特发性心室颤动长期随访的临床与心电图特征

目的 分析特发性心室颤动(室颤)患者的心电图与临床特征,探讨其与预后之间的关系.方法 21例特发性室颤患者,男性10例(47.6%),初次发生症状年龄平均(38.5±19.0)岁,随访分析其临床及体表心电图特征,按照心电图有无J波分为J波阳性组(J+组)和J波阴性组(J-组),比较两组死亡和室颤、晕厥发生的情况.结果 21例特发性室颤的患者中,9例室颤发生于凌晨睡眠时,5例室颤发生于情绪激动时,7例室颤发作无明确诱因.J+组(n=15)中有7例心电图J波合并QRS波切迹,1例合并早期复极.合并QRS波切迹的7例患者室颤发作时间为凌晨睡眠中.平均随访(42.4±39.9)个月后,J+组患者的年平均室颤发作次数明显高于J-组(n=6),分别为(1.3±0.5)次/年和(0.4±0.3)次/年,P＜0.01.J+组死亡2例,J-组死亡1例.多因素回归分析结果显示,特发性室颤患者中J波阳性患者出现室颤复发的危险性高于J波阴性患者(RR 1.9,95%CI 1.1～2.9;P=0.03).结论 报道QRS波切迹的室颤患者有相似的凌晨睡眠时发作特点;J波在特发性室颤患者中的发生率较高,而且预示着具有更高的室颤复发率.J波有望成为特发性室颤预后的预测因子.

Association between electrocardiogram characteristics and long-term outcome in patients with idiopathic ventricular fibrillation

Objective To explore the association between clinical and ECG characteristics and prognoses in patients with idiopathic ventricular fibrillation (VF). Methods We reviewed the data from 21 VF patients [male 47.6%, mean age (38.5 ± 19.0) years] with first event of VF, all patients were resuscitated after cardiac arrest and diagnosed as idiopathic VF. The prevalence of J wave was assessed and patients were divided into J wave positive (J + group) and negative group (J - group). The end point was death or syncope from arrhythmia, and recorded VF recurrence during the follow-up. Results J wave was frequent in subjects with idiopathic VF (71.4%). Among patients in the J + group ( 15 cases), notch on the QRS wave was found in 7 subjects (46. 7% ), these patients were more likely to suffer from the sudden cardiac arrest during sleep at early morning than those with J wave but without notch on the QRS wave. Two patients dead suddenly in the J + group and l dead from embolism in the J - group during follow-up [ mean (42.4 ±39. 9) months]. The mean year-onset of VF or syncope was significantly higher in the J + group than in the J - group [ ( 1.3 ± 0. 5 ) episodes/year vs. (0. 4 ± 0. 3 ) episodes/year, P ＜ 0. 01 ]. J wave positive was also associated with an increased risk of VF recurrence ( RR 1.9, 95% CI 1.1 to 2. 9, P =0. 03). Conclusion J wave prevalence is high in patients with history of idiopathic VF, and positive J wave is associated with high risk of recurrence of sudden cardiac death.