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PubMedDate not supplied

A specific effect of lidocaine and tocainide on ventricular conduction of mid-range extrasystoles.

Lidocaine and tocainide had no effect on ventricular conduction of extrasystoles with coupling intervals longer than 500 msec in isolated blood-perfused dog hearts, but caused interval-related increases in conduction time of extrasystoles in the range of 250--400 msec, here called mid-range extrasystoles (MRE). Quinidine, procainamide, disopyramide, and methyl lidocaine increased conduction times of extrasystoles at all coupling intervals, and no additional slowing of MRE was observed. The slowing of MRE specific to lidocaine and tocainide was confirmed in the intact dog heart. During acute myocardial ischemia in the intact dog heart, conduction was slowed and additional slowing of MRE was found. Lidocaine and tocainide caused further slowing of conduction of MRE. This unique effect of lidocaine and tocainide on the conduction of MRE may be important in the suppression of reentrant arrhythmias. However, lidocaine and tocainide were also found to be arrhythmogenic when extrasystoles were introduced, after acute coronary occlusion, in those animals in which such occlusion alone did not allow demonstration of arrhythmias due to extrasystoles.

Anilides↗

PubMed1986

Frequency of extrasystoles in healthy male employees.

To determine reference values for ectopic activity 147 actively employed healthy men aged from 15 to 65 years were examined by 24 hour Holter monitoring during their ordinary daily activities. Age was the only risk factor significantly associated with supraventricular and ventricular extrasystoles. During a six year follow up only two men died. In both the frequency of ventricular extrasystoles had been high, but neither of them died from cardiovascular disease. Because the distribution of the frequency of extrasystoles in the study group was highly skewed a percentile distribution was used to determine normal values. This distribution showed that 95% of men aged 15-39 years had less than 2.9 ventricular extrasystoles per hour and the same proportion of men aged 40 years or older had less than 36 ventricular extrasystoles per hour. For field studies values above the 90th percentile (that is more than 10 ventricular extrasystoles per hour for men 40 years or older) may be a more appropriate cut off point.

Adolescent↗

PubMed1974

Significance of coupling intervals of ventricular extrasystoles.

Extrasystoles may have fixed or variable coupling intervals. The latter may be divided into those with coupling intervals related to and following the T wave of the preceding QRS (approximate coupling) and those which occur throughout electrical diastole with no obvious relationship to the T wave of the dominant rhythm (random coupling). Extrasystoles with random and approximate coupling may or may not be parasystolic. The relationship of extrasystoles to the dominant rhythm may alter. In particular, fixed coupling may precede or alternate with approximate coupling. These groups cannot be considered distinct, in view of transitions from one type of extrasystole to another. Extrasystoles with both approximate coupling and fixed coupling tend to occur just after the T wave and often occurred on the apex of the U wave. Approximate non-parasystolic coupling was infrequent in electrocardiograms which were otherwise normal. Random non-parasystolic coupling and parasystole only occurred in patients with cardiac disease. In view of these findings, it is proposed that extrasystoles should be described by their degree of dependence on each other (regularity of interectopic intervals) and their degree of dependence on conducted beats (regularity of coupling intervals),

Cardiac Complexes, Premature↗

PubMed2001

[Clinical and experimental study of effect of yangxin fumai oral liquid in treating patients with extrasystole].

OBJECTIVE: To evaluate the therapeutic effect of Yangxin Fumai Oral Liquid (YFOL), a Chinese herbal medicine for nourishing heart and restoring pulse, in treating patients with extrasystole. METHODS: The effect of YFOL was observed in treating 30 patients with different kinds of extrasystole and compared with that in 30 patients treated by propafenone. The effect of YFOL on experimental arrhythmia was studied in animals as well. RESULTS: Clinical observation showed that the effect of YFOL against extrasystole in the two groups was similar, but the YFOL group showed better effect in symptom improvement (P < 0.01) with no marked side-effects. Experimental study showed that YFOL could reduce the chloroform induced ventricular fibrillation occurrence in mice, delay the initiating time of ventricular extrasystole, tachycardia and fibrillation induced by aconitine, BaCl2 and coronary artery ligation in rats, or shorten the lasting time of arrhythmia, reduce the attacking rate of ventricular extrasystole. There was significant difference in comparing with the control group (P < 0.05, P < 0.01). CONCLUSION: YFOL is a good and convenient Chinese herbal preparation for different kinds of extrasystole with low toxic and side-effects in clinical practice.

Aconitine↗

PubMed1989

[Heart rate-ventricular extrasystole relations and their dependence on circadian rhythms].

The linear correlation of the circadian rhythms (CR) of heart rate (HR) with those of ventricular extrasystole (VE) is analyzed by electrocardiographic ambulatory monitoring in 32 patients: 22 with ischemic post-infarction cardiopathy (group A) and ten free of structural cardiopathy (group B). Variability expressed as the coefficient of ventricular extrasystole variation (100 x standard deviation/mean) presented an inverse correlation with the number of recording extrasystoles. Linear correlation between HR and VE was statistically significant in 72% of recordings in group A, and in 60% in group B. The percentage of cases with significant linear correlation was greater on analyzing the three-minute periods than with the longer periods. When the cases analyzed presented over 200 extrasystoles, the percentage with significant linear correlation between HR and extrasystole was greater in group A than in group B. The circadian rhythm of the ventricular extrasystoles using interpolation of a cosinor function was significant in 50% of group A cases, and in 60% of group B. The achrophases were diurnal in group B, but only in 45% of cases in group A, two correspondence models being found between the CR achrophases and the inverse linear correlation between HR and VE.

Adolescent↗

PubMed1982

[Comparison of data from exercise tests and continuous electrocardiographic recording in patients with ventricular extrasystole. Apropos of 131 cases].

A series of 131 patients aged from 4 to 70 years old with significant ventricular arrhythmias corresponding to at least Grade 2 of Lown's classification underwent exercise stress testing and continuous 24 hour electrocardiography. There were two objectives: to compare exercise electrocardiography and Holter monitoring in the detection and assessment of the seriousness of the arrhythmia, and to assess the arrhythmia's modifications on exercise. The patients were divided into 4 types: "chronic coronary insufficiency", "mitral valve prolapse", "other cardiac disease" and "idiopathic" arrhythmias. The maximum grade of arrhythmia corresponded to salvos of ventricular extrasystoles in 44 cases (33,5 p. 100), doublets in 44 cases (33,5 p. 100), polymorphic extrasystoles in 10 cases (7,6 p. 100) and monomorphic extrasystoles in 33 cases (25,2 p. 100). A significant arrhythmia was found in 90,8 p. 100 of cases by Holter and in 82,4 p. 100 of cases on exercise stress testing. The maximum grade of arrhythmia was also better appreciated on Holter monitoring (84,7 p. 100) compared to exercise stress testing (46,5 p. 100). The difference being more clear cut for repetitive forms. The superiority of Holter monitoring for assessing the grade of arrhythmia was obvious in the "idiopathic", "other cardiac disease" and "coronary" groups (79,4 p. 100 compared to 41,2 p. 100) but was not significant in the mitral valve prolapse group (73,9 p. 100 compared to 65,2 p. 100). Aggravation of the arrhythmia on exercise defined as a large increase, even transient of the number of extrasystoles (7 cases) or changing to a higher grade (59 cases) was significantly less common (p less than 0,01) in the idiopathic group (30 p. 100) than in the other groups (64,1 p. 100 in the coronary, 65,2 p. 100 in the mitral valve prolapse group). Aggravation of the arrhythmia in the coronary group was not observed more often in positive than in negative exercise electrocardiography. Complete regression of extrasystoles in the last two minutes was observed in 50 cases and significantly more often in idiopathic arrhythmias (p less than 0,01). There was no correlation between the behavior of the arrhythmia on exercise and the presence of salvos of extrasystoles, previous syncope or electrical cardioversion. Important individual differences were observed in all groups of patients. These observations suggest that the statistical superiority of Holter monitoring is debatable and imply that it is often necessary to request both investigations for the exact diagnosis of the arrhythmia and for the eventual therapeutic management of the patient and his mode of life.

Adolescent↗

PubMed1984

[Differential diagnosis of linked parasystole and extrasystole].

The differentiation between linked parasystole and extrasystole was based on functional tests with exercise and atropin as stimuli. A total of 116 patients (71 with parasystole and 45 with extrasystole) were investigated. Two mechanisms involved in parasystole with fixed links between ectopic complexes were identified: 1) a mechanism of simple quantitative correlation between two pace-makers, 2) a mechanism of the principal pace-maker being discharged with impulses from the parasystolic one. Extrasystole is based on the trigger mechanism of relationship between ectopic excitation and the impulse from the principal pace-maker. Prolonged ECG recording established limits for the maximum interval of links between monotopic extrasystoles and the interectopic interval for paired extrasystole. Extrasystole was shown to be incapable of generating a pace of its own, i.e. a succession of three or more ectopic complexes of similar morphology.

Arrhythmias, Cardiac↗

PubMed1995

Bradycardia- and tachycardia-dependent termination of ventricular bigeminy: mechanism of ventricular extrasystoles with fixed coupling.

Fourteen men with intermittent ventricular bigeminy were selected for this study because coupling intervals of the extrasystoles were considerably long and usually fixed, and bradycardia-dependent (10 cases) and/or tachycardia-dependent (12 cases) termination of bigeminy occurred. In all cases, when the heart rate ranged between two certain values, ventricular bigeminy with fixed-coupled extrasystoles was sustained. In all cases showing bradycardia-dependent termination, bigeminy was suddenly terminated with no changes in coupling of the preceding extrasystoles when the heart rate was decreased below a certain lower value. In all cases showing tachycardia-dependent termination except one, when the heart rate increased beyond a certain higher value, coupling intervals gradually lengthened until bigeminy was terminated. These findings strongly suggest the possibility that, in a considerably large number of clinical cases, ventricular extrasystoles with fixed coupling are caused by longitudinal dissociation of conduction in the reentrant pathway of extrasystoles.

Adult↗

PubMed1978

Value of a noninvasively induced ventricular extrasystole during echocardiographic and phonocardiographic assessment of patients with idiopathic hypertrophic subaortic stenosis.

Fifteen patients with idiopathic hypertrophic subaortic stenosis had a ventricular extrasystole induced with a new external mechanical cardiac stimulator during noninvasive evaluation of left ventricular outflow tract obstruction. Ten patients were monitored with simultaneous echocardiogram, phonocardiogram and indirect carotid pulse tracing; five were monitored with the phonocardiogram and indirect carotid pulse tracing alone. Nine of the 15 patients showed obstruction in the beat after the ventricular extrasystole, as defined by appearance of the characteristic bifid carotid pulse contour and, where recorded, an increase in systolic anterior motion of the mitral valve on echocardiography. Six patients did not show obstruction. All nine patients with obstruction had greater than 20 msec prolongation of uncorrected systolic ejection time in the post-extrasystolic beat of the carotid pulse tracing. Change in the uncorrected ejection time was + 0.038 +/- 0.15 second (mean +/- standard deviation) in these nine patients compared with -0.003 +/- 0.005 second in the six not showing obstruction (P less than 0.01). Six patients underwent cardiac catheterization: Three patients without obstruction after a noninvasively induced ventricular extrasystole had no obstruction at catheterization and three patients with obstruction after noninvasively induced ventricular premature beats demonstrated obstruction at rest or after provocative maneuvers during catheterization. These results indicate that the noninvasive induction of a ventricular extrasystole is a useful and easily performed procedure for both diagnosing and evaluating the dynamic left ventricular outflow tract obstruction of idiopathic hypertrophic subaortic stenosis.

Adolescent↗

PubMed1996

Mechanism of tachycardia-dependent appearance of ventricular extrasystoles in concealed bigeminy.

A case of concealed ventricular bigeminy is reported in which the number of sinus QRS complexes intervening between two successive noninterpolated extrasystoles was always uneven. Coupling intervals of manifest extrasystoles to the preceding sinus QRS complexes were almost fixed and much longer than sinus QT intervals. Bradycardia-dependent disappearance of manifest bigeminy and tachycardia-dependent appearance of extrasystoles occurred in this case. Apparently, 2:1 block of sinus impulses occurred in the reentrant pathway, with markedly depressed conductivity. Concealed electrotonic conduction of blocked sinus impulses in the pathway of extrasystoles may have favored the appearance of the subsequent manifest extrasystoles without concealed conduction owing to two-level block. A possible explanation for the mechanism of such concealed bigeminy is presented, which uses the concepts of longitudinal dissociation and electrotonic inhibition in the reentrant pathway with markedly depressed conductivity.

Adult↗

PubMed1986

[Long-term observation of ventricular extrasystole in children with normal hearts].

UNLABELLED: Between 1971 and 1980 uniform ventricular extrasystoles, classified as benign, were noticed in 47 children with normal hearts. After a mean observation period of 4.4 years 27 of these children, mean age 10.5 years, could be reexamined. This involved physical examination followed by resting and exercise ECG, 24-hour continuous ECG and echocardiography. Of the 27 children, 18 still had extrasystoles having the same morphological characteristics and identical behaviour under exercise as those seen on first examination. Nine children were free of extrasystoles in all ECG examinations. In none of the 27 children were there any complaints between the first and the second examination or signs of degeneration of the extrasystoles into threatening dysrhythmias. CONCLUSION: Uniform extrasystoles disappearing or decreasing on exercise in otherwise healthy children require no treatment even when occurring frequently and persisting over years.

Adolescent↗

PubMed1979

Post-extrasystolic left ventricular peak pressure with and without left ventricular failure.

18 patients without valvular pathology, coronary artery disease, or idiopathic hypertrophic subaortic stenosis were haemodynamically and angiographically investigated in order to analyse the effects of a ventricular extrasystolic beat upon the post-extrasystolic left ventricular peak pressure. In eight normal patients (group I), the post-extrasystolic peak pressure (P.ES.P.P.) was lower than that of the pre-extrasystolic beat; in 10 patients with symptoms of left ventricular failure (group II) the P.ES.P.P. significantly increased. The reasons are: 1) cardiac origin: stroke volume increased more in group II; 2) arterial origin. a) aortic compliance was lower in group II (this is probably related to the older age of patients in group II), and by decrease in end-diastolic aortic pressure was smaller in group II. Part of this arterial effect (2b) may probably be explained from the fact that post-extrasystolic compensatory pauses are equal in both groups, but the decay time of arterial pressure during diastole (assuming an exponential decay) is larger in group II. At the same age and with the identical aortic compliance only the two factors 1 and 2b play a part in the changes in P.ES.P.P.

Adult↗

PubMed1990

Intermittent ventricular bigeminy as an expression of two-level Wenckebach periodicity in the reentrant pathway of extrasystoles.

A patient with intermittent ventricular bigeminy is reported in whom the presence of two-level Wenckebach periodicity in the reentrant pathway of extra-systoles is suggested. When sinus arrest was caused by vagal stimulation, no ectopic QRS complex occurred. This indicated that ventricular bigeminy was not parasystolic bigeminy but ordinary extrasystolic bigeminy. Observations of the electrocardiogram suggested that Wenckebach block occurred at two different levels in the reentrant pathway of ventricular extrasystoles. When extrasystoles were noninterpolated, Wenckebach block occurred at the distal level of the pathway and caused termination of ventricular bigeminy. On the other hand, when extrasystoles were interpolated, Wenckebach block occurred at the proximal level of the pathway. This is the first report to suggest the presence of two-level Wenckebach periodicity in a reentrant pathway of extrasystoles.

Adult↗

PubMed1977

Prognostic importance of ventricular extrasystoles in acute myocardial infarction.

Ventricular arrhythmias were recorded in 233 patients in a prospective study of patients with acute myocardial infarction. In over 95% of patients antiarrhythmic therapy was not given until the onset of ventricular tachycardia, ventricular fibrillation, or persistent idioventricular rhythm. There was a mortality of 18% during the patients' stay in hospital. The most important features of ventricular ectopic activity, which preceded these severe ventricular arrhythmias in the first 48 hr, were multiformity, variation of coupling intervals of larger or equal to 0-1 sec, the R-on-T phenomenon, double ventricular extrasystoles and ventricular bigeminy. The number of a single ventricular extrasystoles per minute was related to the probability of these severe ventricular arrhythmias but to a lesser degree. It was found that if all the patients with the first two prognostic features that if all the patients with the first two prognostic features were removed, the number of single ventricular extrasystoles was not of significant import and the other features were less important. Three-quarters of the severe arrhythmias occurred in the first 24 hr and during this period 60% were preceded by either multiform ventricular extrasystoles or extrasystoles with variable coupling. The importance of these findings in relation to prophylactic therapy is discussed.

Acute Disease↗

PubMed1994

Pseudo-atrioventricular dissociation caused by interpolated ventricular extrasystoles in the presence of dual atrioventricular nodal pathway.

This report describes a patient manifesting with ventricular extrasystoles. The pause occasioned by extrasystoles often is followed by narrow QRS complexes not preceded by P waves, but at times is followed by a sinus P wave. At first glance, the pattern suggests a diagnosis of atrioventricular (A-V) junctional escape complexes. Analysis reveals that ventricular extrasystoles are, in fact, interpolated; the sinus P wave that follows the extrasystole is conducted to the ventricles with a very prolonged P-R interval (up to 0.80 s). The phenomenon is due to the presence of a dual A-V nodal pathway. The sinus impulse that follows the extrasystole is blocked in the fast pathway but may still be conducted to the ventricles through the slow pathway, resulting i a very prolonged P-R interval.

Aged↗

PubMed2006

Vulnerable window for conduction block in a one-dimensional cable of cardiac cells, 1: single extrasystoles.

Spatial dispersion of refractoriness, which is amplified by genetic diseases, drugs, and electrical and structural remodeling during heart disease, is recognized as a major factor increasing the risk of lethal arrhythmias and sudden cardiac death. Dispersion forms the substrate for unidirectional conduction block, which is required for the initiation of reentry by extrasystoles or rapid pacing. In this study, we examine theoretically and numerically how preexisting gradients in refractoriness control the vulnerable window for unidirectional conduction block by a single premature extrasystole. Using a kinematic model to represent wavefront-waveback interactions, we first analytically derived the relationship (under simplified conditions) between the vulnerable window and various electrophysiological parameters such as action potential duration gradients, refractoriness barriers, conduction velocity restitution, etc. We then compared these findings to numerical simulations using the kinematic model or the Luo-Rudy action potential model in a one-dimensional cable of cardiac cells. The results from all three methods agreed well. We show that a critical gradient in action potential duration for conduction block can be analytically derived, and once this critical gradient is exceeded, the vulnerable window increases proportionately with the refractory barrier and is modulated by conduction velocity restitution and gap junctional conductance. Moreover, the critical gradient for conduction block is higher for an extrasystole traveling in the opposite direction from the sinus beat than for one traveling in the same direction (e.g., an epicardial extrasystole versus an endocardial extrasystole).

Biomechanical Phenomena↗

PubMed1992

[Extrasystole following heart transplantation].

A 43 year old man developed extensive supraventricular and ventricular extrasystoles (over 500 supraventricular extrasystoles per hour, VES class II) within 3 months after orthotopic heart transplantation because of dilatative cardiomyopathy. At the same time severe graft rejection (class III according to Billingham) was documented. After treatment of the rejection the following three controls by 24 hours Holter EKG showed only slight supraventricular extrasystoles of less than 10 per hour and in three consecutive myocardial biopsies no rejection process requiring additional treatment was found. In individual cases severe ventricular arrhythmia registered by the family doctor may be a first hint for early rejection. Since intervals for inpatient controls have been extended observation of extrasystoles may be helpful for initiation of a next inpatient control. Incidence of extrasystoles after heart transplantation in the cyclosporine-era is discussed.

Adult↗

PubMed1980

[Influence of acupuncture and electroacupuncture on heart rate and extrasystoles (author's transl)].

In 33 patients with constant ventricular extrasystoles the influence of acupuncture and electroacupuncture on the extrasystoles and the heart rate was examined. There was no difference in heart rate between the treatment-conditions and the non-treatment-conditions. Differences were seen however in the frequencies of the ventricular extrasystoles: During acupuncture (normal as well as electric) the total sum of ventricular extrasystoles and the number of subjects with ventricular extrasystoles was lowered significantly in relation to the non-treatment-condition. The findings are discussed as to neurovegetative and neuroendocrine influence of acupuncture.

Acupuncture Therapy↗