心脏室间隔起搏与右室心尖部起搏对心功能的影响

目的:探讨右心室间隔部(Right Ventricular Septum,RVS)起搏和右心室心尖部(Rightventricularape,RVA)起搏对心功能的影响,为临床提供参考.方法:采用前瞻性研究的方法,对我院自2008年8月-2011年8月收治的行起搏器治疗的72例患者随机均分为实验组和对照组,实验组采用RVS起搏,对照组采用RVA起搏,比较植入后15分钟和1年后测定两组间心室起搏参数差异及血流动力学参数左室射血分数(LVED、每搏量(sv)、心脏指数(CD、二尖瓣血流E峰和A峰最大充盈速度比值(E/A)差异.结果:植入后15分钟和1年后,实验组和对照组起搏参数起搏阈值、电极阻抗、心腔内R波幅度进行比较,差异无统计学意义(P＞0.05).植入后1年后,两组间的血流动力学参数比较,差异有统计学意义(P＜0.05).结论:RVS起搏优于RVA起搏,有望替代传统的右心室心尖部成为最佳的心室起搏部位.     

致心律失常性右室心肌病/ 发育不良1 例报告并文献复习

目的:探讨致心律失常性右室心肌病/发育不良的临床特点、病理特征诊断及治疗。方法:回顾性分析1例致心律失常性右室心肌病/发育不良的临床资料,并复习相关文献。结果:致心律失常性右室心肌病/发育不良常见临床表现有心悸、头晕、晕厥、气急胸闷,心电图可见延迟除极epsiton波。结论:致心律失常性右室心肌病/发育不良临床罕见,心脏超声及冠脉CT,心电图为主要确诊手段,治疗以限制运动与药物治疗为主。     

Right Ventricular Endomyocardial Fibrosis Presenting With Ventricular Tachycardia And Apical Thrombus - An Interesting Presentation

Endomyocardial fibrosis is a progressive disease of unknown origin affecting children and young adults. It involves inflow portion of right and/or left ventricle and apex. It may be associated with thrombus. Literature regarding right ventricular endomyocardial fibrosis with thrombus is scarce. Here we report a rare case of right ventricular endomyocardial fibrosis presenting as ventricular tachycardia and echocardiographic evidence of apical thrombus. Interestingly there was no pulmonary involvement or evidence of deep venous thrombosis. This case also underscores the importance of urgent echocardiography in diagnosis of obscure cases of ventricular tachycardia.     

Transient Global Amnesia after Ablation of Premature Ventricular Beats Arising from the Right Coronary Cusp

A 58-year-old female underwent PVC ablation within the right coronary cusp for symptomatic PVCs and suspected PVC-induced cardiomyopathy. Immediately after the procedure, she started to complain about feelings of impending doom, disorientation to time and place, and amnesia regarding the procedure. No sensory or motor deficits could be elicited. A thromboembolic event was suspected and she was evaluated by a neurologist. CT scan of her brain was negative. She was diagnosed with transient global amnesia and her mentation returned to baseline within 4 hours after the procedure.     

致心律失常性右心室心肌病致病蛋白的挖掘

目的:鉴定疾病蛋白对深入理解致心律失常性右心室心肌病(ARVC)致病机制至关重要。可以采用计算生物学的方法,在ARVC疾病相关网络中挖掘新的潜在的致病蛋白。方法:本文整合HPRD和BioGRID的蛋白质互作数据,获得了较为全面且真实可靠的蛋白质互作数据;通过结合文本挖掘和统计学检验筛选出ARVC种子蛋白,应用最近邻居扩增的方法,构建ARVC蛋白质互作网络(PPIN),并采用PRINCESS法则对网络中每对互作蛋白加权;最后,基于ARVC关联得分策略对网络中的每个蛋白质打分并排秩。结果:分析发现排秩前50的候选蛋白大都与ARVC关系密切,如PRKCA,CDH1,SMAD4,SMAD2,CDH5,CTNNA1,DSC1等在调节心肌收缩、细胞程序性死亡、心脏的发育过程及维持桥粒的完整性方面起重要作用。结论:我们提出的方法为鉴定与ARVC致病机制相关的新致病蛋白提供了有效的途径。     

Verapamil Sensitive Ventricular Tachycardia Associated With A Cardiac Hemangioma In The Right Ventricular Outflow Tract

Primary tumors of the heart are rare, but they are often associated with refractory arrhythmias. Vascular tumors of the heart comprise a small minority of primary cardiac tumors. In patients with structurally normal hearts, ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT) can be sensitive to adenosine, vagal maneuvers, and calcium channel blockers. In this report, we describe a case of ventricular tachycardia originating from within a hemangioma in the RVOT that was ultimately controlled with verapamil.     

Extensive Preferential Pathway Ablation for the Elimination of Premature Ventricular Contractions Arising from the Right Ventricular Outflow Tract

A 76 y/o women presented with 2 different types of premature ventricular contractions (VPCs 1 and 2) arising from the right ventricular outflow tract (RVOT). Catheter ablation (CA) eliminated PVC1 at the earliest activation site (EAS), but thereafter another PVC morphology (PVC3) appeared. Small potentials preceding the local potential were broadly exhibited from the RVOT’s supero-anterior region to the EAS during PVC3. Point CA targeting such prepotentials failed. Transverse-linear CA with a line connecting sites with such pre-potentials eliminated both PVCs 3 and 2. In cases with broadly spreading preferential pathways, extensive CA might be needed to eliminate the PVCs.     

特发性右心室流出道室性心律失常射频消融术后复发因素分析

目的:探讨特发性右心室流出道室性心律失常射频消融术后,患者室性心律失常复发的原因,旨在为进一步降低复发率提供线索。方法:1999年12月至2009年12月,在解放军总医院老年心血管内科住院行导管射频消融的特发性右心室流出道室性心律失常患者共145例(男55例,女90例),治疗终点为室性心律失常消失,不能被心室电刺激和静滴盐酸异丙肾上腺素诱发,术后1天复查动态心电图并电话随访观察疗效。结果:在145例患者中,即刻成功136例,成功率为93.8%。随访23.8±6.7月,共有9例患者复发,复发率为6.62%。9例复发患者再次行射频消融术的靶点局部激动(34.0±7.6 ms)明显早于第一次射频消融术(30.4±8.5 ms)(P<0.05);靶点起搏与自发心律失常体表心电图QRS波形的符合数(11.8±0.45)大于第一次射频消融术(11.1±0.78)(P<0.05);复发患者第一次手术在最早激动点处单极标测r波的出现比例大于第二次手术(P<0.05),再次手术均成功。结论:导管射频消融治疗特发性右心室流出道室性心律失常是有效、可行的方法。靶点标测欠精确是术后复发的主要原因。     

Right coronary artery supply to a cardiac mass

Netherlands Heart Journal -     

On the Alleged Right to Participate in High‐Risk Research

Reigning regulatory frameworks for biomedical research impose on researchers and research ethics committees an obligation to protect research participants from risks that are unnecessary, disproportionate to potential research benefits, and non‐minimized. Where the research has no potential to produce results of direct benefit to the subjects and the subjects are unable to give consent, these requirements are strengthened by an additional condition, that risks should not exceed a certain minimal threshold. In this article, I address the question of whether there should be limits of permissible risks in non‐therapeutic research involving competent and healthy subjects. Some commentators argue that competent and informed individuals should have a right to participate even in extremely risky research and that research ethics committees should never reject studies because they are too dangerous. To use David Shaw's expression, competent volunteers should have ‘a right to participate in high‐risk research’. I argue that this idea is ill‐founded, as it does not take into account the social mission and complex collaborative nature of research practice as well as the inequity of power between researchers and subjects. Imposition of limits on permissible risks for healthy volunteers is justified by the need to protect research enterprise and the need to protect the weaker party, namely the subjects. Also, I suggest that the best way to set boundaries on research risks is to leave the judgment of risk acceptability to research ethics committees.     

Persistent bi-coronary Thebesian veins to the left ventricle

In this image case we describe a relatively rare vascular malformation known of as Thebesian veins, which in some cases could cause cardiac ischemia and ventricular arrhytmias.     

PHB2抑制低氧性肺动脉高压小鼠右心室重塑的作用

摘要 目的：探讨抗增殖蛋白2（PHB2）在低氧性肺动脉高压（HPH）诱导的右心室重塑中的作用及可能机制。方法：将普通8周龄的C57BL/6小鼠随机分为：对照组（Control）、HPH组、HPH+空病毒（HPH+vector）组、HPH+过表达PHB2（HPH+PHB2）组。HPH组、HPH+空病毒组、HPH+过表达PHB2组置于低压低氧人工舱内维持4 w,对照组置于常压常氧环境中维持4 w。实验开始3 w前,尾静脉注射平滑肌特异性PHB2过表达的AAV9腺相关病毒及其对照病毒。评估小鼠右室血流动力学、右室重塑指标、炎症、氧化应激、血管活性物质水平以及肺组织PHB2和p-Stat3蛋白表达。结果：与对照组相比,HPH组和HPH+空病毒组RVSP、RVAW、RVHI显著增加（P<0.05）,而RVID显著降低（P<0.05）,右室CVF显著增加（P<0.05）,血浆ET-1和BNP显著增加（P<0.05）,血浆NO、总NOS和iNOS显著降低（P<0.05）,右心IL-1β、IL-6及TNF-α显著增加（P<0.05）,SOD和GSH-Px显著降低（P<0.05）,肺组织PHB2表达降低（P<0.05）,p-STAT3表达增加（P<0.05）。与HPH组和HPH+空病毒组相比,HPH+过表达PHB2组RVSP、RVAW、RVHI显著降低（P<0.05）,而RVID显著增加（P<0.05）,右室CVF显著降低（P<0.05）,血浆ET-1和BNP显著降低（P<0.05）,血浆NO、总NOS和iNOS显著增加（P<0.05）,右心IL-1β、IL-6及TNF-α显著降低（P<0.05）,SOD和GSH-Px显著增加（P<0.05）,肺组织PHB2表达增加（P<0.05）,p-STAT3表达降低（P<0.05）。结论：PHB2可减轻HPH诱发的右心室重塑,其机制可能与PHB2抑制STAT3的磷酸化水平有关。     

Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room

Studies conducted during the last 50 years have proposed electrocardiographic criteria and algorithms to determine if a wide QRS tachycardia is ventricular or supraventricular in origin. Sustained ventricular tachycardia is an uncommon reason for consultation in the emergency room. The latter and the complexity of available electrocardiographic diagnostic criteria and algorithms result in frequent misdiagnoses. Good hemodynamic tolerance of tachycardia in the supine position does not exclude its ventricular origin. Although rare, ventricular tachycardia in patients with and without structural heart disease may show a QRS duration <120 ms. Interruption of tachycardia by coughing, carotid sinus massage, Valsalva maneuver, or following the infusion of adenosine or verapamil should not discard the ventricular origin of the arrhythmia. In patients with regular, uniform, sustained broad QRS tachycardia, the presence of structural heart disease or A-V dissociation strongly suggest its ventricular origin. Occasionally, ventricular tachycardia can present with AV dissociation without this being evident on the 12-lead ECG. Cardiac auscultation, examination of the jugular venous pulse, and arterial pulse palpation provide additional clues for identifying A-V dissociation during tachycardia. This paper does not review the electrocardiographic criteria for categorizing tachycardia as ventricular but rather why emergency physicians misdiagnose these patients.