave duration of 16 patients [5 men, mean age (45.0±18.2) years] was (155.1±9.0)ms. The prevalence of R>r' and r<R' of V1QRS morphology was 6/16 and 9/16, respectively. Earliest local ventricular electrogram preceded QRS wave by (30.8±8.4)ms at successful ablation site. Immediate success were achieved in 14 patients (14/16) ,11 patients(11/16) had full clinical follow-up and recurrences occurred in 5 patients (5/11). Conclusions Electrocardiography of ventricular arrhythmias originating from left ventricular posterior papillary muscles has its specifi c features. Earliest focal electrogram indicates successful ablation site and transthoracic echocardiography can demonstrate ablation catheter position and increase success rate but recurrence rate is still high.

Effect of amiodarone hydrochloride treatment time on treatment success rate of ventricular premature beats after radiofrequency ablation / 中国生化药物杂志

Objective To investigate the effect of treatment time with amiodarone hydrochloride on treatment success rate of ventricular premature beats after radiofrequency ablation. Methods 46 cases of patients with frequent premature ventricular arrhythmia who received RFCA for the first time in department of gardiology,huangyan hospital of wenzhou medical university from February 2013 to February 2015 were selected,and randomly divided into two groups,the control group were treated with amiodarone hydrochloride for one months,the study group were treated with amiodarone hydrochloride for six months.Left ventricular function and structural parameters,heart rate variability were measured in two groups,the main clinical symptom scores,success rate,efficacy and safety were compared. Results Compared with before treatment,two groups of LVESD,LVEDD and PVC decreased (P<0.05),LVEF increased (P<0.05),SDNN,rMSSD,PNN50,LF and HF increased (P<0.05),scores of palpitation,shortness of breath,chest tightness and main symptom score decreased (P<0.05).Compared with the control group,level of PVC in the study group was lower (P<0.05),LVEF was higher(P<0.05),LVESD and LVEDD were had no significant differences,levels of SDNN,rMSSD,PNN50,LF,HF were higher (P<0.05),scores of palpitations,shortness of breath,chest tightness main symptom score were lower (P<0.05).There were no significant differences in the success rate, clinical efficacy and adverse reaction rate between the two groups. Conclusion The time of taking amiodarone after radiofrequency catheter ablation in patients with PVCs,but taking six months and medication compared to one month,can reduce heart palpitations,chest tightness and other symptoms,and improve left ventricular function,with high security.

Premature ventricular complex-induced cardiomyopathy / 中华实用儿科临床杂志

Premature ventricular complex (PVC)-induced cardiomyopathy is due to frequent PVCs and it can be potentially reversible in selected patients resolves after catheter ablation.PVCs burden is importantly associated with impaired left ventricular(LV) function.Necessary evaluation is important for PVCs patients.For patients with high PVC burdens above 15％-25％ of the total cardiac beats in 24 hours,medical treatment should be used to reduce PVC burden and to improve LV function.Catheter ablation of PVCs is recommended for selected patients with high PVC burdens associated with a decline in LV systolic function.

Advances in the diagnosis and treatment of premature ventricular contraction in children / 国际儿科学杂志

Premature ventricular contraction(PVC)is one of the most common types of arrhythmias in children.PVC in children usually disappears with age gradually and doesn't affect cardiac function and has a fa-vorable prognosis.Some PVC patients may have malignant arrhythmias or cardiomyopathy,which cause the de-creased ventricular systolic function,and even cardiac arrest,leading to poor prognosis.PVC can be classified to functional and structural type,and can also be classified according to the origin site.Until now,there are still no well-accepted standards to assess the prognosis and treatments of PVC in children.The PVC therapy in children mainly depends on the PVC frequency,type and the presence of congenital heart disease.Currently,propafenone, β-blocker and amiodarone are the nost commonly used drugs in PVC.Radiofrequency ablation(RFA)is another way of treating refractory cases. In this paper,we reviewed the prognosis of different types and therapies of PVC,and hope it could guide the clinical treatments of PVC in children.

Completely-zero-ray for radiofrequency catheter ablation treating premature ventricular complexes from right ventricular outflow tract / 实用医学杂志

Objective To evaluate the efficacy and safety of Completely-zero-ray for radiofrequency catheter ablation(RFA)of premature ventricular complexes from right ventricular outflow tract(RVOT-PVC)using a 3-dimensional electroanatomic mapping system with single catheter compared with conventional two-dimensional catheter ablation guided by X-ray. Methods 25 patients with RVOT-PVC undergoing ablation treatment in our hospital between April 2015 and March 2017 were included in the research.13 patients were in the 3-dimensional(3-D)group treated by CARTO 3 molding and mapping and ablation with completely zero X-ray.12 patients were in the 2-dimensional(2-D)group treated by ablation guided by traditional X-ray. Such indexes as mapping time,total fluoroscopy time,total procedure time,discharge times,success rate,and complications of the two groups were compared.Results The two groups have no difference in success rate(91.6% vs 92.3%,P=0.953). Compared with 2-D group,the 3-D group have the significant decrease in mapping time(14.8 ± 4.3 vs 4.5 ± 2.2,P=0.000),total fluoroscopy time(20.0 ± 4.6 vs 0 ± 0,P=0.000),total procedure time(63.8 ± 3.9 vs 54.4 ± 4.6,P=0.000)and discharge times(5.7 ± 2.3 vs 3.4 ± 1.0,P=0.003). Conclusions Compared with traditional X-ray guided ablation, mapping time,operation time,discharge times in 3-D group decreased significantly,and zero fluoroscopy can be avoided.Complete ablation for RVOT-PVC guided by zero X-ray fluoroscopy using the CARTO 3 is safe and effective.

Curative effect of bisoprolol fumarate combined with wenxin granule for patients with heart failure complicated with premature ventricular / 药物评价研究

Objective To explore the curative effect of bisoprolol fumarate combined with wenxin granule for patients with heart failure complicated with premature ventricular.Methods 132 patients with heart failure and premature ventricular complexes were enrolled in our hospital from January 2013 to January 2016,and which patients divided into two groups,bisoprolol fumarate group (Group BF,n =66) accepted bisoprolol fumarate treatment (5 mg/time,1 times/day),and bisoprolol fumarate combined with wenxin granule group (Group BW n =66) adopted wenxin granule (9 g/time,3 times/day) based on the patients in Group BF.After 4 weeks treatment,the curative effect of all patients were evaluated with electrocardiogram monitor and cardiac ultrasound examination,and the plasma NT-proBNP concentration and hemorheology indexes were analyzed compared with pre-treatment.Results The recovery of ventricular function in Group BW was better significantly than that patients in Group BF from the cardiac ultrasound examination (P ＜ 0.05);The total relieved effective of clinical symptom,premature ventricular complexes and heart failure in Group BW were more remarkable than those in Group BF,and which difference from them was significance (P ＜ 0.05);The blood viscosity,plasma viscosity,plasma fibrinogen and plasma NT-proBNP concentration in patients with Group BW were significantly lower than those Group BF (P ＜ 0.05).Conclusions The clinical curative effect of bisoprolol fumarate combined with Wenxin Granule for heart failure complicated with premature ventricular was more remarkable compare with bisoprolol fumarate single treatment,and which possessed the relative safety.

The effect of the physical activity on polymorphic premature ventricular complexes in chronic kidney disease

BACKGROUND: Polymorphic premature ventricular complexes (PVCs) are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Endurance exercise training clearly lowers sympathetic activity in sympatho-excitatory disease states and may be tolerated by patients with chronic kidney disease (CKD). METHODS: We assessed 40 CKD patients with hypertension with polymorphic PVCs. Patients underwent a complete medical history and physical examination. We evaluated the effectiveness of β blocker only or β blocker + exercise during 12 months of follow-up regarding the changes of the numbers of PVCs and mean heart rate (HR) by 24-hour-Holter. RESULTS: We observed in the β blocker group a significant decrease in the number of polymorphic PVCs from baseline 36,515 ± 3,518 to 3, 6, 9 and 12 months of follow-up, 28,314 ± 2,938, 23,709 ± 1,846, 22,564 ± 1,673, and 22,725 ± 1,415, respectively (P < 0.001). In the β blocker + exercise group a significant decrease in the number of polymorphic PVCs also occurred from baseline 36,091 ± 3,327 to 3, 6, 9 and 12 months of follow-up, 29,252 ± 3,211, 20,948 ± 2,386, 14,238 ± 3,338, and 6,225 ± 2,319, respectively (P < 0.001). Comparisons between the two groups at the same time point showed differences from the sixth month onwards: the 6th (Δ = −2,761, P = 0.045), 9th (Δ = −8,325, P < 0.001) and 12th (Δ = −16,500, P < 0.001) months. There was an improvement during the 12 months of follow-up vs. baseline, after the β blocker or β blocker + exercise in mean 24-hour HR Holter monitoring, creatinine values, eGFR, and ACR. CONCLUSION: Polymorphic PVCs may be modifiable by physical activity in CKD patients with hypertension without structural heart disease.

Detailed Electrode Catheter Positioning is Important for the Ablation of Outflow Tract Origin Ventricular Arrhythmias

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.

Differentiating origins of outflow tract ventricular arrhythmias: a comparison of three different electrocardiographic algorithms

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.

Establishment of biological assess for quality control of Fuzi based on determination of premature ventricular contractions in rats / 中国中药杂志

Aconiti Lateralis Radix (Fuzi) is a toxic traditional Chinese medicine with definite efficacy. In order to improve the quality control of its different prepared products and ensure the security in clinic, it is significant to establish a method of quality evaluation related to clinic adverse effects. Aiming at the important biological marker of early cardiac toxicity reaction, there was no method to detect it. In this manuscript, a novel approach for measuring the minimal toxic dose (MTD) of premature ventricular contractions (PVC) poisoning of rats was established. Then, the determination methodology and conditions were optimized to meet the needs of the quality and biological assessment, including animal sex, weight, stability of standards and test solutions. Using this method, the MTD value of different Fuzi products were determined, such as Heishunpian, Baifupian, Zhengfupian, Baofupian, and Paotianxiong. The results showed that the MTD of Fuzi was significantly decreased after detoxification processed (P<0.05) and the MTD of Heishunpian, Zhengfupian, Baofupian and Baifupian was as much as 15.76, 22.36, 19.65 and 20.97 times to that of unprocessed Shengfuzi. In addition, Paotianxiong could not induce PVC in rats, which indicated that Paotianxiong was nontoxic and safe.This method could appropriately reflects the cardiotoxity of Fuzi and its prepared samples. Together with the chemical composition analysis, the contents of diester alkaloids were explored including aconitine, mesaconitine and hypaconitine as well as monoester alkaloids in Fuzi and its prepared products were significantly associated with PVC. Furthermore, there may be some components undetermined facilitating arrhythmia to be worth exploring. This research provides an overall and comprehensive approach to diagnose early clinical cardiotoxity and control the quality of Fuzi, which could not only be a complementary solution for the chemical evaluation, but a new method to ensure its efficacy and security of clinical application.

Compared with conventional electrophysiological mapping of radiofrequency catheter ablation of the prema-ture ventricular contractions in the ventricular outflow tract / 中国基层医药

Objective To assess the efficacy of radiofrequency catheter ablation ( RFCA) in premature ven-tricular contractions ( PVCs) by electrophysiological mapping.Methods 60 patients with symptomatic PVCs original from the right ventricular outflow tract underwent RFCA guided by pace mapping and activation mapping,ablation was performed by a catheter with temperature control.The patients were divided into 3 groups,20 cases in each group.The first group ( the combination group ) was the combination with pacing mapping and activation mapping underwent RFCA.The second group ( the activation mapping group) was guided by activation mapping underwent RFCA.The third group( the pacing mapping group) was guided by pacing mapping underwent RFCA.Successful ablation immedi-ate end was that PVCs disappeared and could not be induced by isoproterenol.The success rate,time and composition ratio of the three groups were observed.Results The immediate success rate of ablation of either the combination group or the activation mapping group was higher than that of the pacing mapping group.But the ablation time of the combination group was the shortest.There was no statistical difference between the baseline results of each test group. The cardiac arrhythmia originated from the septum was usual (45/60,75.0%),and the arrhythmia originated from the free wall (15/60,25.0%) was less.The success rate of PVCs ablation of right ventricle was high,and the total success rate was 91.7%(55/60).There was no significant difference in the success rate of the combined mapping and the activation mapping (χ2 =0.084,P>0.05),but were significantly higher than those in the pacing mapping group (χ2 =0.032,0.047,all P<0.05).The ablation time of the pacing mapping group and the combination group were significantly lower than that of the activation mapping group(all P<0.05).Conclusion The effect of the com-bination with pacing mapping and activation mapping is the best.Pacing mapping is better than activation mapping during RFCA of PVCs.