床旁心脏临时起搏对获得性长QT间期综合征伴尖端扭转型室性心动过速的干预研究

目的 评价床旁心脏临时起搏对获得性长QT间期综合征(LQTS)伴尖端扭转型室性心动过速(TdP)患者的治疗作用.方法 分析12例获得性LQTS伴TdP患者的临床资料、心电图、动态心电图和临床治疗情况,对常规治疗不能控制TdP发作的患者紧急行床旁心脏临时起搏.结果 12例患者在常规治疗的基础上均成功完成床旁经股静脉心脏临时起搏,平均操作时间(10.5±2.4)min.与起搏前比较,起搏后QT间期和QTC间期均缩短[(0.42±0.03)s比(0.52±0.06)s,(0.43±0.04)s比(0.53±0.05)s],差异均有统计学意义(P<0.05);起搏前TdP发作(4.6±1.2)次/d,起搏后TdP发作消失,平均起搏时间(3.8±1.4)d,停止起搏后QT间期和QTc间期分别为(0.41±0.02)s和(0.42±0.05)s,与起搏前比较,差异有统计学意义(P<0.05).出院后随访1年无TdP发作,QT间期和QTC间期分别为(0.41±0.06)s和(0.42±0.05)s.结论 获得性LQTS患者伴TdP是一种危急的情况,常规治疗不能控制发作时,紧急床旁心脏临时起搏是一种安全有效的方法.

The safety and efficacy of temporary cardiac pacing by bedside to interfere the torsades de points in patients with acquired long QT syndrome

Objective To evaluate the safety and efficacy of the temporary bedside cardiac pacing in controlling torsades de points (TdP) in patients with acquired long QT syndrome (LQTS). Methods Twelve patients with acquired LQTS were enrolled from April 2003 to August 2007 consecutively and their clinical data were analyzed. Bedside cardiac pacing was adopted when other methods couldn't terminate the repeated TdP. Results Twelve patients successfully experienced the temporary bedside cardiac pacing via femoral venous. The average time spent in bedside cardiac pacing was about (10.5±2.4) min. After cardiac pacing the interval of QT and QTc were shortened [ (0.42±0.03 ) svs (0.52±0.06) s, P < 0.05; (0.43± 0.04 ) s vs (0.53±0.05 ) s, P <0.05 ]. The TdP occurred (4.6±1.2 ) times per day before cardiac pacing and it didn't reoccur any more after bedside cardiac pacing. The average time for cardiac pacing was(3.8±1.4) d. When the patients were discharged, the interval of QT and QTe were (0.41±0.02) s and (0.42±0.05) s respectively, there were significant differences compared with that before cardiac pacing(P< 0.05). During 1 year follow-up, the patients didn't experience TdP any more, and the interval of QT and QTe were (0.41± 0.06) s and (0.42±0.05) s respectively. Conclusion The immediate bedside cardiac pacing is a safe and effective way to control the repeated TdP.