| Arrhythmia is cardiac pacing and cardiac rhythm and conductiondisorders occur frequency or abnormal activation sequence. Mainly astachycardia, bradycardia, arrhythmia and cardiac arrest, cardiac arrest orfibrillation is the main form of cardiac arrestTorsades de pointes ventricular tachycardia is one of the mainreasons for hospital patients with cardiac death, despite the rare but highdegree of malignancy. The typical ECG drug Tdp for short-and long-shortcycle, are warming up and cooling phenomenon. Tdp can usuallyterminates itself vulnerable to repeated, but can progress to ventricularfibrillation.Restore the heart rhythm or arrhythmia treatment principles shouldbe the basis of great importance to eliminate the cause or incentives tocontrol ventricular rate. Rapid the development of non-drug treatmentarrhythmia recent years, supraventricular tachycardia and ventriculartachycardia with radiofrequency ablation to achieve the purpose ofhealing, but still occupy an important position in the drug treatment ofarrhythmias, arrhythmia medication irreplaceable. Torsades de pointesventricular tachycardia is a special type of polymorphic ventriculartachycardia occurred on the basis of QT prolongation. Acquired long QTinterval is the most common incentives for drug factors in hospitalizedpatients, drug-induced Tdp is one of the important causes of suddencardiac death. Therefore, the impact of the drug on the QT interval gradually attracted attention, and a variety of drugs and drugs interactionincreasingly aroused the attention of clinicians. This article aims toretrospective analysis of torsades de pointes ventricular tachycardia inpatients with ECG characteristics and clinical drug use, so that in futureclinical work, more secure, reasonable application of drugs to prevent theemergence of malignant arrhythmias.Objective: Application of drugs for treating arrhythmia patients forthe study, to measure and compare the medication before and after the QTinterval and QTc changes, explore the QT interval TDP of diagnosticvalue and clinical treatment strategies.Method: The cases from the China-Japan Union Hospital of Jilinuniversity in March2012to January2013more than1,000cases ofelectronic, and diagnosed with arrhythmia patients, inclusion criteria foratrial arrhythmia, Supraventricular arrhythmias and ventriculararrhythmias, and a total of68medical records were found and exclusioncriteria for the final application by radiofrequency ablation for thetreatment of patients, a total of15cases, including10cases of malepatients,5cases of female patients,50-84years old, with an average(61.4±9.19) years old,4cases of which were Recurring torsades depointes ventricular tachycardia after drug treatment aged56-76years old,the average age (65.50±7.92) years old, including males one case,female three cases. All subjects were recorded synchronous12-lead ECG,with twelve-lead ECG (ECG-9130P) is produced by Nihon Kohden Corp.QT interval from the beginning of the QRS complex to the distance fromthe end of the T wave, observed on the same patient should choose thesame lead. The end of the T wave is difficult to observe, you can choosefrom the T-wave decline in support at the steepest draw a tangent, theintersection of the tangent with the baseline as the end of the T wave. For the patients with of atrial fibrillation, due to the RR interval periodabsolute is do not the same as, so choose of of interphase with theshortest in in the the longest RR and RR interval, respectively, calculationthe QTc, and then averaged. The measurement of the QT interval of eachECG lead V2manual measurement, continuous measurement of threecardiac cycles, averagedResults: A total of four cases in15patients enrolled Torsades depointes ventricular tachycardia56-76years old, the average age (65.50±7.92) years, and the remaining11patients, aged50-84years old, theaverage age of (59.91±9.17) years, after drug treatment only QTprolongation, Torsades de pointes not appear. This matched with theknown study that patients over the age of65Tdp risk increased. Selectedfive female patients,3cases of torsades de pointes ventricular tachycardia;selected10male patients, only one case of torsades de pointes. Occur inpatients with Tdp its drug QT interval480-520ms, mean QT interval (508±16) ms. Patients without Tdp its drug QT interval in the320-500ms,average QT interval (409±49) ms. The Tdp patients, the drug QTc500-550ms, average QTc (528±19) ms. Patients without Tdp its drugQTc (458±32) ms. Four cases Tdp patients also extension of the QTinterval in the interim period,470-510ms, average (495±18) ms, visiblefrequency of multi-source chamber premature contraction, R-ON-Tphenomenon. The bigeminy longer before Tdp occurred,560-630ms,average (598±26) ms. Tdp attack when the direction of the main wave ofthe QRS complex around an imaginary line reversed. One patientepisodes of rapid progress to ventricular fibrillation and therefore givesthe defibrillation process, after atropine, isoproterenol treatment. TheTdp-attack patients in the remaining three cases were given25%magnesium sulfate10ml in20ml0.9%saline, slow intravenous bolus successfully terminated Tdp attack, but were unable to maintain.Therefore, serum potassium, magnesium ion situation, intravenousmaintain potassium, magnesium supplementation therapy, atropine,isoproterenol improve sinus rhythm therapy. One patient above thetreatment is not successful, given the implanted temporary pacemakerVVI mode, pacing rate of90-110beats/min. Apart from one patientfamily to give up treatment, and the remaining patients were treatmentsuccess.Conclusion:1The Tdp patients after the application of anti-arrhythmic drugtherapy, QT interval significantly prolonged than not appear Tdp patients.2. The Tdp patients after the application of anti-arrhythmic drugtherapy, QTc interval significantly prolonged than not appear Tdppatients.3. Clear Tdp diagnosis depends on the history, incentives, ECGattack, improve the diagnosis of consciousness, quickly identify thetypical Tdp ECG is effective in treating the premise.4The key of the Tdp treatment key is to remove the cause. To givepotassium, magnesium supplementation to improve heart rate and othertreatment can improve symptoms, if necessary, temporary pacemakerimplantation. |
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