Cardiopulmonary resuscitation (CPR) is a very important treatment after cardiac arrest. The optimal treatment strategy of CPR is uncertain. With the accumulation of clinical medical evidence, the CPR treatment recommendations have been changed. This article will review the current hot issues and progress, including the pathophysiological mechanisms of CPR, how to achieve high-quality chest compression, how to achieve CPR quality monitoring, how to achieve optimal CPR for different individuals and how to use antiarrhythmic drugs.
【摘要】 目的 观察原发性高血压左心室肥厚患者的心律失常情况。 方法 对2000年1月-2009年10月收治的251例原发性高血压患者进行超声心动图及Holter检查，比较有左心室肥厚（left ventricular hypertrophy，LVH）及无LVH两组各类心律失常的发生情况。 结果 LVH组各种心律失常的发生率与非LVH组比较，差异有统计学意义（Plt;0.01）。LVH组室性心律失常及复杂性室性心律失常的检出率为83.33%和51.85%，明显高于非LVH组（28.67%和9.09%），差异有统计学意义（Plt;0.01）。 结论 高血压并发LVH与心律失常的发生有一定密切关系。【Abstract】 Objective To analyze the condition of arrhythmia in the patients with primary hypertension combined with left ventricular hypertrophy. Methods A total of 251 patients with primary hypertension from January 2000 to October 2009 were selected. All the patients had undergone the examinations of ultrasonic cardiogram, 12-lead electrocardiogram and Holter test to compare the incidence of arrhythmia between LVH and non-LVH group. Results There were significant differences in the incidences of arrhythmia between the two groups (Plt;0.01). Furthermore, the incidence of ventricular arrhythmias and complexity of ventricular arrhythmias of the patients in LVH group was 83.33% and 51.85% respectively, significantly higher than that in non-LVH group (28.67% and 9.09%; Plt;0.01). Conclusion Primary hypertension combined with LVH is relevant to arrhythmias.
As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.
Objective To investigate the risky factors of ventricular arrhythmias following open heart surgery in patients with giant left ventricle, and offer the basis in order to prevent it’s occurrence. Methods The clinical materials of 176 patients who had undergone the open heart surgery were analyzed retrospectively. There were 44 patients who had ventricular arrhythmia (ventricular arrhythmia group), 132 patients who had no ventricular arrhythmia as contrast (control group). The preoperative clinical data, indexes of types of cardiopathy, ultrasonic cardiogram, electrocardiogram and cardiopulmonary bypass (CPB) etc. were choosed, and tested by using χ2 test,t test and logistic regression to analyse the high endangered factors for incidence of ventricular arrhythmia after open heart surgery. Results Age≥55 years (OR=3.469), left ventricular enddiastolic diameter(LVEDD)≥80 mm (OR=3.927), left ventricular ejection fraction（LVEF）≤55% (OR=2.967), CPB time≥120min(OR=5.170) and aortic clamping time≥80min(OR=4.501) were the independent risk factors of ventricular arrhythmia. Conclusion Ventricular arrhythmia is a severe complication for the patients with giant left ventricle after open heart surgery, and influence the prognosis of the patients. Patient’s age, size of the left ventricle, cardiac function, CPB time and clamping time could influence the incidence of ventricular arrhythmias.
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is characterized by an interventricular communication with an overriding aorta, subpulmonary obstruction, and consequent right ventricular hypertrophy. The potential for late complications is an important concern for growing number of survivors after surgical repair, although long-term survival rates are excellent. Progressive pulmonary valve regurgitation leading to right heart failure and arrhythmias are common late complications and major reasons of mortality. In this review, we focus on research progress of pathogenesis and treatment of late complications after TOF repair, and the importance of long-term follow-up is emphasized.
Objective To systematically review the effectiveness of amiodarone in treating repurfusion arrhythmia (RA) after thrombolytic therapy for acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational thrombolytic therapy for AMI. Methods Randomized controlled trails (RCTs) on amiodarone in treating RA after thrombolytic therapy for AMI were electronically retrieved in PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CBM, CNKI, VIP and WanFang Data from inception to January, 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs involving 440 patients were included. The results of meta-analysis suggested that, compared with the blank control, amiodarone reduced the incidence of RA after thrombolytic therapy in treating AMI (RR=0.60, 95%CI 0.48 to 0.74, Plt;0.000 01) and the incidence of ventricular fibrillation (RR=0.47, 95%CI 0.26 to 0.85, P=0.01). It neither affected the recanalization rate of occluded arteries after thrombolytic therapy (RR=1.00, 95%CI 0.88 to 1.15, P=0.94) nor decreased the mortality after surgery (RR=0.33, 95%CI 0.10 to 1.09, P=0.07). Conclusion Current evidence indicated that, amiodarone can decrease the incidence of RA. Unfortunately, the mortality rate can’t be reduced by amiodarone. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion
Objective To observe the change of sino-atrial nodal tissue structure and ectopic pacing function after xenogenic sino-atrial nodal tissue transplanted into left ventricular wall, so as to provide new ideas for the treatment of sick sinus syndrome and severe atrioventricular block. Methods Seventy healthy rabbits were selected, male or female, and weighing 1.5-2.0 kg. Of them, 42 were used as reci pient animals and randomly divided into sham operation group, warm ischemia transplantation group, and cold ischemia transplantation group (n=14), the other 28 were used as donors of warm ischemia and cold ischemia transplantation groups, which were sibl ing of the recipients. In recipients, a 6-mm-long and about 2-mm-deep incision was made in the vascular sparse area of left ventricular free wall near the apex. In sham operation group, the incision was sutrued directly by 7-0 Prolene suture; in cold ischemia transplantation group, after the aortic roots cross-clamping, 4 ℃ cold crystalloid perfusion fluid infusion to cardiac arrest, then sinoatrial node were cut 5 mm × 3 mm for transplantation; in warm ischemia transplantation group, the same size of the sinus node tissue was captured for transplantation. After 1, 2, 3, and 4 weeks, 3 rabbits of each group were harvested to make bradycardia by stimulating bilateral vagus nerve and the cardiac electrical activity was observed; the transplanted sinus node histology and ultrastructural changes were observed. Results Thirty-six recipient rabbits survived (12 rabbits each group). At 1, 2, 3, and 4 weeks after bilateral vagus nerve stimulation, the cardiac electrical activity in each group was significantly slower, and showed sinus bradycardia. Four weeks after operation the heart rates of sham operation group, warm ischemia, and cold ischemia transplantation group were (81.17 ± 5.67), (82.42 ± 7.97), and (80.83 ± 6.95) beats/ minute, respectively; showing no significant difference among groups (P gt; 0.05). And no ectopic rhythm of ventricular pacing occurred. Sino-atrial nodal tissue survived in 6 of warm ischemic transplantation group and in 8 of cold ischemia transplantation group; showing no significant difference between two groups (P gt; 0.05). Two adjacent sinoatrial node cells, vacuole-l ike structure in the cytoplasm, a few scattered muscle microfilaments, and gap junctions between adjacent cells were found in transplanted sinus node. Conclusion The allograft sinus node can survive, but can not play a role in ectopic pacing.
Atrial fibrillation is the most common arrhythmia in clinical practice, and catheter ablation has become a first-line treatment strategy. Among them, cryoballoon ablation has become a standardized treatment for atrial fibrillation due to its advantages such as short surgical time, short learning curve, and minimal patient pain. Currently, a large amount of clinical practice and research have provided new evidence for cryoballoon ablation as a first-line treatment for atrial fibrillation. Therefore, this article provides a review of the current status of catheter ablation, the current status, challenges faced, and prospects as a first-line catheter ablation strategy for atrial fibrillation of cryoballoon ablation, with the aim of providing reference for cardiologists in clinical decision-making in the initial rhythm control of atrial fibrillation.