心房颤动患者胺碘酮转复期间发生尖端扭转型室性心动过速的心电图及临床危险因素  

Electrocardiogram and clinical risk factors of torsades de pointes in patients with atrial fibrillation during amiodarone conversion

作　　者：张楠[1] 杨亚娟[1,2] 公永太 赵文萍[4] 许纲[1] 王如兴[2] 李广平[1] 刘彤[1] Zhang Nan;Yang Yajuan;Gong Yongtai;Zhao Wenping;Xu Gang;Wang Ruxing;Li Guangping;Liu Tong(Department of Cardiology,The Second Hospital of Tianjin Medical University,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease,Tianjin Institute of Cardiology,Tianjin 300211,China;Department of Cardiology,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Wuxi 214002,China;Department of Cardiology,The First Affiliated Hospital of Harbin Medical University,Harbin 150000,China;Department of Cardiology,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]天津医科大学第二医院心脏科、天津市心血管病离子与分子机能重点实验室、天津心脏病学研究所,天津300211 [2]南京医科大学附属无锡市人民医院心内科,无锡214002 [3]哈尔滨医科大学附属第一医院心内科,哈尔滨150000 [4]河北大学附属医院心血管内科,保定071000

出　　处：《中华心律失常学杂志》2023年第4期295-302,共8页Chinese Journal of Cardiac Arrhythmias

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-029A)。

摘　　要：目的识别能够早期预测胺碘酮相关尖端扭转型室性心动过速(TdP)的危险因素。方法本研究为病例对照研究。纳入2012年7月至2022年7月就诊于天津医科大学第二医院、哈尔滨医科大学附属第一医院、河北大学附属医院及无锡市人民医院使用胺碘酮转复后发生TdP的心房颤动(房颤)患者,按照1∶4的比例纳入胺碘酮转复后未发生TdP的房颤患者。分析并比较房颤患者胺碘酮转复后包括QT间期、T波波峰至T波终点时限(Tp-Te间期)、Tp-Te间期与QT间期比值(Tp-Te/QT)、心脏电生理平衡指数(iCEB)等在内的心电图特征,以及年龄、性别、合并疾病、超声心动图指标等基线临床资料,从而识别能够预测胺碘酮相关TdP的危险因素。结果共纳入40例房颤患者,其中8例在接受胺碘酮转复后发生TdP(TdP组),其余32例未发生TdP(对照组)。①临床特征:TdP组患者左心室射血分数[LVEF,55.15%(57.50%,73.75%)对63.00%(60.00%,65.00%),P=0.024]、室间隔厚度[(8.00±1.85)mm对(10.01±1.56)mm,P=0.021]、左心室后壁厚度[(7.96±1.47)mm对(9.50±1.19)mm,P=0.020]及血清白蛋白水平[36.55(30.53,39.50)g/L对38.80(37.30,40.20)g/L,P=0.009]水平明显低于对照组,左心室舒张末期内径显著扩大[(55.18±6.56)mm对(44.49±4.47)mm,P<0.001]。②心电图特征:TdP组患者的QT间期[V_(2)导联:(635.60±185.44)ms对(464.22±90.51)ms,P<0.001]、校正QT间期[QTc间期,V_(2)导联:(681.20±155.30)ms对(492.39±52.93)ms,P<0.001]、Tp-Te间期[V_(2)导联:(196.93±87.01)ms对(120.30±65.49)ms,P=0.008]、校正Tp-Te间期[Tp-Tec间期,V_(2)导联:(208.53±82.44)ms对(126.94±61.05)ms,P=0.003]、Tp-Te/QT[V_(5)导联:(0.32±0.12)对(0.24±0.06),P=0.016]及iCEB[V_(2)导联:(5.61±1.62)对(4.24±0.96),P=0.002]均显著高于对照组。此外,TdP组患者房颤转复后的窦性心律心电图存在T波双向[50.0%(4/8)对12.5%(4/32),P=0.037]、T波倒置[75.0%(6/8)对31.3%(10/32),P=0.032]、T波电交替[37.5%(3/8)对0(0/32),P<0.001]和短-Objective To identify risk factors for amiodarone-induced torsades de pointes(TdP)in patients with atrial fibrillation(AF).Methods This is a case-control study.AF patients with and without amiodarone-induced TdP(1∶4)were enrolled from Second Hospital of Tianjin Medical University,Wuxi People’s Hospital Affiliated to Nanjing Medical University,The First Affiliated Hospital of Harbin Medical University,and Affiliated Hospital of Hebei University,from July 2012 to July 2022.Baseline clinical characteristics including age,gender,comorbidities and echocardiographic parameters,as well as sinus electrocardiogram(ECG)characteristics including QT interval,T peak to end interval(Tp-Te),Tp-Te interval/QT interval ratio(Tp-Te/QT),and index of cardio-electrophysiological balance(iCEB),were analyzed and compared in patients with AF after amiodarone conversion retrospectively.Results A total of 40 patients with AF were included,8 of whom developed TdP after conversion with amiodarone(TdP group),and the other 32 did ont develop TdP(control group).Compared to those without TdP,patients with TdP presented with significantly lower left ventricular ejection fraction[LVEF,55.15%(57.50%,73.75%)vs.63.00%(60.00%,65.00%),P=0.024],interventricular septal thickness[(8.00±1.85)mm vs.(10.01±1.56)mm,P=0.021],left ventricular posterior wall thickness[(7.96±1.47)mm vs.(9.50±1.19)mm,P=0.020],and serum level of albumin[36.55(30.53,39.50)g/L vs.38.80(37.30,40.20)g/L,P=0.009],as well as enlarged left ventricular end-diastolic diameter[LVEDD,(55.18±6.56)mm vs.(44.49±4.47)mm,P<0.001].As for the ECG characteristics,TdP group patients had a significantly longer mean QT interval[V_(2):(635.60±185.44)ms vs.(464.22±90.51)ms,P<0.001],corrected QT interval[QTc interval,V_(2):(681.20±155.30)ms vs.(492.39±52.93)ms,P<0.001],Tp-Te interval[V_(2):(196.93±87.01)ms vs.(120.30±65.49)ms,P=0.008],corrected Tp-Te interval[Tp-Tec interval,V_(2):(208.53±82.44)ms vs.(126.94±61.05)ms,P=0.003],a higher Tp-Te/QT ratio[Tp-Te/QT,V_(5):(0.32±0.12)vs.(0.24±0

关 键 词：心房颤动 胺碘酮 尖端扭转型室性心动过速 危险因素 心电图 

分 类 号：R541.75[医药卫生—心血管疾病] R540.41[医药卫生—内科学]