心脏再同步治疗对复极离散度和室性心律失常的影响  

Effect of Cardiac Resynchronization Therapy in Patients With Dispersion of Re-polarization and Ventricular Arrhythmia

作　　者：薛聪[1] 华伟[1] 蔡迟[1] 丁立刚[1] 牛红霞[1] 王靖[1] 张澍[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心血管疾病国家重点实验室心律失常诊治中心,北京市100037

出　　处：《中国循环杂志》2016年第3期250-253,共4页Chinese Circulation Journal

摘　　要：目的:探讨心脏再同步治疗(CRT)对复极离散度和室性心律失常的影响。方法:入选86例CRT植入患者,根据术后6个月左心室射血分数(LVEF)绝对值是否较基线水平提高≥10%,分为反应组(n=43)和无反应组(n=43)。比较两组患者CRT植入后不同时期QRS间期、校正的QT间期(QTc间期)、T波峰末间期(Tp Te间期)等复极离散度指标变化及室性心律失常事件情况。结果:反应组患者术后1年QRS间期和Tp Te间期较术前和术后<24 h明显缩短(P均<0.05),而无反应组各时期上述指标差异均无统计学意义(P>0.05)。在术后1年中,反应组室性早搏(PVCs)和室性早搏连发(PVC runs)的发生次数,明显少于无反应组[lg PVCs:(1.78±0.77)vs(2.73±0.61);lg PVC runs:(0.64±0.48)vs(1.98±0.72),P<0.05]。分别对CRT术后lg(PVCs)和lg(PVC runs)的多重线性回归分析发现,术后<24 h的Tp Te间期是lg(PVCs)和lg(PVC runs)的独立预测因素(B=0.143,比值比=1.154,P=0.001;B=0.122,比值比=1.047,P=0.001)。结论:CRT心室逆重构可以减小复极离散度,降低患者室性心律失常事件发生风险,改善预后。术后当天的Tp Te间期时限对CRT术后室性心律失常事件有预测意义。Objective： To explore the effects of cardiac resynchronization therapy（CRT） in patients with dispersion of re-polarization and ventricular arrhythmia.Methods： A total of 86 consecutive patents with CRT implantation were enrolled. According to weather absolute value of LVEF increased≥10% from baseline at 6 months after CRT implantation, the patients were divided into 2 groups： Response group and Non-response group, n=43 in each group. Dispersion of re-polarization indexes as QRS duration, QTc interval, TpT e interval and the events of ventricular arrhythmia were compared between 2 groups at different time points after CRT.Results：（1） In Response group, compared with pre-operation, QRS duration and Tp Te interval were shorter at 1 year and within 24 h after CRT implantation, all P0.05, while the above indexes were similar in Non-response group, all P0.05.（2） During 1 year after CRT implantation, the incidences of PVCs and PVC runs in Response group were much less than those in Non-response group, for lgP VCs：（1.78 ± 0.77） vs（2.73 ± 0.61）, for lgP VC runs：（0.64 ± 0.48） vs（1.98 ± 0.72）, P〉0.05.（3） Multi liner regression analysis demonstrated that Tp Te interval within 24 h after CRT implantation was an independent predictor for both lgP VCs：（B=0.143, OR=1.154, P=0.001） and lgP VC runs：（B=0.122, OR=1.047, P=0.001）. Conclusion： CRT ventricular reverse remodeling may reduce dispersion of re-polarization and the risk of ventricular arrhythmia, therefore improve the prognosis in relevant patients; TpT e interval within 24 h after CRT had the predictive valuefor ventricular arrhythmia.

关 键 词：心律失常 心脏再同步治疗 TpTe间期 跨壁复极离散度 

分 类 号：R54[医药卫生—心血管疾病]