心电图评价致心律失常性右心室心肌病病变程度的临床价值  

Association between abnormal electrocardiographic features and disease severity in patients with arrhythmogenic right ventricular cardiomyopathy

作　　者：赵英杰[1] 贾玉和[1] 关立克[1] 韦伟[1] 王靖[1] 毛克修[1] 陈旭华[1] 刘萧燕 张澍[1] 楚建民[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心律失常诊治中心,100037

出　　处：《中华心血管病杂志》2011年第8期734-738,共5页Chinese Journal of Cardiology

摘　　要：目的分析致心律失常性右心室心肌病（ARVC）患者的病变程度与心电图表现之间的关系。方法分析61例已确诊的ARVC患者，根据心脏核磁共振成像（MRI）检查结果，将其按病变侵犯部位分为右心室局部病变组、右心室弥漫病变组、双心室病变组，分析比较三组的心电图特征。结果心脏MRI结果显示右心室局部病变组19例（31％），右心室弥漫病变组28例（46％），双心室病变组14例（23％）。心电图正常者3例，三组中各1例。伴有Epsilon波的患者24例（39％）、V1～V3导联的QRS波时限≥110ms的患者21例（34％）、V1～V3导联S波升支≥55ms的患者17例（28％）、完全右束支传导阻滞的患者10例（16％）、病理性Q波的患者9例（15％），这些指标的发生率均随病变程度的加重而增高（右心室局部病变组〈右心室弥漫病变组〈双心室病变组）。Epsilon波、V1～V3导联的QRS波时限≥110ms、完全性右束支传导阻滞（RBBB）、病理性Q波的发生率在双心室病变组中要高于右心室局部病变组，且两组间比较差异有统计学意义（P〈0．05）。V1～V3导联S波升支I〉55ms的发生率在双心室病变组中要高于右心室局部病变组，且两组间比较差异有统计学意义（P〈0．05）；在双心室病变组要高于右心室弥漫病变组，且两组间比较差异均有统计学意义（P均〈0．05）。一度房室传导阻滞的发生率在双心室病变组中要高于右心室弥漫病变组，且两组间比较差异有统计学意义（P〈0．05）。右心室局部病变组患者心电图T波倒置多局限于V1导联，右心室弥漫病变组和双心室病变组T波倒置多数表现于胸前导联V1～V3或超过V3导联的胸前导联、以及下壁导联。结论心电图正常并不能排除ARVC。ARVC患者T波倒置在12导联心电图上具有很高的发生率，并且T波倒置在胸部导联的延伸与病变程度是相关的，T波倒�Objective To analyze the relationship between electrocardiographic （ECG） features and disease severity in patients with the arrhythmogenic right ventricular cardiomyopathy （ARVC）. Method The study group consisted of 61 subjects with a definite diagnosis of ARVC on the basis of published guideline criteria and patients were divided into 3 subgroups according to the extent of diseased myocardium defined by cardiac magnetic resonance imaging （MRI） ： Group A： local involvement （n = 19, 31% ）, Group B ： diffuse involvement of whole right ventricle （ n = 28, 46% ） and Group C ： involvement of both right and left ventricles （ n = 14, 23% ）. Results Normal electrocardiogram was shown in 1 patient in each group. Epsilon wave was detected in 24 （39%） patients, QRS duration was prolonged [ ≥ 110 ms（ V1 -V3 ） ] in 21 （34%） patients, S-wave upstroke was prolonged （ ≥55 ms） in 17 （28%） patients, complete right branch bundle block was evidenced in 10 （ 16% ） patients and pathologic Q waves was found in 9 （ 15% ） patients. The incidence of above abnormal ECG changes was increased in proportion to the degree of disease severity （ group A 〈 group B 〈 group C）. Incidence of Epsilon wave and prolonged QRS duration [ ≥ 110 ms（ V1 - V3 ） ] were significantly higher in Group C than in Group A. Incidence of prolonged S-wave upstroke （ ≥55 ms） was significantly higher in Group C than in Group A and Group B. T-wave inversion in V1 leads was often found in Group A. T-wave inversion in inferior leads （ V1 - V3 leads or beyond V3 ） was often presented in Group B and Group C. Conclusions Normal ECG does not exclude the possibility of diagnosis of ARVC. The extent of T-wave inversion in the precordial leads and incidence of Epsilon wave, prolonged QRS duration [ ≥ 110 ms （V1 -V3 ） ] and prolonged S-wave upstroke （ ≥55 ms） were related to degree of disease severity in patients with ARVC.

关 键 词：心律失常性右心室发育不良 心电描记术 磁共振成像 

分 类 号：R542.2[医药卫生—心血管疾病]