碎裂QRS波在致心律失常性右心室心肌病诊断中的价值

Objective To evaluate diagnostic value of fragmented QRS complex (fQRS)in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Forty-three patients [33 men, aged (40. 4 ± 13.9)years]meet the ISFC/ESC diagnostic criteria for ARVC were enrolled in this study. A standard twelve-lead electrocardiogram was obtained during the resting status. Characteristics of fQRS were detailedly studied by three doctors independently. A comparison of the prevalence among fQRS, epsilon wave and T wave inversion( TWI )in the right precordial leads exceeding V3 was done. Results Most fQRS could be found in the inferior leads (44. 3% ) and the right precordial leads (24. 2% ). Within the QRS complex, the prevalence of fQRS in the R wave was significantly higher than it in the S wave(58. 4% vs 32. 9% ,Z =4. 30,P ＜0. 01 ).fQRS could be found in a total of 31 of 43 cases( mean 4. 6 ± 1.7 ( range 2 to 9) per patient). The prevalence of fQRS was significantly higher than that of epsilon wave ( 73.8% vs 30. 2%, Z = 3.67, P ＜ 0. 01 ) and TWI (73.8% vs41.9% ,Z =2. 61 ,P＜0. 01 ). Conclusion fQRS was a common electrocardiographic abnormality,and most was found in the inferior and right precardial leads in patients with ARVC. It may be used as an important noninvasive preliminary screening electrocardiographic criteria.     

老年房颤患者导管射频消融疗效及复发相关因素分析

目的：研究老年房颤患者导管射频消融的疗效及复发相关因素。方法：收集2013年1月—2016年12月于南京医科大学第一附属医院行房颤导管射频消融,且年龄≥60岁患者的临床资料,分析手术疗效、安全性及复发的相关因素。结果：共入组482例患者,年龄（66.5±4.7）岁。其中,男297例（61.6%）,女185例（38.4%）,阵发性房颤239例（49.6%）,持续性房颤243例（50.4%）。围术期共4例穿刺局部并发症,无严重并发症发生。随访（20.4±5.6）个月,共104例（21.6%）患者房颤复发。房颤复发组与未复发组在左心房大小、糖尿病、心衰、房颤患者卒中风险评估评分（CHA2DS2?VASc）积分等因素存在显著差异（P < 0.05）,两组年龄、性别、高血压病等因素无显著差异。结论：导管射频消融治疗老年房颤患者安全有效,左心房增大、合并糖尿病、心衰等可能与复发相关。     

碎裂QRS波在致心律失常性右心室心肌病诊断中的价值

目的评价碎裂QRS波（fQRs波）在致心律失常性右心室心肌病（ARVC）诊断中的价值。方法43例符合ARVC诊断标准的患者,男性33例,平均年龄（40．4±13．9）岁。采集临床资料,记录静息状态下标准12导联心电图,描述fQRs波的心电图特征,判断是否存在fQRs波、epsilon波和右胸前导联T波倒置（TWI）并比较其阳性率之间的差异。结果本组患者fQRs波以下壁导联（44．3％）和右胸前导联（24．2％）最为多见。QRS波中,fQRs波见于R波者多于S波者（58．4％对32．9％,Z=4．30,P〈0．01）。共31例患者判断为fQRS波阳性,2～9（4．6±1．7）个／例。fQRs波阳性率较epsilon波（73．8％VS30．2％,Z=3．67,P〈0．01）和TWI（73．8％对41．9％,Z=2．61,P〈0．01）显著增高。结论fQRs波阳性是ARVC患者常见的心电图异常,常见于下壁和右胸前导联,可作为提示诊断的无创心电指标。