Takayanagi K, Kamishirado H, Iwasaki Y, Fujito T, Sakai Y, Inoue T, Hayashi T, Morooka S
Department of Cardiology, Dokkyo University Koshigaya Hospital, Japan.
Jpn Heart J. 1999 Mar;40(2):135-44. doi: 10.1536/jhj.40.135.
Ventricular premature contractions (VPCs) occasionally appear successively in the form of bigeminy, trigeminy or quadrigeminy associated with quiescent periods. However, details of these rhythmic VPC bursts have not been well documented. We analyzed the incidence, periodicity and interval of VPC bursts exhibiting bigeminy or trigeminy using ambulatory ECG monitoring and computer analysis. We defined VPC bursts as more than 5 successive groups of VPCs each containing more than 20 VPCs in the form of bigeminy or trigeminy that were interrupted by normal sinus rhythm lasting for more than 60 seconds. Bursts thus defined were observed transiently or continuously in 78 out of 500 consecutive patients showing > 3000 VPCs a day. Their age ranged from 14 to 76 years (mean 48). Forty patients were men and 38 were women. We could discriminate between two types of bursts on the instantaneous heart rate tachograms. Dome type bursts (n = 48) showed gradual shortening of the VPC coupling intervals whereas horizontal type bursts (n = 30) demonstrated fixed coupling intervals during the bursts. Cycle length of the dome type burst was 185 +/- 40 seconds and regular, whereas it was 210 +/- 63 seconds and irregular in the horizontal type (NS). Duration of the VPC bursts was 101 +/- 31 seconds in the dome type and 98 +/- 41 seconds in the horizontal type. Both burst types were associated with transient increases in sinus rate and abbreviated VPC-VPC intervals. We suspect ventricular parasystole to be the mechanism of these bursts especially in the dome type. Recognition of these two burst types from heart rate tachograms may be of value in the suppression of VPCs.
室性早搏（VPCs）偶尔会连续出现，呈二联律、三联律或四联律的形式，并伴有静息期。然而，这些有节律的室性早搏连发的细节尚未得到充分记录。我们使用动态心电图监测和计算机分析，分析了表现为二联律或三联律的室性早搏连发的发生率、周期性和间期。我们将室性早搏连发定义为连续5组以上的室性早搏，每组包含20个以上呈二联律或三联律形式的室性早搏，并被持续超过60秒的正常窦性心律打断。在连续500例每日室性早搏>3000次的患者中，有78例短暂或持续观察到如此定义的连发。他们的年龄在14至76岁之间（平均48岁）。40例为男性，38例为女性。我们可以在瞬时心率图上区分两种类型的连发。圆顶型连发（n = 48）显示室性早搏联律间期逐渐缩短，而水平型连发（n = 30）在连发期间显示固定的联律间期。圆顶型连发的周期长度为185±40秒且规则，而水平型的周期长度为210±63秒且不规则（无显著性差异）。室性早搏连发的持续时间在圆顶型为101±31秒，在水平型为98±41秒。两种连发类型均与窦性心率的短暂增加和室性早搏 - 室性早搏间期缩短有关。我们怀疑心室并行心律是这些连发的机制，尤其是在圆顶型中。从心率图上识别这两种连发类型可能对抑制室性早搏有价值。
