碎裂QRS波预测ARVC患者室性心律失常事件  

Fragmented QRS as a predictor of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy

作　　者：薛社亮[1,2] 徐波 李文华[1,2] 蔡高军 宋艳斌[1,2] 俞磊 李峰[1,2] 肖建强 Xue sheliang;Xu bo;Li wenhua;Cai gaojun;Song yanbin;Yu lei;Li feng;Xiao jianqiang(Department of Cardiology of Wujin Hospital Afilialed with Jiangsu University Changhou,213017,China;Deparment of Cardiology of Wujin Clinical college of Xuzhou Medical Universily,Changzhou,213017,China)

机构地区：[1]江苏大学附属武进医院心血管内科,213017 [2]徐州医科大学武进临床学院心血管内科,213017

出　　处：《临床心电学杂志》2022年第3期168-171,共4页Journal of Clinical Electrocardiology

基　　金：常州市武进区科技支撑(社会发展)项目(WS201802);江苏大学2018年度临床医学科技发展基金项目(JLY20180082)。

摘　　要：目的探讨心电图碎裂QRS波(Fragmented QRS Complex,f QRS)对致心律失常性右室心肌病(Arrhythmogenic Right Ventricular Cardiomyopathy,ARVC)患者室性心律失常事件发生的远期预测价值。方法2007年1月至2008年11月顺序入组35例ARVC患者(男性28例,年龄38.6±11.0岁),分析并记录其临床资料,如晕厥史、家族史、服药史、心电图f QRS、左室射血分数(LVEF)、心功能分级等,并随访观察阳性事件发生情况。随访方案为每3-6月进行一次电话或门诊随访,有症状随时就诊。阳性事件定义为症状性持续性室性心动过速、ICD恰当治疗及心脏性猝死的发作情况。结果致心律失常性右室心肌病患者35例,随访99.9±7.7个月,15例发生阳性事件(其中1例为心脏性猝死,其余14例发生持续性室速,2例因室速发生晕厥,2例植入ICD者因室速行放电治疗)。生存分析-单因素Cox回归模型提示,f QRS(HR3.0;95%CI:0.95-9.46;p=0.05)是随访中阳性事件发生的高危因素;Kaplan-Meier曲线分析表明,f QRS波阳性患者无心律失常事件的累积生存率显著降低。结论碎裂QRS波是ARVC患者室性心律失常事件发生的高危因素。Objective To investigate the long-term prediction value of fragmented QRS(f QRS)for ventricular arrhythmia events in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC).Methods Thirty-five ARVC patients were enrolled from January 2007 to November 2008.Clinical data were analyzed and recorded,such as syncope history,family history,medication history,f QRS,left ventricular ejection fraction(LVEF),and cardiac function classification.A positive event was defined as the first occurrence of sudden cardiac death(SCD),documented sustained ventricular tachycardia(VT),ventricular fibrillation(VF),or the administration of appropriate implantable cardioverter defibrillator(ICD)therapy.Results The 35 ARVC patients were followed up for 99.9±7.7months and 15 positive events occurred.The univariate Cox regression model for survival showed that f QRS was a high risk factor for positive events during follow-up.Kaplan-Meier curve analysis showed a significant decrease in cumulative survival without arrhythmia events in patients with f QRS.Conclusions Fragmented QRS could predict ventricular arrhythmia events in ARVC patients.

关 键 词：碎裂QRS波 致心律失常性右室心肌病 室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]