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
ObjectiveTo investigate the clinical efficacy and safety of carvedilol in the treatment of arrhythmia in patients with hypertension complicated with diabetes mellitus. MethodsWe selected the patients with hypertension complicated with diabetes mellitus who were hospitalized in the Harrison International Peace Hospital Affiliated to Hebei Medical University for treatment from Oct. 2011 to Oct. 2013. The cases were divided into a trial group and a control group. The control group was given routine treatment (eg., hypoglycaemic drugs, angiotensin converting enzyme inhibitors). On the basis of the same treatment of the control group, the trial group was given carvedilol. The efficacy and adverse reaction were observed, recorded and then analyzed between the two groups. ResultsA total of 140 patients were included (70 cases in each group). With the loss of 10 cases in the control group, the data of 70 cases in the trial group and 60 cases in the control group were finally analyzed. The results showed that the trial group was superior to the control group in the total effectiveness (χ2=8.320, P=0.004) and the dynamic ECG improvement of premature ventricular contraction (χ2=5.333, P=0.014) with significant differences. Both groups were significantly improved in blood pressure and heart beats compared with the situation before treatment (Both P < 0.05), and the trial group was better than the control group with a significant difference. During the treatment, three cases in the trial group had mild gastrointestinal symptoms which spontaneously disappeared later. ConclusionThe clinical effectiveness of carvedilol for arrhythmia in patients with hypertension complicated with diabetes mellitus is significant. It is safe and effective which is recommended in clinical application.
ObjectiveTo analyze the occurrence of arrhythmia in patients during the recovery period of anesthesia, in order to take appropriate measures in nursing care to ensure the safety of patients. Method We carried out a retrospective analysis of 18 931 general anesthesia post-operative patients (aged 16-84 years old) transferred to anesthesia recovery from September 2012 to July 2013, and we observed the incidence rate of arrhythmia, and documented the clinical manifestations of the patients. ResultsDuring the anesthesia recovery, out of 18 931 general anesthesia postoperative patients, 269 cases of arrhythmia occurred, and the incidence rate was 1.42%. Twenty minutes after nursing intervention and use of medication, the difference of systolic blood pressure, bradycardic heart rate, and tachycardic heart rate of the patients were statistically better than those beofre the treatment (P＜ 0.05) . ConclusionEarly discovery and analysis of arrhythmia in patients during anesthesia recovery, along with timely provision of analgesic and antiarrhythmic treatment can effectively improve the circulation status of the patients, thus ensure the safety of the patients during anesthesia recovery.
ObjectiveTo systematically review the clinical efficacy of potassium magnesium aspartate in prevention of arrhythmia after cardiac heart surgery. MethodsSearching PubMed, MEDLINE, EMbase, The Cochrane Library (Issue 5, 2014), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about the clinical efficacy of potassium magnesium aspartate in prevention of arrhythmia after cardiac heart surgery from the date of establishment of the databases to May 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two reviewers independently. Meta-analysis was then conducted by RevMan 5.2 software. ResultsA total of nine RCTs involving 825 patients were enrolled. The results of meta-analysis indicated that: compared with the control group, timely giving supplement of potassium magnesium aspartate before and after surgery significantly reduced the incidences of arrhythmia (OR=0.25, 95%CI 0.09 to 0.69, P=0.008), premature beats (OR=0.08, 95%CI 0.03 to 0.23, P < 0.000 01), tachycardia (OR=0.29, 95%CI 0.17 to 0.49, P < 0.000 01) and 24 h low cardiac output (OR=0.27, 95%CI 0.10 to 0.72, P=0.009); and increased auto-resuscitation rates (OR=12.16, 95%CI 4.82 to 30.68, P < 0.000 01), with significant differences. However, the two groups were alike in the incidences of atrial fibrillation (OR=0.05, 95%CI-0.16 to 0.05, P=0.34) and ventricular fibrillation (OR=1.24, 95%CI 0.73 to 2.13, P=0.43). ConclusionPotassium magnesium aspartate is effective in prevention of arrhythmias after cardiac surgery, and protective to the myocardium. However, compared with conventional treatment it cannot significantly decrease the incidences of atrial fibrillation and ventricular fibrillation. Due to the limited quantity and quality of the included studies, more multi-centre high quality RCTs with large sample size are needed to verify the above conclusion.
Deep learning method can be used to automatically analyze electrocardiogram (ECG) data and rapidly implement arrhythmia classification, which provides significant clinical value for the early screening of arrhythmias. How to select arrhythmia features effectively under limited abnormal sample supervision is an urgent issue to address. This paper proposed an arrhythmia classification algorithm based on an adaptive multi-feature fusion network. The algorithm extracted RR interval features from ECG signals, employed one-dimensional convolutional neural network (1D-CNN) to extract time-domain deep features, employed Mel frequency cepstral coefficients (MFCC) and two-dimensional convolutional neural network (2D-CNN) to extract frequency-domain deep features. The features were fused using adaptive weighting strategy for arrhythmia classification. The paper used the arrhythmia database jointly developed by the Massachusetts Institute of Technology and Beth Israel Hospital (MIT-BIH) and evaluated the algorithm under the inter-patient paradigm. Experimental results demonstrated that the proposed algorithm achieved an average precision of 75.2%, an average recall of 70.1% and an average F1-score of 71.3%, demonstrating high classification accuracy and being able to provide algorithmic support for arrhythmia classification in wearable devices.
Objective To summary the clinical experiences of ventricular septal myotomymyectomy on hypertrophic obstructive cardiomyopathy(HOCM) and investigate the treatment strategies during perioperative period for better clinical results. Methods From October 1996 to June 2009, 62 patients with HOCM underwent surgical treatment. There were 41 male and 21 female, aged 668 years with mean 34.05 years. The ventricular septal myotomymyectomy operation (Morrow operation or modified Morrow operation) was performed through the aortic incision under general anesthesia and hypothermic cardiopulmonary bypass (CPB). The concomitant operations included coronary artery bypass grafting (5 cases), mitral valve replacement (12 cases), mitral valve plasty(9 cases), aortic valve replacement (4 cases), tricuspid valve plasty(2 cases) and ductus arteriosus closure (2 cases). During the perioperative period, the patients were examined by echocardiography or transesophageal echocardiograph(TEE), electrocardiogram or dynamic echocardiogram and chest radiography. Left atrial diameter，left ventricular enddiastolic [CM(159mm]diameter，left ventricular outflow tract (LVOT) pressuregradient，interventricular septal thickness, ejection fraction[CM)](EF), the changes of mitral valve construction and function were evaluated. Results The time of CPB and aortic occlusion were 104.23±47.14 min and 66.76±36.32 min, respectively. The endotracheal intubation time was 13.23±11.76 h and the postoperative intensive care unit(ICU) stay was 42.53±37.41 h. Four patients died and the mortality was 6.45％(4/62). The main causes of death included septic shock complicated with acute renal failure(1 case), refractory arrhythmia, ventricular fibrillation, atrial flutter complicated with severe low cardiac output syndrome (1 case), severe acute renal failure(1 case) and Ⅲ°atrioventricular(AV) block complicated with low cardiac output syndrome(1 case). Postoperative left atrial diameter (34.56±6.45 mm vs.43.46±7.21 mm，t=6.948,P=0.000), left ventricular enddiastolic diameter (37.14±6.31 mm vs.42.03±6.23 mm，t=3.145,P=0.020), LVOT pressure gradient (23.54±17.78 mm Hg vs. 103.84±44.04 mm Hg,t=13.618,P=0.000) and interventricular septal thickness (17.12±5.67 mm vs.26.93±5.23 mm, t=10.694,P=0.000) decreased significantly compared with those before operation. There was no mitral valve regurgitation, or only mild mitral valve regurgitation. No systolic anterior motion(SAM) was found. The main postoperative arrhythmias included complete left bundle branch block, intraventricular block, complete atrioventricular block and atrial fibrillation. All the 58 cases were cured and discharged. Fiftythree cases were followed up for 3 months12 years, and 5 cases were lost. No death, complication and reoperation were found. Symptoms relieved significantly. The cardiac function was in New York Heart Association grade Ⅰ-Ⅱ. The quality of life improved significantly. Conclusion Most patients with HOCM can achieve satisfactory relief of LVOT obstruction and SAM via ventricular septal myotomymyectomy. The main arrhythmias after operation are bundle branch block and atrial fibrillation. Satisfactory effects can be achieved by accurate surgical technique and effective drug treatments.
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.
ObjectivesTo systematically review the efficacy of traditional Chinese medicine for arrhythmia caused by anthracycline drugs.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of traditional Chinese medicine for arrhythmia caused by anthracycline drugs from inception to October 2017. Two reviewers independently screened literature, extracted data and evaluated risk of bias of included studies. Meta-analysis was then performed by Revman 5.3 software.ResultsA total of 4 RCTs involving 312 patients were included. The results of meta-analysis showed that: the incidence of tachycardia in the Wenxin granule treatment group was lower than that in the control group (RR=0.35, 95%CI 0.18 to 0.67, P=0.002). Baoxinkang was more effective than antioxidant western medicine in protecting myocardial SOD activity (RR=2.25, 95%CI 1.74 to 2.76, P<0.000 01). But there was no significant difference between two groups on the incidence of atrial premature beats (RR=0.40, 95%CI 0.15 to 1.08,P=0.07), premature ventricular contractions (RR=0.56, 95%CI 0.23 to 1.34, P=0.19) and atrial fibrillation (RR=0.41, 95%CI 0.11 to 1.53, P=0.18). In addition, there was no significant difference between Wenxin granules and amiodarone in treating arrhythmia induced by anthracycline. The addition of Wenxin granules on the basis of anthracycline antitumor chemotherapy regimens was not effective in delaying disease progression compared with anthracycline alone. Wenxin granules could not change the SOD level of breast cancer patients with cardiotoxicity caused by anthracycline chemotherapy, compared with chemotherapy and basic treatment.ConclusionsThe current evidence shows that Wenxin granules can prevent and reduce anthracycline-induced tachycardia, but its efficacy in improving the overall efficiency, preventing and reducing atrial premature beats, premature ventricular contractions, atrial fibrillation, and SOD levels are unclear. Baoxinkang can protect myocardial SOD activity. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To explore how to differentiate the epilepsy and syncope in order to minimize the misdiagnosis. Methods Retrospectively analyzed the medical record of 6 cases which were misdiagnosed as epilepsy or syncope during April 2008 to September 2012 and reviewed the literatures about the differential diagnosis. Results Among the clinical characteristics, the ictal positional tone and loss of consciousness as well as the duration of postictal confusion are very important to the differential diagnosis. The ictal EEG shows highly rhythmic abnormal discharges when epileptic seizures occur. However, the ictal EEG would become slower and flatler during syncope. Conclusions When the automomic disorder and signs such as chest distress, arrhythmia. appear, the causes should not be limited in the cardiac diseases, the functional or structural abnormalities of the nervous system innervating the heart should also be considered; on the contrary, convulsions might not only due to the abnormal electrical activity in the brain, but syncope.
The judgment of the type of arrhythmia is the key to the prevention and diagnosis of early cardiovascular disease. Therefore, electrocardiogram (ECG) analysis has been widely used as an important basis for doctors to diagnose. However, due to the large differences in ECG signal morphology among different patients and the unbalanced distribution of categories, the existing automatic detection algorithms for arrhythmias have certain difficulties in the identification process. This paper designs a variable scale fusion network model for automatic recognition of heart rhythm types. In this study, a variable-scale fusion network model was proposed for automatic identification of heart rhythm types. The improved ECG generation network (EGAN) module was used to solve the imbalance of ECG data, and the ECG signal was reproduced in two dimensions in the form of gray recurrence plot (GRP) and spectrogram. Combined with the branching structure of the model, the automatic classification of variable-length heart beats was realized. The results of the study were verified by the Massachusetts institute of technology and Beth Israel hospital (MIT-BIH) arrhythmia database, which distinguished eight heart rhythm types. The average accuracy rate reached 99.36%, and the sensitivity and specificity were 96.11% and 99.84%, respectively. In conclusion, it is expected that this method can be used for clinical auxiliary diagnosis and smart wearable devices in the future.