2008年早期复极(early repolarization,ER)首次被Haissa-guerre[1]明确证明和室性心律失常有关. ER一旦出现临床症状,常常表现为胸痛、心悸、晕厥,即形成了早期复极综合征(early repolarization syndrome,ERS), 往往代表其预后不良.ERS患者不明原因晕厥,是"恶性变"的类型,可能是未来的心律失常事件一个重要的预测因子.

Objective To evaluate the relationship between cardiovascular responses during the treadmill exercise test and exercise-induced muscle vasodilatation in individuals with suspected coronary heart disease and asymptomatic individuals.Methods The study included 396 subjects (231 females and 165 males) treadmill exercise test.We evaluated the heart rate (chronotropic reserve and heart rate recovery),blood pressure (maximum systolic and diastolic blood pressure) and exercise capacity during treadmill exercise testing.At the same time,measurement of forearm blood flow and vascular response during isometric handgrip test.Results Forearm blood flow increase during the handgrip exercise was positively correlated with heart rate recovery during treadmill exercise testing.The increasement of forearm vascular conductance during the handgrip exercise was negatively correlated with exercise diastolic blood pressure during exercise treadmill testing.No significant association was found between exercise capacity and exercise-induced muscle vasodilation.Conclusions Exercise-induced muscle vasodilatation is correlated with heart rate and blood pressure responses during treadmill exercise testing,but is not correlated with exercise capacity.These findings suggest that favorable hemodynamic and chronotropic responses are correlated with better vasodilator capacity,but exercise capacity does not predict muscle vasodilatation.

目的 评价平板运动试验后心率恢复、心率变异性与冠心病的关系及临床意义.方法 对310例拟诊为冠心病的患者行活动平板运动试验,并对照其冠状动脉造影结果,将患者分为冠心病组106例和非冠心病组204例.比较两组患者的心率恢复值、达标时间、静息心率及运动最大心率,分析心率恢复异常与冠心病.同时评估短期心率变异性.结果 冠心病组运动后心率恢复值低于非冠心病组,差异有统计学意义;冠心病组心率变异性与非冠心病组相比,差异有统计学意义.结论 冠心病组与非冠心病组相比,心率恢复异常及心率变异性差异均有统计学意义,两者综合评价冠心病的准确率更高.

近年来，随着人们对高血压认识不断深入，自主神经功能对高血压影响越来越受到重视。自主神经不单对血压、心率调控起重要作用，同时影响血压变异性（BPV）和心率变异性（HRV）。美国心脏病学会的研究发现BPV能对脑卒中和冠状动脉事件风险作出强有力的预测［1］，而HRV也可作为一个强有力的心血管事件的预测因子。文献［2，3］中有报道老年高血压患者家庭自测BPV与HRV的相关性及老年冠心病患者的动态血压变化与HRV的关系。但鲜有关于健康人群及高血压人群BPV与HRV的相关性报告。本研究通过进行动态心电图及动态血压检查，检测HRV和BPV，旨在探究健康人群及高血压人群BPV与HRV的相关性。

目的：探讨异丙肾上腺素在无创电生理检查中的应用价值。方法：a）疑似室上速病例100例，50例行基础食管电生理诱发；50例静滴异丙肾上腺素后诱发。b）疑似神经血管性晕厥100例，50例行基础倾斜试验诱发晕厥；50例静滴异丙肾上腺素后诱发。结果：食管组：基础有11例诱发心动过速；异丙肾上腺素组23例诱发心动过速。晕厥组：基础有9例诱发晕厥；异丙肾上腺素组有31例诱发晕厥。结论：异丙肾上腺素在食管调搏和直立倾斜试验中有肯定的应用价值。

慢性心率增快是指24 h动态心电图中平均心率≥80次／min。其作为一个独立的心血管危险因素，危害仅次于吸烟，可导致病死率明显升高。越来越受到临床医生，尤其是心血管医生的重视，而慢性心率增快本身现已作为一个独立的治疗指征。但慢性心率增快与何种疾病相关性好，即何种疾病常伴有慢性心率增快是本分析旨在讨论的方向。

Category: 27. Clinical Electrophysiology—Ventricular ArrhythmiasSession-Poster Board Number: 1057-381 Authors: Yoshihiro Yamashina, Tetsuo Yagi, Akio Namekawa, Akihiko Ishida, Hirokazu Sato, Takashi Nakagawa, Manjirou Sakuramoto, Eiji Sato, Tomoyuki Yambe, Sendai City Hospital, Sendai, Japan, Tohoku University School of Medicine, Sendai, Japan Background: The relationship between J waves during sinus rhythm and idiopathic ventricular tachycardia (VT) or premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT) has not been reported. The aim of this study was to investigate the prevalence and characteristics of idiopathic RVOT-VT/PVCs associated with J waves. Methods: The study enrolled 121 consecutive idiopathic RVOT-VT/PVC patients (mean age 45 ± 16 years, 46 males) undergoing radiofrequency catheter ablation (RFCA). The prevalence of J waves was assessed. The clinical and electrophysiological data were compared between the patients with J waves (J-wave group) and those without (Non-J-wave group). Results: J waves were present in 53 (43.8%) idiopathic RVOT-VT/PVC patients. The distribution of the J waves was as follows: Inferior leads = 62%, inferior-lateral leads = 24.5% and lateral leads = 13.2%. The J-wave group had a higher incidence of sustained VT (22.6% vs. 3.5%, P<0.01), shorter VT cycle length (303 ± 56 msec vs. 351 ± 62 msec, P<0.01) and more episodes of syncope (16% vs. 3%, P<0.05) than did the Non-J-wave group. There were no significant differences between the 2 groups in terms of the success rate of RFCA (90.9% vs. 88.8%, P= 0.72) or clinical outcome: No ventricular fibrillation, syncope or cardiac sudden death were observed in any patients during the follow up period. Conclusions: There was a high prevalence of J waves in the idiopathic RVOT-VT/PVC patients. J waves may play an important arrhythmogenic role in high risk idiopathic RVOT-VT patients.

目的分析正常变异J波与异常J波形态之间的区别,探讨J波形态在冠心病诊断方面的临床意义。方法健康体检者心电图出现J波122例(健康组),冠心病患者心电图显示J波者106例(冠心病组),对J波的形态进行分析。结果健康组122例J波呈尖峰型95例,呈顿挫型15例,呈驼峰型12例;106例冠心病患者中J波呈尖峰型6例,顿挫型39例,驼峰型61例。顿挫型及驼峰型分别与尖峰型比较,差异有统计学意义(P<0.05);两组内顿挫型与驼峰型间比较,差异无统计学意义(P>0.05)。讨论J波形态与心脏事件及心肌缺血的发生有一定的关系。

目的探讨先天性心脏病(CHD)患儿常规12导联心电图中ST-T改变与缺损大小、心脏功能状态的相关性,以找出ST-T改变临床意义的层次。方法选择12岁(含12岁)以下的非紫紺型左向右分流的单纯性房间隔缺损(ASD)、单纯性室间隔缺损(VSD)共300例。搜集其术前、术后一年静息12导联心电图、心脏彩超、普通X线胸片各一份,对其ST-T改变与缺损大小、心脏功能状态的关系进行横向、纵向比较,对照并统计分析。结果VSD者ST-T改变与缺损大小有统计学意义(P<0.01),ASD、VSD者ST-T改变均与心脏功能状态有统计学意义(P<0.01)。结论ST-T改变对VSD的缺损大小有一定的评估价值。CHD者术前、术后一年的ST-T改变对心脏功能状态有一定的评估价值。