Effect of burden and origin sites of premature ventricular contractions on left ventricular function by 7-day Holter monitor

Recent studies have shown that premature ventricular contractions （PVCs） could enlarge the heart, but its risk factors are incompletely understood as a single 24-hour recording cannot reflect the true PVC burden due to day-to-day variability. Our purpose was to investigate the effect of burden and origin sites on left ventricular （LV） function in patients with PVCs by 7-day Holter electrocardiography （ECG）. From May 2012 to August 2013, 112 consecutive patients with PVCs were recruited from the authors＇ affiliated hospital. All patients received 2-dimensional transthoracic echocardiography, 12-lead routing ECG and 7-days Holter ECG. Serum N-terminal pro- brain natriuretic peptide （NT-proBNP） levels were measured. A total of 102 participants with PVCs were included in the final analysis. Origin of PVCs from the tricuspid annulus had the highest burden and NT-proBNP level. LV papillary muscle had a higher LV ejection fraction （EF） level and a lower LV end-systolic dimension （ESD） than other PVC foci （P〈0.05）. The high burden group had a higher LV end-diastolic dimension （EDD） and LVESD but lower LVEF than the other two groups （P〈0.05）. Female, older age, physical work, and history of PVCs had a significantly positive correlation with symptoms. Male, older age, physical work, and high burden were positive predictors of enlarged LVEDD, LVESD and higher serum NT-proBNP level, but lower LVEF. Seven-day dynamic ECG Holter monitor showed the true PVC burden on patients with PVCs. PVCs with a lower burden or origin from the LV papillary muscle and the fascicle were relatively benign, while PVCs with a higher burden or origin from the tricuspid annulus may lead to cardiac dysfunction.

Adenosine Sensitivity is Associated with Ablation Success Rate and Recurrence Rate with Nonirrigated Catheters in Patients with Ventricular Premature Contractions/Tachycardia from the Ventricular Outflow Tract

Background：A high ablation success rate for ventricular arrhythmia （VA） from outflow tract has been achieved,but some of them cannot be eliminated from endocardium.We investigated the association between adenosine sensitivity and ablation success/recurrence rates with a nonirrigated or an irrigated catheter.Methods：According to adenosine test,all patients were divided into a sensitive group （S group） or an insensitive group （Ⅰ group）.The patients of each group were randomized into a nonirrigated catheter （NA） subgroup or an irrigated catheter （IA） subgroup with a 2∶1 ratio.Results：In S group of 122 patients （84 in NA subgroup）,the ablation success rate was similar between two subgroups （94.7% vs.90.5%,P 〉 0.05）,but in Ⅰ group of 94 patients （60 in NA subgroup）,it was higher in IA subgroup （94.1%） than that in NA subgroup （73.3%,P 〈 0.05）.The success rate using nonirrigated catheter was significantly higher in S group （90.5%） than that in Ⅰ group （73.3%,P 〈 0.01）,and the recurrence rate was lower in S group than that in Ⅰ group （1.3%,vs.13.6%,P 〈 0.05）.On the contrary,the success rate and the recurrence rate using irrigated catheter were similar between S group and 1 group （94.7%,94.1%,P 〉 0.05,vs.2.8%,6.3%,P 〉 0.05）.Conclusions：Adenosine insensitivity is associated with a lower success rate and a higher recurrence rate for VA patients undergoing nonirrigated catheter ablation.Thus,irrigated catheters should be the first choice for VA ablation in adenosine insensitive patients.

Using Three-Dimensional Lorenz Scatter Plots to Detect Patients with Atrioventricular Node Double Path Caused by Interpolated Ventricular Premature Systoles: A Case Study

A series of related electrophysiology phenomena can be caused by the occurrence of interpolated ventricular premature contraction.In our recent three-dimensional Lorenz R-R scatter plot research,we found that atrioventricular node double path caused by interpolated ventricular premature contraction imprints a specifi c pattern on three-dimensional Lorenz plots generated from 24-hour Holter recordings.We found two independent subclusters separated from the interpolated premature beat precluster,the interpolated premature beat cluster,and the interpolated premature beat postcluster,respectively.Combined with use of the trajectory tracking function and the leap phenomenon,our results reveal the presence of the atrioventricular node double conduction path.

Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach

BACKGROUND Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle.Patients are usually asymptomatic,and clinical presentation depends on location and adjacent structures impairment.Right ventricle lipomas are scarce in the literature.Moreover,the previous published cases were reported in over 18-year-old patients.CASE SUMMARY We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up.The diagnosis was confirmed by histopathological examination,and a conservative approach was performed.CONCLUSION Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis.The therapeutic approach depends on clinical presentation.

The Efficacy and Safety of Wenxin Keli in Patients with Frequent Premature Ventricular Contractions： A Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter Trial

Background：Premature ventricular contractions （PVCs） are common in the general population,and frequent PVCs may result in the poor quality of life or even the damage of cardiac function.We examined the efficacy and safety of a traditional Chinese medicine Wenxin Keli for the treatment of frequent PVCs among a relatively large Chinese cohort.Methods：We performed a randomized,double-blind,placebo-controlled,parallel-group,multicenter trial.A total of 1200 eligible participants were randomly assigned in a ratio of 1：1 to receive Wenxin Keli or the placebo for 4 weeks.The primary and secondary endpoint was the change of PVC numbers and PVC-related symptoms after a 4-week treatment compared with baseline,respectively.In addition,vital signs,laboratory values,and electrocardiographic parameters were assessed in a safety analysis.Results：At the initial evaluation,no significant differences in the baseline characteristics were observed between the Wenxin Keli group and the placebo group.A smaller number of PVCs was observed after the 4-week treatment than at baseline,in both the Wenxin Keli group （5686 ± 5940 vs.15,138 ± 7597 beats/d,P ＜ 0.001） and the placebo group （10,592 ± 8009 vs.14,529 ± 5929 beats/d,P ＜ 0.001）;moreover,the Wenxin Keli group demonstrated a significantly greater reduction in the frequency of PVCs than the placebo group （P ＜ 0.001）.In a full analysis set,patients in the Wenxin Keli group exhibited significantly higher total effective responses in the reduction of PVCs compared to those in the placebo group （83.8％ vs.43.5％,P ＜ 0.001）.The per-protocol analysis yielded similar results （83.0％ vs.39.3％,P ＜ 0.001）.Treatment with Wenxin Keli also demonstrated superior performance compared to the placebo with respect to PVC-related symptoms.No severe adverse effects attributable to Wenxin Keli were reported.Conclusions：Wenxin Keli treatment effectively reduced the overall number of PVCs and alleviated PVC-related symptoms in patients without structural heart diseases and had no severe side effects.

Evaluation of the traditional Chinese medicine Shensongyangxin capsule on treating premature ventricular contractions： a randomized, double-blind, controlled multicenter trial

Background Premature ventricular contraction （PVC） is one of the most common kinds of arrhythmias for which the treatment falls into dilemma. Previous clinical application showed that the traditional Chinese Medicine Shensongyangxin （SSYX） capsule is efficacious for the treatment of PVCs. This randomized clinical trial aimed to further evaluate the efficacy and safety of SSYX capsule on treating PVC. Methods The subjects who had frequent PVCs with or without organic heart disease and normal cardiac function were enrolled in the study. The primary endpoint was the change of PVC numbers after eight-week medication with SSYX capsule. The secondary endpoints included change of clinical symptoms related to PVCs and the safety evaluation of SSYX capsule. Totally 188 PVC patients were randomly enrolled in the non-organic heart disease PVCs trial and orally took either $SYX capsules or analogues （three times per day, 4 capsules one time）. A total of 671 PVCs patients were randomly enrolled in the organic heart disease PVCs trial, and orally took either SSYX capsules （three times per day, 4 capsules one time） or mexiletine tablet （three times per day, 150 mg one time）. The PVCs were monitored and calculated with 24-hour Holter electrocardiogram. Routine blood, liver and kidney function were tested before and after medication with SSYX capsule. Results SSYX capsules significantly decreased the PVCs numbers and alleviated the related symptoms in patients with or without organic heart disease. In non-organic heart disease group, SSYX capsules and the placebos decreased the PVCs from 12561.34±9777.93 to 4806.87±6507.17, and 12 605.69±8736.34 to 10364.94±9903.41, respectively. The total effective rate was 74.2% and 28.9% in SSYX and placebo groups （P〈0.001）. In organic heart disease group, SSYX capsule and mexiletine decreased the PVCs from 8641.01±8923.57 to 3853.68±7096.42, 8621.61±8367.74 to 5648.29±8667.38, respectively, The total effective rate was 65.8% and 50.7% in SSYX and mexiletine groups （P〈0.001）. In addition, SSYX capsule significantly alleviated PVCs-related symptoms such as palpitations, chest tightness, insomnia fatigue, and night sweats. No adverse cardiac events were observed except some slight gastrointestinal side effects during the study. Conclusions Compared with placebo or mexiletine, SSYX capsules have significant therapeutic efficacy in reducing PVCs numbers and alleviate PVCs-related symptoms.

A cross-sectional survey on the prevalence of anxiety symptoms in Chinese patients with premature ventricular contractions without structural heart disease

Background Anxiety appears to be more common in patients with coronary artery disease （CHD） than in the general population, and anxiety symptoms may precede onset of CHD and play an important role in development of CHD. Little is known about the prevalence of anxiety symptoms in Chinese patients with premature ventricular contractions （PVCs）. Our objective was to study anxiety symptoms and potential risk factors in a Chinese population with PVCs but without structural heart disease. Methods The Zung self-rating anxiety scale （ZSAS） was used to assess anxiety symptoms. Correlation between anxiety symptoms and socio-demographics and medical factors were analyzed by Logistic regression. Results Of 1144 patients with PVCs （487 males and 657 females）, age （53＋23） years old, disease duration 1 month to 24 years, a total of 381 （33.3%） patients were categorized as having anxiety symptoms. Anxiety symptoms increased with age, low income, low education level, nationality, PVC count/24 hours, bad social support, village settlement type （P 〈0.05）. Multivariate Logistic regression indicated that six variablesmeducation level, ethnic minorities, dwelling place, age, PVC count/24 hours, and social support--significantly and independently related with anxiety symptoms （P 〈0.05）. Conclusions In the Chinese population, anxiety symptoms in subjects with PVCs were frequent. Education level, ethnic minorities, dwelling place, age, PVC count/24 hours, and social support were independent risk factors for anxiety symptoms. Further research on the relationship between PVCs and anxiety symptoms in China is necessary.

Anesthetic management of a patient with preoperative R-on-T phenomenon undergoing laparoscopic-assisted sigmoid colon resection:A case report

BACKGROUND The R-on-T phenomenon is a malignant arrhythmia associated with potentially catastrophic consequences.It may initiate ventricular tachycardia or ventricular fibrillation,which can result in syncope or sudden cardiac death.This manifestation poses a great challenge for anesthesiologists.However,it is rarely encountered in the perioperative setting.CASE SUMMARY We herein present a case in which the R-on-T phenomenon was incidentally revealed by 24-h Holter monitoring in a patient diagnosed with sigmoid colon cancer.Careful evaluation and treatment with mexiletine were carried out preoperatively under consultation with a cardiovascular specialist,and surgery was uneventfully performed under general anesthesia after thorough preparation.CONCLUSION Physicians should be vigilant about this infrequent but potentially fatal arrhythmia.Our experience suggests that the anesthetic process can be greatly optimized with careful preparation.

Detecting Premature Ventricular Contraction in Children with Deep Learning

Premature ventricular contractions(PVCs) are abnormal heart beats that indicate potential heart diseases. Diagnosis of PVCs is made by physicians examining long recordings of electrocardiogram(ECG), which is onerous and time-consuming. In this study, deep learning was applied to develop models that can detect PVCs in children automatically. This computer-aided diagnosis model achieved high accuracy while sustained stable performance. It could save time and repeated efforts for physicians, enabling them to focus on more complicated tasks.This study is a first step toward children's PVC auto-detection in clinics. Further study will improve the model's performance with optimized structure and more data in different sources, while facing the challenges of the variety and uncertainty of children's ECG with heart diseases.

Epidemiological study of premature ventricular contraction in Guangzhou communities

Background Premature ventricular contractions（PVCs） are associated with an increased risk of morbidity and mortality. Therefore, this study was aimed to assess the prevalence and risk factors of frequent PVCs in Guangzhou communities. Methods Our population-based study included 12013 adults from the permanent residents aged 35 years old and above in 20 communities of Yuexiu District and Panyu District in Guangzhou. Standard 12-lead ECG was performed in 11,634 residents. PVC count was determined by 24-hour Holter ECG in8172 residents. We performed multivariable regression analysis using stepwise backward selection to identify factors independently associated with frequent PVCs（≥ 1% of the total beats）. Results Among those who received12-lead ECG, 4,095 were men, accounting for 35.2% of 11634 participants. 1.6% the residents had PVCs and median age was 59 years. 2852（34.9%） were male in 8172 subjects who received 24-hour Holter ECG and 1239 of the 8172 subjects（15.2%） were diagnosed with PVCs by single-lead dynamic electrocardiogram. 2.9% subjects were accounted PVCs exceeded 1% of the total heartbeats, 0.2% subjects were accounted PVC exceeded 10% of the total heartbeats. The multivariable analysis showed that four factors related with frequent premature ventricular contractions included aging（odds ratio（OR） 1.027; 95% CI 1.015 to 1.039）, male gender（1.533; 95% CI1.162 to 2.023）, high diastolic pressure（1.027; 95% CI 1.015 to 1.039） and long QTc interval（1.016; 95% CI1.005 to 1.027）. Besides, frequent vegetable intake（0.225; 95% CI 0.064 to 0.795）, high LDL（0.787; 95% CI0.684 to 0.906） and high TG（0.873; 95% CI 0.771 to 0.989） were the protective factors of frequent PVCs. Conclusion PVCs is prevalent in Guangzhou communities. The factors such as age, gender, blood pressure, QTc,vegetable intake, LDL and TG care associated with PVCs.

A Construction Method of Personalized ECG Template and Its Application in Premature Ventricular Contraction Recognition for ECG Mobile Phones

Premature ventricular contraction(PVC) is the most frequent arrhythmia encountered in clinical practice. PVC may occur in health subjects, which is not imminently life-threatening but may require therapies to prevent further problems. So,the timely PVC recognition becomes very important for the analysis of electrocardiogram(ECG), especially for the remote ECG monitoring using mobile phones. In this paper,a construction method of personalized ECG template and a PVC recognition method based on template matching were studied. Firstly, we selected 43 ECG recordings from the MIT-BIH arrhythmia database. All recordings were divided into two datasets(DS1for training and DS2 for testing) and each dataset approximately contained the same proportion of PVC beats. Subsequently, for each recording(30 min) in DS1, the first5 min recordings were used to construct the personalized ECG template and the last25 min recordings were used for the R-wave peaks detection and PVC recognition,where the template matching method were used. The validity of the proposed methods was tested using DS2. The results showed that: 1) high beat detection accuracy was achieved for both PVC beats and non-PVC beats; 2) the sensitivity and specificity of PVC recognition were 99.11% and 99.96% for the first 5 min recordings respectively,99.17% and 99.43% for the last 25 min recordings respectively. All the proposed methods can be real-time performed, which show a promising prospect for the application of ECG mobile phones.

Medium to long term prognoses in children with premature ventricular contractions: Follow-up analysis of 106 cases

Background Premature ventricular contractions （PVCs） are frequently seen in children. However, there are less systematic and longer following-up studies examining the prognosis of PVCs in children. The aim of this study was to evaluate the medium to long term prognosis of PVCs in childhood and whether there is a differential prognosis in different primary diseases of PVCs. Methods This study reviewed the data of 106 pediatric patients （49F/57M, 7.5 _ 3.8 years） seen at the Affiliated Hospital of Qingdao University with the diagnosis of PVCs between 1999 and 2005. Data on demographics, clinical presentation, laboratory tests, and echocardiograms of patients were extracted from the available clinical records. Results A total of 35 （33.0%） children presented with PVCs due to myocarditis, 7（6.6%） due to cardiomyopathies, 7（6.6%） due to mitral valve prolapse （MVP）, 10（9.4%） due to operation for congenital heart disease （O-CHD）, 16（15.2%） due to left ventricular false tendons （LVFT）, and 31（29.2%） due to unknown cause. Holter did not show PVCs during follow-up period in 100% of myocarditis patients, 57% of cardiomyopathy patients, 71% of MVP patients, 60% of O-CHD patients, 88% of LVFT patients, 87% of unknown cause patients. The PVCs disappeared in 93% of patients who did not use anti-arrhythmic drugs and in 76% of patients who used anti- arrhythmic drugs. There was no a significant difference in prognosis between myocardial nutrition combined with intravenous injection of immunoglobulin （IVIG） group and propafenone group. Conclusions PVCs caused by different primary diseases has a favorable prognosis in children. Usually, the PVCs will reduce even disappear during follow-up. The patients with PVCs due to myocarditis should be preferred use myocardial nutrient combined with IVIG.

A pilot study of traditional Chinese medicine Shensong Yangxin capsule in patients with premature ventricular contractions and bradycardia

Background Management of premature ventricular contractions （PVCs） and bradycardia is difficult, because most antiarrhythmic drugs may lead to more severe bradycardia, so other effective drugs with less side effects are alternatives for treating those patients. To evaluate the efficacy and safety of the traditional Chinese medicine Shensong Yangxin capsule （SYC） in patients with bradycardia and PVCs, a pilot study was conducted. Methods One hundred and sixty-eight patients with bradycardia and PVCs were randomly assigned to receive either SYC （trial group, = 86） or placebo （control group, = 82） for 4 weeks. ECG, 24-hour continuous ECG recording, echocardiography, quality of life, hepatic function and renal were evaluated at baseline and after 4-week treatment. Results The average heart rate, the fastest heart rate, and the lowest heart rate in the trial group were all significantly higher than those in the baseline and the control group after 4-week follow-up （ 〈 0.01, 0.05, 0.05, respectively.）. Compared with pretreatment, the PVCs in the trial group decreased significantly after treatment （1911.7 ±402.6 vs. 5550.1 ± 973.7, 〈 0.01）. Both the quality of life and the symptom scores in the trial group were significantly better than those in the control group. No severe adverse effects were reported. Conclusion SYC is effective and safe for the treatment of PVCs and bradycardia and improves the symptoms and quality of life.

Intravascular lithotripsy for coronary calcium:A case report and review of the literature

BACKGROUND Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events.Aggressive balloon post-dilatation though helpful is usually inadequate.Multiple plaque ablation techniques are in vogue,but they are technically demanding and are not without complications.Shockwave intravascular lithotripsy(S-IVL)has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin.A series of trials(DISRUPT CAD I-IV)have demonstrated both short-term and long-term safety and efficacy of the technique.As experience with the technique grows more and more,therapy areas like stent restenosis are being covered by the S-IVL.CASE SUMMARY We report a series of 2 cases successfully managed with S-IVL therapy at our center.The first case is of a 57-year-old smoker who presented with acute coronary syndrome.His left anterior descending coronary artery revealed calcified 90%stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging.The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted.The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram.She also demonstrated a mixture of superficial and deep seated calcium zones on imaging.S-IVL therapy was applied to generate fractures in calcium,and two overlapping drug-eluting stents were implanted successfully without any complications.CONCLUSION S-IVL is an emerging,efficient,user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.