HRV changes before and after radiofrequency ablation in patients with different origin of right ventricular outflow tract ventricular premature contraction

Objective:To observe the HRV changes before and after the radiofrequency current catheter ablationventricular premature beats originated from different site of right ventricular outflow tract.Methods:A total of 102 patients with frequent RVOT-VPC admitted to our hospital were accepted radiofrequency current catheter ablation (RF). According to the origin of RVOT-VPC, it was divided into 2 groups, one is from ventricular septum, and the other one is from free wall, and in each group, male and female are observed separately.Results:(1) HRV before RF ablation: 1) rMSSD in the female patients with RVOT-VPC from free wall was significantly lower than those from septum;2) frequency domain index (W, LF) were higher than normal range, and in male patients, LF/HF<1 were found, but in female patients, LF/HF>1. (2) HRV after RF ablation: 1) Significant changes were found in female patients with RVOT-VPC from septum, rMSSD, PNN50, HF and LF decreased;2) In female patients with RVOT-VPC from free wall, rMSSD decreased;3) In male patients, there were no significant HRV changes found before and after RF ablation. (3) Heart rate changes: 1) In female patients with RVOT-VPC from septum, heart rate decreased significantly ((76.47±9.47) bpm vs (69.29±14.59) bpm)2) No significant changes were found in male patients.Conclusion:In patients with RVOT-PVC sympathetic and vagus excitability increased, and after catheter ablation, in female patients with RVOT-PVC originated from septum, the HRV index relating to sympathetic and vagus excitability significantly decreased.

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.

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.

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.

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.

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.

参松养心胶囊治疗老年冠心病室性早搏气阴两虚、心络瘀阻型患者临床观察

目的:观察参松养心胶囊对老年冠心病室性早搏气阴两虚、心络瘀阻型患者临床疗效、动态心电图室性早搏次数及中医证候积分的影响。方法:选择老年冠心病室性早搏气阴两虚、心络瘀阻型患者60例,按照随机数字表法分为对照组和观察组,每组30例。对照组给予口服酒石酸美托洛尔,观察组在对照组基础上口服参松养心胶囊。两组均连续治疗4周。观察两组治疗前后临床疗效,24 h动态心电图室性早搏次数及中医证候积分。结果:对照组有效率[73.33%(22/30)]高于观察组[96.67%(29/30)](P<0.05)。两组治疗后室性早搏次数均减少,观察组减少较对照组更明显(P<0.05)。与治疗前比较,两组心悸、悸动不安、神疲乏力、气短、五心烦热等中医证候积分均下降(P<0.05),且治疗后观察组上述指标改善优于对照组(P<0.05)。结论:参松养心胶囊能有效减少老年冠心病室性早搏患者的室性早搏次数,改善患者临床症状。

激动标测和起搏标测联合指引下解剖消融治疗特发性右室流出道室性早搏的效果

目的探讨激动标测和起搏标测联合指引下解剖消融治疗特发性右室流出道(RVOT)室性早搏的临床价值。方法回顾性分析2023年1—10月在郑州大学第一附属医院心血管内科和许昌市中心医院心血管内科住院接受室性早搏射频消融术的36例患者的资料,经电生理检查证实室性早搏来源于RVOT,根据术中室性早搏数量多少灵活采用激动标测和或起搏标测找到靶点进行对应肺动脉根部瓣下和瓣上联合消融,分析该方法即刻及3个月成功率。结果术中室性早搏数量少的患者也可以快速有效地进行导管消融术并取得满意的远期效果。结论激动标测和起搏标测联合指引下解剖消融治疗特发性RVOT室性早搏临床可行,效果较好。

特发性室性早搏经射频消融后自主神经系统活性的变化

目的射频导管消融术(RFCA)是特发性室性早搏(IPVC)的标准治疗方法。本研究旨在确定低、中、高负荷量的患者在RFCA术前术后的自主神经系统(ANS)活动。方法回顾性分析2017年6月至2021年3月共200例特发性室性早搏行射频消融手术的患者。在200例患者中,179例(89.5%)手术消融成功。将消融成功的患者分为低负荷组(负荷量≤15%)、中负荷组(负荷量15%~25%)和高负荷组(负荷量≥25%)。评估不同负荷和不同消融部位患者的临床数据、心率变异性(HRV)各参数、窦性心率震荡(HRT)及心率减速力(DC)。结果高负荷组的平均心率、5 min均值标准差(SDANN)、正常RR间期标准差(SDNN)、正常RR间期标准差(SDNN)指数、逐次R-R区间差异均方根(rMSSD)、相邻RR间期差值超过50 ms的RR间期所占百分数(pNN50)高于低负荷组,而低频功率(LF)/高频功率(HF)之比低于低负荷组。消融后,SDNN、SDNN指数、SDANN、rMSSD、pNN50、震荡斜率(TS)和DC显著降低(P<0.01),LF/HF和震荡初始(TO)显著升高(P<0.01)。术前早搏负荷与左心室舒张末期内径(LVEDd)、平均心率、SDNN指数、SDANN、rMSSD、pNN50呈正相关,与总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、左心室射血分数(LVEF)、LF/HF呈负相关。回归分析显示,特发性室性早搏负荷与平均心率(P<0.01)、SDANN(P<0.01)和rMSSD(P<0.01)呈正相关。结论随特发性室性早搏负荷增加,交感神经和迷走神经活动增强,并以交感神经活性增强为主。特发性室性早搏的发生可能与自主神经平衡调节受损有关。射频消融术可降低交感神经和迷走神经活性。

清热化痰类中药治疗痰火扰心型室性期前收缩疗效及安全性的Meta分析

目的:系统评价清热化痰类中药治疗痰火扰心型室性期前收缩的疗效及安全性。方法:检索中国知网(CNKI)、维普数据库(VIP)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、Web of Science及the Cochrane Library。检索时间限定为自建库至2022年5月1日。纳入运用清热化痰类中药治疗痰火扰心型室性期前收缩的随机对照试验(RCT),2名研究者通过阅读文献题目和摘要,并结合全文,对文献进行资料提取,应用RevMan 5.4软件进行Meta分析。结果:最终纳入符合标准的RCT 12项,涉及1 608例病人,Meta分析结果显示:试验组临床疗效优于对照组[RR=1.23,95%CI(1.15,1.32),P<0.000 01],不良反应发生率低于对照组[RR=0.50,95%CI(0.27,0.92),P=0.03],中医证候疗效优于对照组[RR=1.22,95%CI(1.07,1.39),P=0.002],室性期前收缩次数较对照组明显降低[MD=-706.53,95%CI(-951.62,-461.44),P<0.000 01],中医证候积分较对照组明显降低[MD=-16.30,95%CI(-21.53,-11.08),P<0.000 01]。结论:现有证据表明,清热化痰类中药联合西药治疗痰火扰心型室性期前收缩的疗效优于单纯西药治疗,且具有较高的安全性。

STEMI患者急诊PCI术后出现频发室性早搏的危险因素研究

目的探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠脉介入术(PCI)后出现频发室性早搏(简称“室早”)的危险因素。方法选择2021年7月至2023年7月在海南省中医院胸痛中心就诊的108例STEMI患者纳入本研究,所有患者按急诊PCI术后1周内是否出现频发室早进行分组,分为频发室早组(n=25)和非频发室早组(n=83)。然后记录所有患者入院时的基线数据、急诊PCI资料以及PCI术后血清8-羟基脱氧鸟苷(8-OHDG)水平,对其进行统计学分析。结果基线数据方面,两组患者年龄、性别、烟酒嗜好史、生命体征、Killip分级、电解质水平和左心室射血分数方面比较,差异无统计学意义(P>0.05)。频发室早组患者合并糖尿病的患者数量显著高于非频发室早组,差异有统计学意义(P<0.05);两组患者STEMI发病至到达医院大门时间、医院大门至导丝通过时间、肌钙蛋白I、脑钠肽、肌红蛋白、肌酸激酶同工酶、是否为三只血管病变和是否为左主干或前降支近端病变方面比较,差异无统计学意义(P>0.05)。此外,频发室早组PCI术后血清8-OHDG水平也显著高于非频发室早组,差异有统计学意义(P<0.05)。二元logistic回归分析显示,糖尿病病史和PCI术后高水平的8-OHDG是STEMI患者急诊PCI术后出现频发室早的危险因素(P<0.05)。结论糖尿病病史和PCI术后高水平的8-OHDG是STEMI患者急诊PCI术后出现频发室早的危险因素。

基于因子分析与聚类分析的室性早搏证候要素与中医证候特点研究

[目的]探究室性早搏的中医证候要素及分型规律,旨在为临床早期干预室性早搏辨证论治提供参考。[方法]2018年12月至2022年12月在天津中医药大学第一附属医院等43家医院就诊的室性早搏患者为研究对象,采用“中医证候”“舌象观察表”进行中医临床信息采集,借助SPSS Statistics对临床信息进行因子分析,进而借助SPSS Statistics对提取的公因子进行系统聚类分析,经相关专家评判并结合中医证素分析室性早搏的中医证素规律及其证型分布特点。[结果]本研究共纳入669例患者,采集获得19个临床症状及15个舌象信息,其中常见的临床症状为心悸、胸闷、急躁易怒、失眠、口干等症状;最常见的舌色为舌淡(47.23%);最常见的苔色为苔白(73.09%);最常见的苔质为苔腻(45.59%)。对34个因素进行因子分析,获得12个公因子,室性早搏患者最主要证候要素为火(热),其余依次为阳虚、痰、血虚、水饮、血瘀、气虚、阴虚;病位主要为心,其次为脾、肝、肾、肺。系统聚类分析结果显示,室性早搏的常见证型为痰火扰心证、心脾两虚证、瘀阻心脉证、心阳不振证、阴虚火旺证。[结论]室性早搏中医证候要素以火(热)为主,痰火扰心可能是室性早搏的重要病理因素。

国医大师卢芳教授基于“阳虚作悸”理论辨治室性期前收缩经验

总结国医大师卢芳教授基于“阳虚作悸”理论辨治室性期前收缩的临床经验。通过对“阳虚作悸”理论的阐释,深入探讨卢芳教授对室性期前收缩病因病机的认识,剖析自拟复阳定悸汤组成、方义,并举临床案例加以验证。基于“阳虚作悸”理论,认为室性期前收缩的核心病机为阳气亏虚,波及心、脾、肾三脏。因此以“通阳定心”为法,以复阳定悸汤为核心方剂,并根据不同的疾病分期加减治疗,以改善患者病情,相关的验案1则进一步验证了其治疗策略的可行性。卢芳教授运用复阳定悸汤治疗室性期前收缩疗效显著,结合疾病分期及虚实情况,辨证论治,灵活运用专症专药加减变化,其经验值得临床推广学习。