ventricular premature beat is the most common clinical arrhythmia . The detection rate of through 24h or 48h dynamic electrocardiogram is as high as 40%~75%. Most bedroom premature has a better prognosis, but not all html premature lesions are benign, some are relatively high in risk and there is a risk of adverse cardiac events. Which ones are “bad” premature? Which ventricular premature strokes require medication?
Figure 1 sinus rhythm , multiple monomorphic ventricular premature beat
ventricular premature symptoms?
ventricular early refers to preventive ventricular contraction caused by early depolarization of ectopic excitation foci of the ventricular muscles below the branch of the Hilton bundle and its pre-ventricular contraction. In the general population, the incidence rate is 1% to 4%. The prevalence of premature vascular disease was found by ordinary electrocardiogram screening, while it was as high as 40% to 75% through 24-hour or 48-hour dynamic electrocardiogram test. The incidence of early ventricular aging increases with age, and in people over 75 years of age, the incidence rate can be as high as 69%. The clinical manifestations of
room early vary greatly. Most patients have no obvious symptoms, but they can also cause serious symptoms, including palpitations , chest tightness , heartbeat arrest, etc. Some rooms may lead to decreased cardiac blood discharge in and insufficient blood perfusion of important organs, which may cause fatigue, shortness of breath, sweating, dizziness, etc. 6 ward often has circadian rhythm changes early. Most people have more sympathetic nerve excitability during the day, and some people have more at night. What are the causes and causes of premature room? The mechanism of early childhood in
is mainly self-discipline abnormalities, triggering activities and regression. Any factor that causes early depolarization of the ventricular muscle can be the cause of premature ventricular.
Bad lifestyles such as mental stress, overwork, excessive tobacco, alcohol, and coffee can all induce premature room. Various structural heart diseases such as coronary heart disease , cardiomyopathy and valvular heart disease are also common causes of premature ventricular heart disease. Others such as digitalis, quinidine, tricyclic antidepressants, , electrolyte disorders, (low potassium, low magnesium), etc. can also induce premature ventilatory.
Which ventricular premature prognosis is poor?
Through electrocardiogram and dynamic electrocardiogram examination, we can understand the early morphology (single shape, polymorphism), quantity, origin and movement relationship (increase, decrease), etc. Ordinary 12-lead electrocardiogram is indispensable for judging the origin of the chamber. The lower wall lead QRS wave has a tall and upright R-shaped R-shaped feature of the origin of the chamber of the outflow channel. Dynamic ECG is of great value for judging the total number of early chambers, the distribution of different times, the association with changes in autonomic tone, and whether there are multiple forms.
Occasional chambers are common in individuals with normal heart structure, while frequent chambers are often a sign of potential abnormal heart matrix. Although a very small number of idiopathic "benevolent" ventricular premature can induce malignant ventricular arrhythmias such as pleomorphic ventricular speed or ventricular fibrillation, potential heart disease is still the most important risk factor for frequent premature prognosis.
Table 1 Risk factors for poor ventricular early prognosis
For frequent ventricular early patients (24 hours > 500), referral and further evaluation by a cardiovascular expert to rule out any potential structural heart disease, such as ischemic heart disease or cardiac ion channel disease . Premature ventricular load >20% is a high-risk factor for all-cause death and cardiovascular death, and patients need to be followed up.
Which rooms need medication for early treatment?
For patients with suspected ventricular premature induction cardiomyopathy, the early treatment of the room should be actively treated. For patients with premature ventricular symptoms without structural heart disease, patients who have not yet relieved their clinical symptoms after repeated explanations and notifications to the benign characteristics of premature ventricular symptoms can be given appropriate treatment. For patients with premature ventricular premature ventricular disease, although symptoms can also be the basis for early treatment of premature ventricular, the treatment of structural heart disease should be more focused.
For patients whose symptoms are still not effectively controlled after health education, beta blockers or non-dihydropyridine calcium channel blockers may be considered, but the efficacy is limited and there is no difference even compared with placebo. There is less evidence of the use of calcium channel blockers than beta blockers, and these drugs themselves may also cause obvious symptoms.
Although Class I and III antiarrhythmic drugs may be more effective, the risk-benefit ratio of such drugs in patients with early patients with non-structural heart wards is not clear, and may even increase the mortality rate in patients with severe structural heart disease, so it should be carefully evaluated before treatment. Which patients are
catheter ablation suitable for?
For patients with premature ventricular inducible cardiomyopathy, catheter ablation should be actively recommended in order to cure premature ventricular and improve cardiac function. For patients with frequent premature symptoms, catheter ablation treatment can be recommended, but the specific premature load of the chamber is the strongest indication for catheter ablation. In practice, most of them use 24 hours a day > 10,000 times as the screening standard. Some asymptomatic patients require catheter ablation for reasons such as school entrance, employment or pregnancy. After fully communicating with the patient, catheter ablation treatment can also be tried. The success rate of early ablation of
compartment is highly correlated with its origin site. The success rate of early catheter ablation of outflow tract chamber is relatively high, while the premature ablation of compartment in some areas such as coronary vein, epicardial , left ventricular top and papillary muscle is relatively difficult. Polymorphic ventricular premature or clinical ventricular premature that cannot be induced during surgery will reduce the success rate of catheter ablation. The ideal ablation goal of
is to completely eliminate premature ventricular premature , but even partially eliminating premature ventricular premature , may significantly improve clinical symptoms and left ventricular function. Premature ventricular catheter ablation is safer, and the incidence of complications of premature ventricular ablation currently reported is mostly less than 1%.
core chart:
Figure 2 Flow chart of early diagnosis and treatment of ventricular early diagnosis and treatment
Literature index: Electrophysiology and Pacing Branch of the Chinese Medical Association, Cardiology Rhythmology Professional Committee of the Chinese Medical Association. 2020 Chinese Expert Consensus for Ventry Arrhythmia (2016 Consensus Upgraded Edition). Chinese Journal of Cardiac Pacing and Electrophysiology , 2020; 34(3): 189-253.
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