Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and S...Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and SVT based on surface electrocardiogram (ECG) analysis have been proposed. Following established diagnosis of VT,a specific origination tachycardia site can be supposed according to QRS complex characteristics. This review aims to cover comprehensive and comparative description of the main VT diagnostic algorithms and to present ECG characteristics which permit to suggest the most common VT origination sites.展开更多
The post-infarcted related ventricular tachycardia (VT) is considered associated with increase in mortality or sudden cardiac death (SCD). Implantable cardioverter defibrillation (ICD) has been the standard therapy fo...The post-infarcted related ventricular tachycardia (VT) is considered associated with increase in mortality or sudden cardiac death (SCD). Implantable cardioverter defibrillation (ICD) has been the standard therapy for the first or second prevention of SCD after myocardial infarction (MI). Incessant VT, which has poor response to anti-arrhythmic drugs and can cause repetitive ICD shock, is usually a tough problem in clinical practice. According to the guideline, incessant infracted related VT could be treated with catheter ablation.[1] Herein we reported a case of refractory scar-induced VT accompanied with thrombus in the left chamber, which was full with ups and downs during the therapy.展开更多
A 67-year-old man with a history of a prior cardiac arrest with ventricular fibrillation(VF)due to myocardial infarction underwent phase I(inpatient)and II(outpatient)cardiac rehabilitation(CR)exercise training.On the...A 67-year-old man with a history of a prior cardiac arrest with ventricular fibrillation(VF)due to myocardial infarction underwent phase I(inpatient)and II(outpatient)cardiac rehabilitation(CR)exercise training.On the 33th CR session,15 min after the start of exercise training,the patient had syncope with evidence of a polymorphic and wide QRS complex tachycardia on electrocardiogram(ECG)monitoring.The initiation of a polymorphic ventricular tachycardia was evidenced by the coupled premature ventricular complex observed in the ECG monitoring screen(Figure 1).展开更多
This study evaluated the ability of catheter endocardial pacing at or near the site of origin of spontaneous ventricular tachycardia(VT) to mimic the QRS configuration of the spontaneous VT.Surface electrocardiographi...This study evaluated the ability of catheter endocardial pacing at or near the site of origin of spontaneous ventricular tachycardia(VT) to mimic the QRS configuration of the spontaneous VT.Surface electrocardiographic QRS configuration produced by cathet展开更多
Objectics: Implantable cardioverter-defibrillator (ICI)is an important mean for treating ventricular tachycardia (VT ) in patients with structural heart diseases .This report deals with our primary experiences in clii...Objectics: Implantable cardioverter-defibrillator (ICI)is an important mean for treating ventricular tachycardia (VT ) in patients with structural heart diseases .This report deals with our primary experiences in cliical application of transveneous implantable cardioverter defibrillator.Metgids: A 13- year-old male patient with right ventricular dysplasia (ARVD) ). who lhad a failed result from antiarrhythmic drug therapy was implanted with ICD transveneously. Results: During follow. up. the antitachycardia pacing (ATP) did not terminate the first 2 episodes of VT. The episodes of VT were reverted into sinus rhythm by 4 J shock. The patient had a strong uncomfortable sensation :After resettin ATP program . VTs of patient were automaticallly terminated by ICD with ATP therapy many times. Conclusion: ICD implantation is an effective approach for treating VT and reasonable resetting of ATP is needed.展开更多
Background One of the major challenges in arrhythmogenic right ventricular cardiomyopathy （ARVC） ablation is ventricular tachy-cardia （VT） non-inducibility. The study aimed to assess whether fast rate （≥ 250 bea...Background One of the major challenges in arrhythmogenic right ventricular cardiomyopathy （ARVC） ablation is ventricular tachy-cardia （VT） non-inducibility. The study aimed to assess whether fast rate （≥ 250 beats/min） right ventricular burst stimulation was useful for VT induction in patients with ARVC.Methods Ninety-one consecutive ARVC patients with clinical sustained VT that underwent electro-physiological study were enrolled. The stimulation protocol was implemented at both right ventricular apex and outflow tract as follows： Step A, up to double extra-stimuli; Step B, incremental stimulation with low rate （＆lt; 250 beats/min）; Step C, burst stimulation with fast rate （≥ 250 beats/min）; Step D, repeated all steps above with intravenous infusion of isoproterenol.Results A total of 76 patients had inducible VT （83.5%）, among which 49 were induced by Step C, 15 were induced by Step B, 8 and 4 by Step A and D, respectively. Clinical VTs were induced in 60 patients （65.9%）. Only two spontaneously ceased ventricular fibrillations were induced by Step C. Multivariate analysis showed that a narrower baseline QRS duration under sinus rhythm was independently associated with VT non-inducibility （OR： 1.1; 95% CI： 1.0-1.1;P = 0.019）.ConclusionFast rate （≥ 250 beats/min） right ventricular burst stimulation provides a useful supplemental method for VT induction in ARVC patients.展开更多
The implantable cardioverter-defibrillator(ICD)is a key component in the primary pre-vention of sudden cardiac death in patients with ischemic cardiomyopathy.Appropriate device programming is pivotal in maximizing the...The implantable cardioverter-defibrillator(ICD)is a key component in the primary pre-vention of sudden cardiac death in patients with ischemic cardiomyopathy.Appropriate device programming is pivotal in maximizing the benefit as well as minimizing any proarrhythmic effect of dev-ice therapy.It is even more so for patients who require pacing for bradycardia,in which interaction of the de-vice with intrinsic rhythm may generate unexpected consequences.We report a case of pacing induced ven-tricular tachycardia as a result of complex interplay of competitive atrial pacing,atrial and ventricular func-tional undersensing,ventricular functional loss of capture,and the AutoCapture®algorithm specific to Abbott devices.展开更多
A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitte...A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitted for atypical hepatitis, and received maintenance treatment of oral corticosteroids.展开更多
Acromegaly is an insidious endocrine disease character- ized by chronic elevation of growth hormone （GH） and insulin-like growth factor-1 （IGF-1）.Ell Persistent excess se- cretion of GH and IGF-1 damages both card...Acromegaly is an insidious endocrine disease character- ized by chronic elevation of growth hormone （GH） and insulin-like growth factor-1 （IGF-1）.Ell Persistent excess se- cretion of GH and IGF-1 damages both cardiac structure and function, leading to acromegalic cardiomyopathy, which is one of the most common causes of increased mortality in acromegaly and can result in an average of 10-year reduction in life expectancy.I2＇31 In patients with acromegaly, approximately 3% have been reported having a unique cardiomyopathy characterized by biventricular hypertrophy, myocardial necrosis, lymphocytic infiltration, interstitialfibrosis.展开更多
Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategie...Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence(OR: 0.50;95% CI: 0.30–0.85;P = 0.010), but somehow increased major procedural complications(OR: 4.64;95% CI: 1.28–16.92;P = 0.02), with not evident improvement of acute efficacy(OR: 2.74;95% CI: 0.98–7.65;P = 0.051) or all-cause mortality(OR: 0.87;95% CI: 0.09–8.31;P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.展开更多
A 58-year-old man with hypertension and half a year ago documented left bundle branch block(LBBB)in his past history presented with progressive dyspnea.A pre-admission echocardiography showed severely depressed systol...A 58-year-old man with hypertension and half a year ago documented left bundle branch block(LBBB)in his past history presented with progressive dyspnea.A pre-admission echocardiography showed severely depressed systolic left ventricular function[ejection fraction(EF)=27%],diffuse hypokinesis and dilated heart chambers consistent with dilated cardiomyopathy(DCM).展开更多
Objective To investigate the mechanism of ventricular dilation-induced arrhythmias by dilating isolated rat hearts. Methods Isolated rat hearts were perfused by Langerdorff method. After equilibration,80 hearts were r...Objective To investigate the mechanism of ventricular dilation-induced arrhythmias by dilating isolated rat hearts. Methods Isolated rat hearts were perfused by Langerdorff method. After equilibration,80 hearts were randomly divided into four groups as follows:(1) control group(n=20) ,(2) Ca2+ preconditioning(CPC) group(n=20) ,(3) streptomycin group(n=20) ,and(4) CPC + streptomycin group(n=20) . A latex balloon which can be filled with fluid was anchored in the left ventricle through the left atrium and mitral valve. Epicardial ECG of the left ventricle,left ventricular pressure,coronary flow and heart rate were recorded before and during ventricular dilation by injecting fluid into the latex balloon. The rate and duration of ventricular dilation-induced arrhythmias were recorded. Results Under the same increase in ventricular end-diastolic pressure made by inflation of the balloon,the rate of arrhythmias was 100% and duration of arrhythmias was 2. 56±0.46s in the control group. Both the rates of premature ventricular beat(90%) and ventricular tachycardia 70%) were high. Compared with the control group,the total rate(60%) of arrhythmias was lower,and duration(1.67±0.61s) of arrhythmias was shorter in the CPC group. Both the rates of premature ventricular beat(60%) and ventricular tachycardia(40%) were low comparatively. The rate of arrhythmias(45%) was lower and duration(1.64±0.42s) of arrhythmias was shorter,and the rates of premature ventricular beat(30%) or ventricular tachycardia(35%) were lower in the streptomycin group than in the control one. The least ventricular dilation-induced arrhythmias occurred in the CPC + streptomycin group. The rate of arrhythmias(10%) was the lowest and duration(1.01±0.37s) of arrhythmias was the shortest;both the rates of premature ventricular beat(5%) and ventricular tachycardia(10%) were the lowest. Conclusions Ventricular dilation may induce arrhythmias in isolated rat hearts. Stretch-activated ion channel and the increase in [Ca2+]i are supposed to play important roles in the pathological mechanism.展开更多
目的探讨胺碘酮联合艾司洛尔静脉注射治疗室性心动过速的临床疗效。方法选择2016年10月～2017年10月我院心血管内科收治的室性心动过速患者77例,按照住院号单双号法分为对照组39例和观察组38例。对照组给予胺碘酮治疗,观察组给予胺碘酮...目的探讨胺碘酮联合艾司洛尔静脉注射治疗室性心动过速的临床疗效。方法选择2016年10月～2017年10月我院心血管内科收治的室性心动过速患者77例,按照住院号单双号法分为对照组39例和观察组38例。对照组给予胺碘酮治疗,观察组给予胺碘酮联合艾司洛尔治疗。比较2组患者治疗前后的心率、收缩压、舒张压等指标变化情况,评估2组临床疗效,并观察2组不良反应发生情况。结果与治疗前比较,2组治疗后心率、收缩压及舒张压明显降低,差异有统计学意义(P <0. 05)。且观察组治疗后心率[(71±14)次/min vs (101±16)次/min]、收缩压[(110±17) mm Hg(1 mm Hg=0. 133 k Pa) vs (139±12) mm Hg]及舒张压[(72±12) mm Hg vs (88±11) mm Hg]明显低于对照组,差异有统计学意义(P <0. 05)。观察组治疗后总有效率明显高于对照组,差异有统计学意义(97. 37%vs 76. 92%,P <0. 05)。对照组与观察组不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论室性心动过速采用胺碘酮联合艾司洛尔静脉注射治疗,疗效显著,能够显著改善患者心率、收缩压、舒张压指标,且不良反应少,安全性高。展开更多
文摘Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and SVT based on surface electrocardiogram (ECG) analysis have been proposed. Following established diagnosis of VT,a specific origination tachycardia site can be supposed according to QRS complex characteristics. This review aims to cover comprehensive and comparative description of the main VT diagnostic algorithms and to present ECG characteristics which permit to suggest the most common VT origination sites.
基金supported by grants from Municipal Medical Science Technology Development Foundation of Nanjing (No. YKK17085)
文摘The post-infarcted related ventricular tachycardia (VT) is considered associated with increase in mortality or sudden cardiac death (SCD). Implantable cardioverter defibrillation (ICD) has been the standard therapy for the first or second prevention of SCD after myocardial infarction (MI). Incessant VT, which has poor response to anti-arrhythmic drugs and can cause repetitive ICD shock, is usually a tough problem in clinical practice. According to the guideline, incessant infracted related VT could be treated with catheter ablation.[1] Herein we reported a case of refractory scar-induced VT accompanied with thrombus in the left chamber, which was full with ups and downs during the therapy.
文摘A 67-year-old man with a history of a prior cardiac arrest with ventricular fibrillation(VF)due to myocardial infarction underwent phase I(inpatient)and II(outpatient)cardiac rehabilitation(CR)exercise training.On the 33th CR session,15 min after the start of exercise training,the patient had syncope with evidence of a polymorphic and wide QRS complex tachycardia on electrocardiogram(ECG)monitoring.The initiation of a polymorphic ventricular tachycardia was evidenced by the coupled premature ventricular complex observed in the ECG monitoring screen(Figure 1).
文摘This study evaluated the ability of catheter endocardial pacing at or near the site of origin of spontaneous ventricular tachycardia(VT) to mimic the QRS configuration of the spontaneous VT.Surface electrocardiographic QRS configuration produced by cathet
文摘Objectics: Implantable cardioverter-defibrillator (ICI)is an important mean for treating ventricular tachycardia (VT ) in patients with structural heart diseases .This report deals with our primary experiences in cliical application of transveneous implantable cardioverter defibrillator.Metgids: A 13- year-old male patient with right ventricular dysplasia (ARVD) ). who lhad a failed result from antiarrhythmic drug therapy was implanted with ICD transveneously. Results: During follow. up. the antitachycardia pacing (ATP) did not terminate the first 2 episodes of VT. The episodes of VT were reverted into sinus rhythm by 4 J shock. The patient had a strong uncomfortable sensation :After resettin ATP program . VTs of patient were automaticallly terminated by ICD with ATP therapy many times. Conclusion: ICD implantation is an effective approach for treating VT and reasonable resetting of ATP is needed.
文摘Background One of the major challenges in arrhythmogenic right ventricular cardiomyopathy （ARVC） ablation is ventricular tachy-cardia （VT） non-inducibility. The study aimed to assess whether fast rate （≥ 250 beats/min） right ventricular burst stimulation was useful for VT induction in patients with ARVC.Methods Ninety-one consecutive ARVC patients with clinical sustained VT that underwent electro-physiological study were enrolled. The stimulation protocol was implemented at both right ventricular apex and outflow tract as follows： Step A, up to double extra-stimuli; Step B, incremental stimulation with low rate （＆lt; 250 beats/min）; Step C, burst stimulation with fast rate （≥ 250 beats/min）; Step D, repeated all steps above with intravenous infusion of isoproterenol.Results A total of 76 patients had inducible VT （83.5%）, among which 49 were induced by Step C, 15 were induced by Step B, 8 and 4 by Step A and D, respectively. Clinical VTs were induced in 60 patients （65.9%）. Only two spontaneously ceased ventricular fibrillations were induced by Step C. Multivariate analysis showed that a narrower baseline QRS duration under sinus rhythm was independently associated with VT non-inducibility （OR： 1.1; 95% CI： 1.0-1.1;P = 0.019）.ConclusionFast rate （≥ 250 beats/min） right ventricular burst stimulation provides a useful supplemental method for VT induction in ARVC patients.
文摘The implantable cardioverter-defibrillator(ICD)is a key component in the primary pre-vention of sudden cardiac death in patients with ischemic cardiomyopathy.Appropriate device programming is pivotal in maximizing the benefit as well as minimizing any proarrhythmic effect of dev-ice therapy.It is even more so for patients who require pacing for bradycardia,in which interaction of the de-vice with intrinsic rhythm may generate unexpected consequences.We report a case of pacing induced ven-tricular tachycardia as a result of complex interplay of competitive atrial pacing,atrial and ventricular func-tional undersensing,ventricular functional loss of capture,and the AutoCapture®algorithm specific to Abbott devices.
文摘A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitted for atypical hepatitis, and received maintenance treatment of oral corticosteroids.
文摘Acromegaly is an insidious endocrine disease character- ized by chronic elevation of growth hormone （GH） and insulin-like growth factor-1 （IGF-1）.Ell Persistent excess se- cretion of GH and IGF-1 damages both cardiac structure and function, leading to acromegalic cardiomyopathy, which is one of the most common causes of increased mortality in acromegaly and can result in an average of 10-year reduction in life expectancy.I2＇31 In patients with acromegaly, approximately 3% have been reported having a unique cardiomyopathy characterized by biventricular hypertrophy, myocardial necrosis, lymphocytic infiltration, interstitialfibrosis.
基金supported by the National Natural Science Foundation (81570309)National Key R&D Program of China (2017YFC1307800)。
文摘Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence(OR: 0.50;95% CI: 0.30–0.85;P = 0.010), but somehow increased major procedural complications(OR: 4.64;95% CI: 1.28–16.92;P = 0.02), with not evident improvement of acute efficacy(OR: 2.74;95% CI: 0.98–7.65;P = 0.051) or all-cause mortality(OR: 0.87;95% CI: 0.09–8.31;P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.
文摘A 58-year-old man with hypertension and half a year ago documented left bundle branch block(LBBB)in his past history presented with progressive dyspnea.A pre-admission echocardiography showed severely depressed systolic left ventricular function[ejection fraction(EF)=27%],diffuse hypokinesis and dilated heart chambers consistent with dilated cardiomyopathy(DCM).
基金grants from the National Natural Science Foundation of China (No.30270559)
文摘Objective To investigate the mechanism of ventricular dilation-induced arrhythmias by dilating isolated rat hearts. Methods Isolated rat hearts were perfused by Langerdorff method. After equilibration,80 hearts were randomly divided into four groups as follows:(1) control group(n=20) ,(2) Ca2+ preconditioning(CPC) group(n=20) ,(3) streptomycin group(n=20) ,and(4) CPC + streptomycin group(n=20) . A latex balloon which can be filled with fluid was anchored in the left ventricle through the left atrium and mitral valve. Epicardial ECG of the left ventricle,left ventricular pressure,coronary flow and heart rate were recorded before and during ventricular dilation by injecting fluid into the latex balloon. The rate and duration of ventricular dilation-induced arrhythmias were recorded. Results Under the same increase in ventricular end-diastolic pressure made by inflation of the balloon,the rate of arrhythmias was 100% and duration of arrhythmias was 2. 56±0.46s in the control group. Both the rates of premature ventricular beat(90%) and ventricular tachycardia 70%) were high. Compared with the control group,the total rate(60%) of arrhythmias was lower,and duration(1.67±0.61s) of arrhythmias was shorter in the CPC group. Both the rates of premature ventricular beat(60%) and ventricular tachycardia(40%) were low comparatively. The rate of arrhythmias(45%) was lower and duration(1.64±0.42s) of arrhythmias was shorter,and the rates of premature ventricular beat(30%) or ventricular tachycardia(35%) were lower in the streptomycin group than in the control one. The least ventricular dilation-induced arrhythmias occurred in the CPC + streptomycin group. The rate of arrhythmias(10%) was the lowest and duration(1.01±0.37s) of arrhythmias was the shortest;both the rates of premature ventricular beat(5%) and ventricular tachycardia(10%) were the lowest. Conclusions Ventricular dilation may induce arrhythmias in isolated rat hearts. Stretch-activated ion channel and the increase in [Ca2+]i are supposed to play important roles in the pathological mechanism.
文摘目的探讨胺碘酮联合艾司洛尔静脉注射治疗室性心动过速的临床疗效。方法选择2016年10月～2017年10月我院心血管内科收治的室性心动过速患者77例,按照住院号单双号法分为对照组39例和观察组38例。对照组给予胺碘酮治疗,观察组给予胺碘酮联合艾司洛尔治疗。比较2组患者治疗前后的心率、收缩压、舒张压等指标变化情况,评估2组临床疗效,并观察2组不良反应发生情况。结果与治疗前比较,2组治疗后心率、收缩压及舒张压明显降低,差异有统计学意义(P <0. 05)。且观察组治疗后心率[(71±14)次/min vs (101±16)次/min]、收缩压[(110±17) mm Hg(1 mm Hg=0. 133 k Pa) vs (139±12) mm Hg]及舒张压[(72±12) mm Hg vs (88±11) mm Hg]明显低于对照组,差异有统计学意义(P <0. 05)。观察组治疗后总有效率明显高于对照组,差异有统计学意义(97. 37%vs 76. 92%,P <0. 05)。对照组与观察组不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论室性心动过速采用胺碘酮联合艾司洛尔静脉注射治疗,疗效显著,能够显著改善患者心率、收缩压、舒张压指标,且不良反应少,安全性高。
