[How do I diagnose and treat ventricular extrasystoles?].
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The previous experimental studies have demonstrated that addition of Huang Qi ([symbol: see text] Radix Astragali) to the formulated recipe Sheng Mai Yin ([symbol: see text] Decoction for Pulse-activation) exerts the effects of strengthening the myodynamia, increasing the coronary flow, improving myocardial metabolism, and resisting the arrhythmia. The active component of Huang Lian ([symbol: see text] Rhizoma Coptidis) can prolong the myocardial action potential and antagonize the chloroform-, aconitine-, barium chloride-, epinephrine- or coronary ligation-induced arrhythmia by blocking the calcium channel. Ku Shen ([symbol: see text] Radix Sophorae Flavescentis) contains matrine and flavones, which act as quinidine to decrease the excitability of the myocardium, prolong the refractory period, and inhibit the ectopic cardiac rhythm. And Dan Shen ([symbol: see text] Radix Salviae Miltiorrhizae) has the action of improving the ischemic state of the myocardium by dilating the coronary vessels. In conclusion, the definite therapeutic effects of Huang Lian Sheng Mai Yin in treating ventricular, atrial and nodal arrhythmia suggests that the prescription is rational and accords with the therapeutic principle of TCM. Except discomfort in the gastric cavity and poor appetite experienced by some patients, there is no toxic or adverse reaction.
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The prognostic significance of ventricular premature beats (VPB) and their proper management are still a subject of controversy, particularly since during the last few years a number of publications have raised doubts as to the effectiveness and safety of antiarrhythmic drugs. An appropriate assessment of the VPB must consider: 1) electrocardiographic characteristics. 2) Associated symptoms. 3) Presence or absence of underlying disease, and 4) Ventricular function (VF). On this basis VPB may be classified as "Benign" (isolated; asymptomatic; mild or absent cardiopathy, and preserved VF); "Hazardous" (presence of complex VPB; with or without symptoms, and recognized organic heart disease), and "Malignant" (complex VPB and ventricular tachyarrhythmias; symptomatic cardiac disease, and compromised VF). Antiarrhythmic drugs are indicated for "Hazardous" and "Malignant" VPB. However, selection and efficacy must be documented by objective testing (Holter, stress, plasma levels). When utilized in well defined groups of patients, with reduction in the hourly number of VPB (more than 50-70%) and mainly of complex forms, there is clear benefit in terms of long-term survival, including coronary disease and congestive heart failure.
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