Ventricular premature complexes (VPCs) are known to be one of the most benign cardiac arrhythmias when they occur in structurally normal hearts. We experienced a 32-year old man who presented with dyspnea, palpitations and very frequent VPCs (31% of the total heart beats). Echocardiography revealed a dilated left ventricle (LV 66 mm at end-diastole and 57 mm at end-systole) and a decreased ejection fraction (34%). Very frequent VPCs had been detected 10 years previously and he underwent a failed radiofrequency catheter ablation (RFCA) procedure at that time. The patient had been treated with heart failure medications including betablockers, ACE inhibitors and spironolactone for the two most recent years. Six months after we eliminated these VPCs with a second RFCA procedure, the heart returned to normal function and size. Long standing and very frequent VPCs could be the cause of left ventricular dysfunction in a subset of patients who suffer with dilated cardiomyopathy, and RFCA should be the choice of therapy for these patients.
Ventricular Premature Complexes/*complications ; Tachycardia, Ventricular/*etiology/therapy ; Male ; Humans ; *Catheter Ablation ; Cardiomyopathies/*etiology/therapy ; Adult

OBJECTIVETo determine the predicative significance of HRV and HRT to premature beat on patients with coal-worker's pneumoconiosis.

METHODS100 coal-worker's pneumoconiosis patients with premature beat (including 44 cases of occasional ventricular premature contraction and 56 cases of frequent ventricular premature contraction) were chosen as CWP group, and 50 healthy coal workers were chosen as control group. 24 h DCG was used to monitor and analyze the change of premature beat and to calculate HRV. Index: SDNN, SDANN, HFLF, HRT: TO, TS, compare HRV of CWP group and control group and the changes of HRT of both occasional and frequent ventricular premature contraction.

RESULTSThe incidence of CWP at night (66.1%, 37 cases) is higher than that during daytime (33.9%, 19 cases), and the difference is statistically significant with P < 0.05. HRV (SDNN SDANN HF HL) indexes of CWP group are lower than control group, and the difference is statistically significant with P < 0.05. HRV indexes of control group at night are higher than that during daytime, and the difference is statistically significant with P < 0.05. Comparison of CWP group HRV indexes between day and night is statistically insignificant with P > 0.05. Compared with control group, TO of CWP group is higher while TS is lower, and the difference is statistically significant with P < 0.05. Compared with occasional ventricular premature contraction patients in CWP group, TO of frequent ventricular premature contraction patients is higher while TS is lower, and the difference is statistically significant with P < 0.05.

CONCLUSIONFrequent ventricular premature contraction group in CWP group suffer from severe impaired autonomic nervous function injury, and abnormal HRV and HRT can be prognostic indicator of frequent ventricular premature contraction among coal-worker's pneumoconiosis patients.

Aged ; Anthracosis ; complications ; Case-Control Studies ; Heart Rate ; physiology ; Humans ; Male ; Middle Aged ; Ventricular Premature Complexes ; diagnosis ; etiology

OBJECTIVETo observe the ECG and electrophysiological characteristic of patients with idiopathic ventricular tachycardia (VT) and premature ventricular contraction (PVC) originating from left (LVOT) and right (RVOT) ventricular outflow tracts and assess the clinical effect of radio frequency catheter ablation (RFCA) on these patients.

METHODSRFCA was performed in 58 patients (10 with VT and 48 with PVC, 5 patients with VT from RVOT under the guidance of non-contact mapping system Ensite3000). VT or PVC originated from LVOT in 15 patients (12 out of 15 from left sinus of Valsalva) and RVOT in 43 patients.

RESULTS(1) R wave in II, III, aVF leads was the common characteristics of VT or PVC originated from LVOT and RVOT and difference in wave duration index and R/S-wave amplitude ratio in V(1) or V(2) could be used to define VT and PVC originated from LVOT or RVOT. (2) Ablation was successful in 55 out of 58 patients (9 patients with the 2nd ablation, evaluated as arrhythmia-free at 3 months post ablation without medication) and failed in 3 patients. One patient developed pericardial tamponade during ablation and recovered without complication after related treatments.

CONCLUSIONSRFCA is an effective, safe and curative therapy for VT or PVC originated from LVOT and RVOT. Non-contact mapping system (Ensite3000) is a safe and reliable tool to guide mapping and ablation in patients with complex VT and unstable hemodynamics.

Adolescent ; Adult ; Aged ; Catheter Ablation ; Female ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular ; etiology ; therapy ; Ventricular Outflow Obstruction ; complications ; Ventricular Premature Complexes ; etiology ; therapy ; Young Adult

OBJECTIVETo study the difference in prognosis for children with acute viral myocarditis induced ventricular premature beats (VPB) originating from different positions, and to study the role of 99Mtc-MIBI myocardial perfusion ECT in the prognostic evaluation of VPB.

METHODSThe clinical data of 83 children with viral myocarditis induced VPB were retrospectively studied. They were divided into four groups according to the original site of VPB, as shown by the ECG: right ventricular (RV) outflow tract, RV anterior wall and apex, left ventricular (LV) outflow tract, LV anterior wall and apex. All patients were treated with anti-viral drugs and myocardial nutritional medicine. Short-term and long term outcomes in the four groups were compared. The relationship between the results of 99Mtc-MIBI myocardial perfusion ECT and prognosis in 40 patients was observed.

RESULTSThere were no significant differences in short-term and long-term effective rates among the four groups (P>0.05). There were no differences in the ECT positive rates between the patients with VPB originating from RV and those with VPB originating from LV (P>0.05). The treatment effective rates of ECT-positive patients were higher than the treatment effective rates of ECT-negative ones (P<0.05).

CONCLUSIONSThe short-term and long-term prognosis of children with VPB originating from different positions are not significantly different. In children with viral myocarditis induced VPB, positive ECT results suggest a better prognosis.

Acute Disease ; Humans ; Myocardial Perfusion Imaging ; methods ; Myocarditis ; complications ; Prognosis ; Retrospective Studies ; Technetium Tc 99m Sestamibi ; Ventricular Premature Complexes ; diagnostic imaging ; etiology ; Virus Diseases ; complications

OBJECTIVETo investigate the correlation between heart rate turbulence (HRT) and coronary lesion and the effects of percutaneous transluminal coronary angioplasty (PTCA) on HRT.

METHODSThis study involved 150 patients undergoing 24-hour ambulatory electrocardiography (AECG) and elective coronary angiography (CAG). AECG was monitored on the first day and 7 days after PTCA in 108 patients with positive CAG findings, and the variation of HRT and cardiac functions were observed. The turbulence onset (TO), turbulence slope (TS) and turbulence timing (TT) of each section of HRT were calculated, analyzed and compared.

RESULTSThe values of TO and TT were significantly higher and TS significantly lower in CAG-positive group than in CAG-negative group (P<0.05 or 0.001). Significant difference was found in TO, TS and TT between patients with single and multiple coronary lesions (P<0.05 and 0.001). The values of TO, TS and TT on the first day after PTCA improved significantly in comparison with the those before PTCA in patients with single and multiple coronary lesions (P<0.001). Postoperative follow-up of the patients revealed obviously attenuated HRT in patients with left cardiac insufficiency compared with the patients with normal cardiac function (P<0.05).

CONCLUSIONHRT is correlated to the severity of the coronary lesions and shows significant improvement after PTCA. Cardiac function insufficiency is an important factor affecting the HRT attenuation.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Arrhythmias, Cardiac ; complications ; Coronary Angiography ; Coronary Artery Disease ; complications ; physiopathology ; therapy ; Electrocardiography, Ambulatory ; Female ; Heart Rate ; physiology ; Humans ; Male ; Middle Aged ; Ventricular Premature Complexes ; complications

OBJECTIVETo evaluate the efficacy and safety of Fulu Baoxinping (FLBXP) oral liquid in the treatment of coronary heart disease patients with premature ventricular beat (PVB), differentiated as qi-yin deficiency with phlegm-stasis syndrome type.

METHODSAdopting randomized, double-blinded, double-simulated, positive drug parallel controlled and multi-centered clinical research method, 240 patients enrolled were randomly assigned equally to the treatment group treated with FLBXP 10 mL (containing 13.33 g of crude drug) thrice a day and the control group treated with Wenxin Granule 9 g thrice a day. Meanwhile, simulator of the test or positive control drug was given to them all correspondingly. The therapeutic course for them all was 28 days. Efficacy on PVB and TCM syndrome was observed.

RESULTSThe markedly effective rate and total effective rate on PVB were 55.0% and 78.4% in the treatment group, and 37.2% and 53.1% in the control group, significant difference between groups was shown in comparison of both indexes (P < 0.05). Dynamic ECG showed the total number of PVB decreased for 3460.59 +/- 6516.56 beats/24 h in the treatment group, and for 2148.36 +/- 5129.47 beats/24 h in the control group, difference between them showed no statistical significance (P > 0.05). The TCM syndrome score in both groups was markedly decreased after treatment when compared with before treatment (P < 0.01); the differences of the treated and the control groups were -9.34 +/- 4.21 and -8.08 +/- 4.33 respectively, showing sigificant difference (P < 0.05).

CONCLUSIONFLBXP oral liquid has certain effect on PVB in CHD patients of qi-yin deficiency with phlegm-stasis syndrome type, no obvious adverse reaction was found in the clinical trial.

Administration, Oral ; Adult ; Aged ; Coronary Disease ; complications ; drug therapy ; physiopathology ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Ventricular Premature Complexes ; complications ; drug therapy ; physiopathology

OBJECTIVETo observe the clinical efficacy of shensong yangxin capsule (SYC) on ventricular premature beat (VPB) differentiated in TCM as palpitation of Qi-yin deficiency syndrome or Xin collateral stagnation syndrome, and cardiovascular autonomic nervous function in patients with coronary heart disease (CHD).

METHODSThe randomized, double-blind, parallel contrast method was adopted, patients were randomly assigned by 3:1 ratio into two groups. One hundred and sixty-five patients in SYC treated group and 56 in the control group (treated with Xinlvning tablet), and the therapeutic course for both groups was 4 weeks.

RESULTSThe clinical efficacy on VPB and in improving TCM syndromes was better in SYC group than that in the control group (P < 0.01). After treatment, the heart rate variability (HRV) and QT dispersion in the two groups were improved in a certain degree. The changes of SDNN, SDANN, SDNN Index and PNN50 in the two groups were significantly different (P < 0.05, P < 0.01), the efficacy in the treated group was superior to that in the control group.

CONCLUSIONSYC has definite effect on VPB and TCM Syndromes, it can obviously meliorate the activity of cardiovascular autonomic nervous system in the patients with CHD.

Adult ; Aged ; Autonomic Nervous System ; drug effects ; physiopathology ; Capsules ; Coronary Disease ; complications ; drug therapy ; Double-Blind Method ; Drug Administration Schedule ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart ; innervation ; Humans ; Male ; Middle Aged ; Phytotherapy ; Ventricular Premature Complexes ; drug therapy ; etiology

BACKGROUND: Since the introduction of atrial switch operation, the outlook for patients with complete transposition of the great arteries (TGA) has improved dramatically. However, many survivors are afflicted with postoperative complications and continue to demand medical attention. We therefore performed the study for the evaluation of the clinical course in the patients with complete TGA after atrial switch operation. METHODS: We analyzed the data of 51 patients who underwent the atrial switch operation for complete TGA at Seoul National University Hospital between January 1981 and June 1993 retrospectively. RESULTS: The patients were composed of 36 males and 15 females (mean age at operation, 15+/-30 months, range 2 months-18 years). Senning operation was undertaken in 43 and Mustard operation in 8. Among these, 27 had simple and 24 complex complete TGA. The early mortality rate within 1 month postoperatively was 39% and the late mortality rate 16%. The actuarial survival rate after 10 years was 78%. Of these, 17 cases have been followed up so far. Although the significant tricuspid regurgitation was noted in 9, right ventricular systolic function was maintained in all of them. Preoperative sinus node dysfunction was noted in 1 case. Postoperatively, premature ventricular contractions were found in 8 cases, atrial flutter in 4, and sinus node dysfunction in 7. Subclinical pulmonary venous obstruction was found in 2 and systemic venous obstruction in 1. At present, one takes digoxin for prevention of atrial flutter and 7 take digoxin, furosemide, and/or angiotensin-converting enzyme inhibitors for prevention of ventricular functional deterioration. Twelve cases were in New York Heart Association functional class I at the latest follow-up and 5 were in class II. CONCLUSION: This study revealed that morbidity and mortality were not low after atrial switch operation. However, considering the good long-term functional status in the survivors, atrial switch operation could be an alternative to arterial switch operation in complicated cases of TGA.
Angiotensin-Converting Enzyme Inhibitors ; Arteries* ; Atrial Flutter ; Digoxin ; Female ; Follow-Up Studies* ; Furosemide ; Heart ; Humans ; Male ; Mortality ; Mustard Plant ; Postoperative Complications ; Retrospective Studies ; Seoul ; Sick Sinus Syndrome ; Survival Rate ; Survivors ; Tricuspid Valve Insufficiency ; Ventricular Premature Complexes

BACKGROUND: Since the introduction of atrial switch operation, the outlook for patients with complete transposition of the great arteries (TGA) has improved dramatically. However, many survivors are afflicted with postoperative complications and continue to demand medical attention. We therefore performed the study for the evaluation of the clinical course in the patients with complete TGA after atrial switch operation. METHODS: We analyzed the data of 51 patients who underwent the atrial switch operation for complete TGA at Seoul National University Hospital between January 1981 and June 1993 retrospectively. RESULTS: The patients were composed of 36 males and 15 females (mean age at operation, 15+/-30 months, range 2 months-18 years). Senning operation was undertaken in 43 and Mustard operation in 8. Among these, 27 had simple and 24 complex complete TGA. The early mortality rate within 1 month postoperatively was 39% and the late mortality rate 16%. The actuarial survival rate after 10 years was 78%. Of these, 17 cases have been followed up so far. Although the significant tricuspid regurgitation was noted in 9, right ventricular systolic function was maintained in all of them. Preoperative sinus node dysfunction was noted in 1 case. Postoperatively, premature ventricular contractions were found in 8 cases, atrial flutter in 4, and sinus node dysfunction in 7. Subclinical pulmonary venous obstruction was found in 2 and systemic venous obstruction in 1. At present, one takes digoxin for prevention of atrial flutter and 7 take digoxin, furosemide, and/or angiotensin-converting enzyme inhibitors for prevention of ventricular functional deterioration. Twelve cases were in New York Heart Association functional class I at the latest follow-up and 5 were in class II. CONCLUSION: This study revealed that morbidity and mortality were not low after atrial switch operation. However, considering the good long-term functional status in the survivors, atrial switch operation could be an alternative to arterial switch operation in complicated cases of TGA.
Angiotensin-Converting Enzyme Inhibitors ; Arteries* ; Atrial Flutter ; Digoxin ; Female ; Follow-Up Studies* ; Furosemide ; Heart ; Humans ; Male ; Mortality ; Mustard Plant ; Postoperative Complications ; Retrospective Studies ; Seoul ; Sick Sinus Syndrome ; Survival Rate ; Survivors ; Tricuspid Valve Insufficiency ; Ventricular Premature Complexes

INTRODUCTIONAntimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs has some side effects including cardio toxicity and electrocardiogram (EKG) changes. The objective of our study was to evaluate EKG changes in the patients with CL treated with systemic glucantime.

MATERIALS AND METHODSOne hundred and thirty-one patients were enrolled in this prospective study. All of the selected patients had confirmed CL and were candidates for treatment with systemic glucantime. The patients were treated with systemic glucantime and EKG was performed before, during (weekly) and 1 month after cessation of the treatment. All of the collected data were analysed using SPSS software.

RESULTSThe most common change was prolonged QT interval that was seen in 19% of the patients. ST depression occurred in 6.1% of the patients. Minimal ST elevation occurred in 3% and inverted T was observed in 7.4% of the patients. Single premature atrial contraction (PAC) and single premature ventricular contraction (PVC) occurred in 0.7% and 2.29% of patients, respectively. Bradycardia was observed in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed after stopping the treatment except 1 case with left bundle branch block that lasted for 1 month after the treatment.

CONCLUSIONSOur results showed that treatment with glucantime can induce many ECG changes as QT prolongation have significant risk. We suggest that ECG monitoring should be performed in high-risk patients undergoing glucantime treatment with special attention to ECG changes mostly prolonged QT interval.

Administration, Oral ; Adult ; Animals ; Antimony ; Antiprotozoal Agents ; administration & dosage ; adverse effects ; Atrial Premature Complexes ; chemically induced ; physiopathology ; Bradycardia ; chemically induced ; physiopathology ; Bundle-Branch Block ; chemically induced ; physiopathology ; Dose-Response Relationship, Drug ; Electrocardiography ; drug effects ; Female ; Follow-Up Studies ; Humans ; Leishmaniasis, Cutaneous ; complications ; drug therapy ; physiopathology ; Male ; Meglumine ; administration & dosage ; adverse effects ; Organometallic Compounds ; administration & dosage ; adverse effects ; Prognosis ; Prospective Studies ; Ventricular Premature Complexes ; chemically induced ; physiopathology