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PubMed1994

Initiation of ventricular extrasystoles by myocardial stretch in chronically dilated and failing canine left ventricle.

BACKGROUND: Stretch-induced arrhythmias (SIAs) can be elicited in normal canine left ventricles by transient diastolic dilatation. Since clinically important ventricular arrhythmias arise most commonly in failing and dilated ventricles, we hypothesized that the arrhythmogenic effect of transient diastolic stretch would be enhanced in chronically dilated failing canine hearts. METHODS AND RESULTS: Heart failure was induced in seven dogs by right ventricular pacing at 250 min-1 for 20.2 +/- 1.6 days. Left ventricular (LV) mechanical properties were measured in vivo with serial echocardiograms in these seven dogs with the dogs awake and tranquilized to confirm the development of LV dilation and failure. By the third week of pacing, average short-axis area ejection fraction decreased by 64.3% (P < .001) as end-diastolic and end-systolic diameters increased by 25.9% and 50.7%, respectively (P < .001). After heart failure was established, the hearts were harvested and in vitro data were obtained as an isolated, blood-perfused ventricle preparation. A computerized servo pump system connected to an LV intracavitary balloon was used to measure and control LV volume. Results were compared with in vitro data obtained from eight ventricles not subjected to pacing (controls). LV contractility, quantitated in vitro as the slope of the peak isovolumic pressure-volume relation (Emax) normalized to LV cavity size, was much lower in the heart failure group than in controls (182 +/- 18 versus 365 +/- 38 mm Hg, P < .001). In all isolated hearts, SIAs were induced using an electromechanical stimulation protocol in which eight paced beats at 2 Hz were followed by a transient increase in LV volume during early diastole. Prestretch volume (Vi) was selected to yield end-diastolic pressures of 4 to 8 mm Hg in all hearts. The fractional increase in LV volume (delta V) that produced SIAs 50% of the time (delta V 50/Vi) was smaller in failing hearts than in controls (0.78 +/- 0.04 versus 1.18 +/- 0.17, P = .009), indicating an increased sensitivity to SIAs in the failing hearts. Although ventricular pairs were occasionally induced in both groups, the great majority of the arrhythmias induced in both groups were single extrasystoles, and nonsustained runs of ventricular tachycardia were never elicited in either group. LV end-diastolic and peak stretch pressures were similar in the two groups, but LV end-diastolic wall stress was higher by 35.7% (P = .029) in the dilated failing ventricles because LV hypertrophy, which tends to normalize wall stress as the heart dilates, did not occur during the 3 weeks of pacing. For stretch stimuli of comparable arrhythmogenic effectiveness, peak LV wall stress during stretch was similar in the two groups, whereas the fractional increase in volume was significantly smaller in the heart failure group, indicating impaired viscoelastic properties in the failing ventricles. In five control ventricles, acute exposure to 0.5 mumol/L dobutamine increased ventricular sensitivity to the induction of SIAs, as shown by a decrease in delta V50/Vi from 1.27 +/- 0.16 to 1.06 +/- 0.11 (P = .04). CONCLUSIONS: Altered mechanical properties and/or neurohumoral adaptations associated with chronic dilation and failure predispose the ventricle to induction of ventricular extrasystoles by transient LV diastolic stretch.

Adrenergic beta-Agonists↗
PubMed1975

Concealed extrasystolic ventricular bigeminy with interpolation.

The first reported case of concealed extrasystolic ventricular bigeminy with interpolation is described. This arrhythmia is characterized by the presence of both interpolated ventricular extrasystolic beats and a presumed persistent and continuous bigeminal ectopic rhythm with exit block. The distributional pattern of sinus conducted beats in the present case conforms to a formula defining this unusual disorder of rhythm, while the appearance of manifest ectopic beats follows the rule of bigeminy.

Cardiac Complexes, Premature↗
PubMedDate not supplied

The influence of 50 Hz electric and magnetic fields on the extrasystoles of human heart.

This investigation studied the effect of 50 Hz electric and magnetic fields on the extrasystoles of human heart. The electrocardiograms (ECG) of 27 transmission-line workers and 26 male volunteers were recorded with a Holter monitor both in and outside the fields. The electric field strength varied from 0.14 to 10.21 kV/m and the magnetic flux density from 1.02 to 15.43 microT. The measurement period was from half an hour to a few hours. Analysis of the ECG recordings showed that extrasystoles were as frequent outside the field as in the field. In some cases a small decrease in heart rate was observed after field exposure, but it is possible that the changes in the pulse rate were caused by small changes of work load.

Adolescent↗
PubMedDate not supplied

[The effect of sodium chloride baths on the physical work capacity and extrasystole of patients with ischemic heart disease and stable stenocardia].

73 patients with ischemic heart disease (IHD) and stable angina pectoris of NYHA class I and II underwent balneotherapy. 43 of them took a course of sodium chloride baths, 30 control patients took common water baths. As shown by spiroveloergometry and Holter monitoring, sodium chloride baths are a good training modality in IHD patients. They enhance muscular performance and coronary heart reserve, reduce the mean 24-h number of ventricular extrasystoles by 49.9%, supraventricular extrasystoles by 57.5%.

Angina Pectoris↗
PubMedDate not supplied

[The effect of radon baths on the physical work capacity and extrasystole in patients with ischemic heart disease and stable stenocardia].

Balneotherapy was given to 113 patients with ischemic heart disease (IHD) with stable angina (functional class I and II). 40 patients and 43 patients took radon baths (40 nCi/l and 120 nCi/l, respectively), 30 patients took the course of fresh-water baths. Treatment results were assessed at spiroveloergometry and ambulatory Holter monitoring. Radon baths had a training effect in IHD with extra-systole. It manifests in higher physical performance and coronary heart reserve. Antiarrhythmic effect of the radon baths was different: a significant reduction in the average number of 24-h ventricular extrasystoles by 78.1, supraventricular extrasystoles by 92.3%, and by 79.9 and 94.7% for the 40 nCi/l baths and 120 nCi/l baths, respectively.

Angina Pectoris↗
PubMedDate not supplied

[Effects of the combination of nitrogen baths and physical training on physical performance and extrasystole in patients with coronary heart disease with intraventricular blocks].

99 patients with coronary heart disease (CHD), stable angina pectoris (functional class I-II), intraventricular blocks (IVB) took a course of general artificial nitrogen baths. Of them, 31 patients took the baths alone; 35 patients, in addition, exercised on veloergometer; 33 patients took baths and continued physical training up to 6 months. The results of the treatment were assessed with spiroveloergometry, ambulatory Holter ECG monitoring. Those who took baths and exercised for 6 months benefited from the treatment most as their muscular performance and coronary heart reserve increased; mean daily number of ventricular extrasystoles reduced by 73.3%, supraventricular extrasystoles--by 72.2%; intraventricular conduction was not damaged.

Angina Pectoris↗
PubMed2002

[Effect of superhigh frequency electromagnetic fields and physical exercise on physical performance and extrasystole in myocardial ischemia patients with stable angina pectoris].

AIM: To study impact of UHF electromagnetic fields in combination with bicycle exercise on muscular performance (MP) and extrasystole (ES) in IHD patients with stable angina of functional class 1 and 2 (SA). MATERIAL AND METHODS: The trial included 112 IHD patients with SA and ES. 36 of them were exposed to coursed electromagnetic fields (40 W, on heart area). The other 42 patients received the same treatment and exercised on bicycle ergometer. 34 patients received placebo procedures and did therapeutic exercises. The effect was assessed with spiroveloergometry and ECG Holter ambulatory monitoring. RESULTS: It was found that 40 W UHF electromagnetic fields in combination with exercise on veloergometer exert a training effect in IHD patients with extrasystole manifesting with higher physical performance and coronary heart reserve. The antiarrhythmic effect consisted in a significant daily fall in mean ventricular ES number by 48.2%, supraventricular EX by 54.8%. CONCLUSION: Combined application of 40 W UHF electromagnetic fields on heart area with bicycle exercise is effective in IHD patients with ES.

Angina Pectoris↗
PubMed1992

[Familial polymorph ventricular extrasystole associated with Pierre Robin syndrome].

In a family of 9 persons over 3 generations, 6 had incessant polymorphic ventricular extrasystoles, often in salves, resembling unsustained bidirectional ventricular tachycardia. Ventricular repolarisation was abnormal with giant U waves. Five persons had suffered syncopes. All had a facial abnormality: one woman had a complete Pierre Robin syndrome with mandibular hypoplasia, glossoptos and cleft palate; in the other cases, minor forms were observed, with micrognathia and ogival palate. Two patients had bone abnormalities of the feet with total agenesis of the last 2 phalanges of several toes. This familial polymorphic ventricular extrasystole with repolarisation abnormalities has many features in common with the congenital long QT syndrome; associated with the Pierre Robin syndrome and bone abnormalities of the extremities it would seem to be a new multiple congenital abnormalities syndrome.

Adolescent↗
PubMed2004

Frequent ventricular extrasystole treated by needling neiguan (PC 6) plus oral administration of mexiletine--a report of 30 cases.

PURPOSE: To observe the therapeutic effect of needling at Neiguan (PC 6) plus oral administration of mexiletine. METHODS: 60 cases of frequent ventricular extrasystole were randomly divided into two groups: a treatment group, and a control group. In the control group, mexiletine was orally administered, and in the treatment group needling at bilateral Neiguan (PC 6) plus oral administration of mexiletine were given. 2 weeks of treatments constituted a therapeutic course. RESULTS: Of the 30 cases in the treatment group, 23 cases were markedly effective, 5 cases improved, and 2 cases failed; while in the control group 16 cases were markedly effective, 8 cases improved, 4 cases failed, and 2 cases aggravated. The total effective rates of 90.3% and 80.0%, respectively in the treatment and control groups showed a very significant difference between the two groups (P < 0.01). CONCLUSION: Needling at bilateral Neiguan (PC 6) may enhance the therapeutic effect for frequent ventricular extrasystole.

Acupuncture Points↗
PubMed2004

[Amiodarone (cordarone) efficiency in atrial extrasystole].

AIM: To assess antiarrhythmic amiodarone efficacy of suppressing atrial extrasystoles resistant to other antiarrhythmic modalities. MATERIAL AND METHODS: The antiarrhythmic effect of amiodarone was studied in 70 patients (38 males, 32 females, mean age 49.6 +/- 1.7 years, mean duration of arrhythmia 4.9 +/- 1.5 years). The loading oral dose of amiodarone was 600-1200 mg/day for 10 days, mean maintenance dose--1656.25 mg a week, mean duration of treatment--27.5 +/- 3.2 months. The response to amiodarone was estimated by repeated 24-h Holter monitoring. RESULTS: A complete response was observed in 78.5% patients in loading and in 65.7% patients in maintenance therapy. A partial antiarrhythmic response was seen in 8.57 and 16.41% patients, respectively. CONCLUSION: Amiodarone is a basic drug against ventricular arrhythmia. Its effectiveness in suppression of atrial extrasystole is weaker but also appropriate.

Adolescent↗
PubMed2004

[Ventricular extrasystoles].

Ventricular extrasystoles result from premature excitation of the heart from a site beyond the bifurcation of the bundle of His, at the level of the conductive tissue or myocardial cells. In practice they represent a daily problem for cardiologists due to their frequent occurrence. They can be detected in symptomatic patients and also in asymptomatic subjects, for example during routine health checks. It is therefore important to distinguish benign ventricular extrasystoles from those which are potentially serious, so that a useless or even dangerous treatment is not undertaken and severe anxiety is not caused in patients who have become 'medicalised'. The decision about treatment is only made following electrocardiographic and echographic clinical investigation, with the presence of cardiopathy being one of the major deciding factors.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[The pharmacodynamics of the new anti-arrhythmia preparation bonnecor in patients with extrasystoles].

The pharmacodynamics, antiarrhythmic activity and tolerance of bonnecor were studied in 25 patients with acute myocardial infarction (AMI) and 23 patients with chronic ischemic heart disease (IHD) complicated by cardiac rhythm disorders in the form of extrasystoles. Extrasystoles were revealed in 92% of AMI patients at a single administration of bonnecor and in 82.5% of IHD patients at long-term oral administration of the drug. Bonnecor exerted no influence on arterial blood pressure and heart rate, did not change the parameters of the intracardiac hemodynamics. Bonnecor is well tolerated by patients, its main side effect is the prolongation of PQ interval of the ECG.

Anti-Arrhythmia Agents↗
PubMed1991

[Post-extrasystolic long QT: evaluation and significance].

The dynamic behaviour of the QT interval was studied in 13 patients with a prolongation of greater than 80 ms of the QT interval of the QRS complex following a post-extrasystolic pause. Normal repolarisation under basal conditions (QTc 410 +/- 30 ms) was significantly (p less than 0.001) prolonged after pauses (QTc 512 +/- 90 ms). The study protocol included the measurement of QT during a Holter recording, an exercise test, Valsalva's manoeuvre and the isoprenalin test. Hydroquidine 600-900 mg/d was given to evaluate its action on ventricular repolarisation. The longest sinus cycles seen on the night Holter tracing (mean: 1,395 +/- 666 ms) were accompanied by normal repolarisation (QTc 380 +/- 30 ms). In contrast, exercise or Valsalva's manoeuvre caused a prolongation of QTc (QTc greater than 460 ms) in 11 patients out of 13: exercise QTc 471 +/- 54 ms; Valsalva QTc 480 +/- 50 ms. No arrhythmia occurred during these dynamic manoeuvres nor during the isoprenalin test. Hydroquinidine (mean: 729 mg) induced a QTc of greater than 500 ms in 6 patients out of 13 (46%). A triplet suggestive of a "torsade de pointes" was seen in one patient only. In conclusion, patients with a post-extrasystolic T wave abnormality under basal conditions were shown to fail to appropriately adapt their QT interval during autonomic stimulation manoeuvres and the prescription of hydroquinidine at the usual dose induced a mean QTc of greater than 500 ms in 46% of them.

Adolescent↗
PubMed1991

[Residual myocardial function in dilated myocardiopathy. Response to post-extrasystolic potentiation].

OBJECTIVE: to evaluate the effectiveness of post-extrasystolic potentiation (PESP) to detect latent residual contraction function in patients (pts) with idiopathic dilated cardiomyopathy. DESIGN: retrospective study in pts referred for cardiac catheterization. SETTING: Haemodynamic Laboratory of Cardiology Service, Bellvitge Hospital. Barcelona, Spain. PATIENTS: the criteria for including pts with sinus rhythm were (SR): 1-The appearance of an extra beat R' on the ventriculogram; 2-The location of R' in relation to the preceding sinus beat R1 and the following beat R2 being such that R1-R' less than R'-R2. In patients with atrial fibrillation (AF), the criteria were: 1-An early beat Re had to be identified; 2-R1-Re interval had to be at most half of the Re-R2 interval; 3-The length of the cardiac cycle preceding R, has to be equal to the mean cycle length. All the patients with an increase of the ejection fraction (EF) from R, to R2 less than 12% were included in group A: 12 patients (3 females, 9 males, mean age 51 years, 5 SR, FE 27 +/- 10%). In group B were included patients with an increase of the ejection fraction greater than or equal to 12%; 14 patients (4 females, 10 males, mean age 50 years, 7 SR, FE = 31 +/- 7%). MEASUREMENTS: In each ventriculogram we assessed the performance of left ventricle on R1 and R2 beats by determining: 1-Left ventricular end diastolic (EDV), end systolic (ESV), stroke (SV) volumes; 2-Volumes index (EDVI), (ESVI) (SVI); 3 - Ejection fraction (EF) - Change in ventricular contractility from R1 to R2, delta EF. RESULTS: in the sinus rhythm group the values of R1 and R2 were respectively: EDV: (184 +/- 48 ml/m2; 191 +/- 17 ml/m2; NS); SVI (53 +/- 19 ml/m2; 80 +/- 22 ml/m2; p less than 0.01) FE (29 +/- 7%; 42 +/- 10%; p less than 0.01), delta EF 13 +/- 6%. The change of the ejection fraction from R1 to R2 in pts with SR and AF were respectively: 13 +/- 6% and 11.5 +/- 6.4%; NS. Group A: Deterioration of the functional class and two deaths occurred. Group B: Improvement in functional class in all cases but one. CONCLUSION: our data suggest that augmented ventricular filling and consequent Starling's effect is not a significant contribute for PESP in pts with dilated cardiomyopathy. The analysis of post extrasystolic beat in SR pts and the beat following an early beat with a long diastole in AF, is a valuable method of determining the residual left ventricular function in this group of pts.

Cardiomyopathy, Dilated↗
PubMed1986

[Comparison between amiodarone and disopyramide in the treatment of ventricular extrasystoles].

The authors have compared the anti-arrhythmic activity and tolerance of disopyramide and amiodarone in the treatment of ventricular extrasystoles (VES) by using two quantitative methods of assessment. The stability of the rhythmic disorder was confirmed by two control Holter recordings in 20 patients without treatment, 16 of whom were bearers of an organic cardiopathy. The ventricular extrasystole was greater than 90 VES/hour in 18 patients. After the first control, Holter recording, each patient was treated successively with 400 mg of disopyramide/day in 4 doses for average period of 31 days, then a second Holter control recording without treatment, then 600 mg/day of amiodarone for 8 days followed by a maintenance dose varying from 200 to 400 mg/day: this second period of treatment lasted for an average of 38 days. The reduction of the number of VES was greater than 65 percent (SAMI criterion) in 2 of the 20 patients treated with disopyramide and in 13 of the 20 patients treated with amiodarone. Using the method of variance analysis, disopyramide was found to be efficacious in 5 cases out of 20 and amiodarone in 15 cases out of 20. Both methods indicate that the greater efficacy of amiodarone is statistically significant (p less than 0.01). All of those who did not respond to amiodarone were also non-responders to disopyramide.

Adult↗
PubMed1986

[The nature and clinical significance of the post-extrasystole syndrome].

Symptoms of the postextrasystolic syndrome (PES) were studied in patients with extrasystoles of various origin. PES was shown to be the source of diagnostic information on the state of the coronary vessels, myocardium and intracardiac mechanisms of self-regulation and adaptation. The appearance of PES made it possible to judge of the severity of a pathological process in the myocardium, its topics and facilitated differential diagnosis of extrasystoles of organic and extra-cardiac origin.

Cardiac Complexes, Premature↗
PubMed1989

[Long-term study of propafenone in severe ventricular extrasystole in elderly subjects].

A long-term study of the efficacy and tolerance of propafenone was carried out in cases of severe chronic ventricular extrasystoly in elderly patients (age 70). The patients included presented more than 1,500 ventricular extrasystoles per 24 hours with severe criteria. After the Holter performed upon inclusion, 450 mg/d of propafenone were prescribed (900 mg/d in 4 cases). The Holter tests were then repeated at D8, D30, D60, D180, D360, with possible modification of the dosage. 16 patients were then studied, and the study completed its half of them in one year. The efficacy, evaluated by at least an 83 p. cent decrease of the number of ventricular extrasystoles with disappearance of complex forms, was excellent in 12 out of 16 patients, non-existent or insufficient in 2 patients. The arrhythmia was aggravated in 2 cases. In addition, the efficacy of propafenone was maintained in the 8 patients who responded to the treatment and were followed for one year. A poor tolerance (conduction disorders, aggravated arrhythmia) was noted in 7 patients (44 p. cent of the cases). Conduction disorders were present with a propafenone dosage or on preexisting conduction anomalies. Five deaths occurred during the study, unrelated to the treatment. At a dose of 450 mg/24 h, propafenone is therefore effective, most of the time, effective in the treatment of severe ventricular extrasystoly in elderly patients, with a rather good tolerance, and a long-term efficacy. Higher doses only improve minimally the efficacy and are much less well tolerated.

Aged↗
PubMed1981

[Oral effectiveness of the calcium-antagonist Ro 11-1781 (Tiapamil) in supraventricular and ventricular extrasystoles (author's transl)].

The effectiveness of the calcium-antagonist Ro 11-1781 (Tiapamil) was investigated in 23 patients with extrasystoles of different origin using continuous ECG recordings. Two 24-hour ECG recordings were registered without antiarrhythmic medication, one of these as a placebo period, and 3 during oral application of 3 x 200 mg/day Ro 11-1781, if the state of the health of the patients allowed it. No positive effects of Ro 11-1781 in supraventricular and ventricular extrasystoles were demonstrable, supported by 8 premature terminations of the study. The missing antiarrhythmic effectiveness of Ro 11-1781 corresponds to Verapamil in oral application.

Administration, Oral↗