健康人Tp—e时间与Q—T间期比值的研究

目的观察健康人T波峰-末时间（Tp—e时间）与Q—T间期的比值（Tp—e／Q—T）,为临床Tp—e／Q—T的研究提供正常参考依据。方法选取1012例健康体检者,其12导联心电图T波在Ⅱ、V3、V4和V5直立,终末部清晰可辨,心率60～100次／min。分别测量Ⅱ、V3、V4和V5 Q—T间期、Q—TP间期,计算Tp—e时间、Tp—e／Q—T值。结果Tp—e／Q—T各导联总均值为022±0．03,95％可信区间0．16～0．28;V3、V。和V5Tp—e／Q—T总均值为022±0．03,95％可信区间0.16～0．28。当心率从60次／min至100次／min不等时,各导联间Tp—e／Q—T差异无统计学意义（P〉0．05）;各导联Tp—e／Q—T在不同性别和年龄间差异均无统计学意义（P〉0．05）;不同导联Tp—e／Q—T差异亦无统计学意义（P〉0.05）。结论得到了健康人Tp—e／Q—T的正常参考值。     

Brugada波与Brugada综合征心电图及临床表现分析

目的 探讨Brugada波及Brugada综合征(Bs)的心电图表现及临床特征,并重温其诊断及鉴别.方法 应用MAC1200心电机及世纪3000 24h动态心电图机,记录入选患者同步12导联心电图及24h动态心电图,观察Brugada波及Bs的各项指标.根据2002年、2005年欧洲心脏病协会共识性报告提出的关于Bs的分型及诊断标准[1],由2名以上心电专业医师进行阅图判断.结果 4例符合Bs,2例符合特发性Brugada综合征(Bs)样心电图改变.结论 Bs患者晕厥发作前ST段抬高程度较平时明显.该综合征心电图易与急性前间壁心肌梗塞相混淆,有间歇性易变性的特点.     

Brugada综合征与Brugada波四例

报道3例Brugada综合征,1例Brugada波的心电图。3例Brugada综合征2例为Ⅰ型,1例为Ⅱ型。提高1或2肋描记V1~V3导联可提高Ⅰ型Brugada综合征的检出率。     

Brugada波与Brugada综合征的诊断与鉴别

1 定义 类似右束支传导阻滞(RBBB)伴持续性右胸导联ST段抬高的心电图特征,称为Brugada波。类似RBBB、持续性右胸导联ST段抬高伴发室速、室颤和猝死,称为Brugada综合征。 2 Brugada波回顾     

Brugada综合征三例

临床遇到３例Ｂｒｕｇａｄａ综合征伴有ＳＴ－Ｔ演变的患者,其中１例ＳＴ－Ｔ演变明显,报道如下。 用常规１２导联心电图对３例Ｂｒｕｇａｄａ综合征患者观察１－３周。患者均为男性,年龄分别为４３、６３、和２５岁（例１、２为日本大学板桥医院住院患者,例３为我院门诊患者）。患者的共同症状为反复心悸、胸闷及乏力。无高血压、冠心病及其它器质性心脏病史。体格检查无明显阳性体征。例１曾发生过两次晕厥。血液生化检查各项指标均在正常范围。超声心动图及磁共振检查未见形态学异常。２例日本患者均作了心电生理检查。例１诱发出室…     

Brugada综合征2例分析

Brugada综合征又称右束支传导阻滞-多形性室速-晕厥综合征或意外夜间猝死综合征，患者心脏无器质性病变，其发病机制不明，是目前全球报道较少的心脏病之一，临床较少见，发病迅速，病死率高，1～3年病死率40％。近10年来，随着诊断水平的提高，引起世界各地心内科医生的关注，现将我院2007年6月-2008年1月收治的2例病人分析如下。     

Brugada波与Brugada综合征的区别诊断

Brugada波是一种特殊的心电图形 ,表现为右束支阻滞、右胸导联 ST抬高和 T波倒置“三联征”。 Brugada波患者常突发恶性心律失常 ,称 Brugada综合征。Brugada综合征病情凶险 ,死亡率极高 ,国内李亦晗等曾报道 2例 [1 ] 。因此充分认识本病的意义 ,对 Brugada波与 Brugada综合征进行正确的区别诊断十分必要。1　临床资料　患者 ,男性 ,4 7岁。于 2 0 0 2 - 0 5 - 2 2 ,以外伤血气胸收入院。 0 6 - 0 4 T0 5∶ 0 0突发室上性心动过速 ,HR15 0 /min。静脉注射心律平后转为窦律。 6月 30日行 Holter检查 ,CM1导联见到间歇性右束支阻滞伴 …     

Brugada综合征二例

2例Brugada综合征,心电图上Brugada波的变化呈间歇性和多变性;例1由正常向1型演变,例2由3型向1型的演变。此2例均系回顾性诊断,说明对不明原因的晕厥、心悸的病例应仔细分析心电图的变化,避免误诊。     

疑似Brugada综合征的心电图二例

病例 1,患者男性 ,6 4岁。 1972年偶然机会描记心电图 ,发现Ｖ1、Ｖ2 导联ＱＲＳ波呈ｒｓＲ′型伴Ｔ波倒置 ,ＱＲＳ时限 <0 12ｓ,当时诊断为不全性右束支阻滞 ;1985年自觉有时胸闷 ,再次描记心电图 ,与 1972年相比无变化 ,但诊断改为右心室早期复极综合征 (图 1) ,对这种少见的心电图还进图 1　Ｖ1 、Ｖ2 ＱＲＳ呈ｒｓＲ′型、ＳＴ段下斜型抬高 ,Ｔ波倒置行了个案报道。 1995年再次复查心电图 ,心电图完全恢复正常。病例 2 ,患者男性 ,32岁。平素身体健康 ,因腹痛就诊 ,临床诊断慢性胆囊炎。心电图常规检查示Ｖ1导联ＱＲＳ波呈ｒＳＲ′型 ,…     

药物性Brugada样心电图/综合征

Brugada综合征以心电图上右胸导联ST段抬高和心脏性猝死为特征,是一种遗传性心电疾病。近年来发现多种非心血管疾病领域的药物,如抗精神病药、麻醉药、抗组胺药等在常规或过量使用时,可引起心电图呈Brugada样改变,少数患者可在此基础上发生恶性心律失常等心脏事件。临床医生应充分认识这些药物的电生理效应及其可能的后果并给予足够的重视。     

尿毒症患者Q—T离散度和T波峰末间期的研究

目的探讨行维持性血液透析的尿毒症患者是否存在区域性和跨心室壁复极离散度（TDR）增大。方法分别测量行维持性血液透析的尿毒症患者（尿毒症组,n=35例）和正常健康者（对照组,n=40例）体表心电图的Q—T间期、R—R间期、丁波峰末问期（Tp—e）,进而计算Q-T离散度（Q—Td=Q—Tmax—Q—Tmin）、心率校正的Q—T离散度（Q—Td／R√R--R）,心率校正的最大Tp—e间期（Tp—emax／√R-R）、T波峰末问期离散度（Tp—ed=Tp—emax—Tp—emin）、心率校正的Tp—e间期离散度（Tp—ed／√R—R）。结果尿毒症组的Q—T离散度及校正的Q—T离散度较对照组明显延长（66．3±15．9VS40．2±12．4,681±14．8VS44．5±13．1。均P〈0．05）;尿毒症组的最大Tp—e间期及最大校正Tp—e间期较对照组明显延长（98．34-14．6VS77．6±12．1,94．2±12．6VS72,54-11．4,均P〈O．05）,Tp—e间期离散度及校正的Tp—e问期离散度也较对照组明显延长（48．4±16．3VS32．1±12．3,44．3±12．2VS30．2±12．5,P〈0．05）。结论尿毒症患者的Q—T离散度和Tp—e间期及其离散度较正常者明显延长,表明尿毒症患者区域性和TDR增大。     

Spontaneous Fluctuations between Diagnostic and Nondiagnostic ECGs in Brugada Syndrome Screening: Portuguese Family with Brugada Syndrome

Background: All family members of patients with Brugada syndrome (BS) should be screened. Fluctuations between diagnostic and nondiagnostic electrocardiogram (ECG) patterns in patients with BS are recognized, but systematic studies are lacking. The objective of this work was to prospectively evaluate the spontaneous changes between diagnostic and nondiagnostic ECG patterns in a family screened for BS. Methods: One hundred twenty‐nine family members were possibly affected plus the index case were screened with two ECGs with an interval of 6 months. Only coved‐type ECG pattern was defined as diagnostic; type 2 and 3 ECGs were considered suggestive. Results: The first ECG series made six diagnostics and the second 11, but only three patients maintained the diagnostic ECG. Patients with basal diagnostic ECG were older and more frequently symptomatic. Body mass index (BMI) was significantly lower in adults with diagnostic plus suggestive ECG when compared with the others. No significant gender difference was found among relatives with or without diagnostic ECG. Conclusion: Spontaneous phenotypic manifestation of BS was more frequent in older symptomatic patients, absent in children, and related with low BMI. ECG manifestations were intermittent in more than 3/4 of the affected patients. Fluctuations between diagnostic and nondiagnostic ECGs may have an implication on the correct phenotyping in family screening so several ECGs with drug challenging are mandatory. Ann Noninvasive Electrocardiol 2010;15(4):337‐343     

Long-term follow-up in patients with Brugada Syndrome in South China

ObjectiveTo evaluate the presence of Brugada electrocardiogram (ECG) pattern, clinical characteristics, treatment, and long‐term prognosis of Brugada syndrome in southern Chinese population.MethodsThis prospective study consisted of a consecutive series of patients with diagnostic coved type I Brugada ECG pattern at baseline between January 2007 and February 2020. Histories of symptoms including ventricular tachycardia (VT)/ventricular fibrillation (VF) episode, syncope, and family history of Brugada Syndrome (BrS) or unexplained sudden cardiac death were collected. Electrophysiological study and implantable cardioverter‐defibrillator (ICD) were performed. All patients included in this study were followed up in the outpatient department every 6 months after baseline evaluation. Occurrences of syncope, VF, and sudden death were independently analyzed by two cardiologists.Results45 (56.3%) patients were diagnosed with BrS. During a mean follow‐up of 7.9 ± 3.6 years, six patients had experienced documented VF/sudden cardiac death (SCD) or recurrent syncope. Two patients experienced episodes of syncope more than once. Two patients experienced onset of electrical storm with a total of 11 episodes of VF. There were 50% of these events occurring in fever status. One of patient with BrS died of SCD.ConclusionThere was a very low prevalence of Brugada syndrome in southern Chinese population. The risk of arrhythmic events was low in asymptomatic patients. ICD was high effective in preventing SCD without adverse device outcome in long‐term follow‐up. Fever can lead to predispose to malignant arrhythmia, and aggressive treatment of febrile state in Brugada syndrome was recommended.     

Brugada Phenocopy: New Terminology and Proposed Classification

Brugada syndrome is a channelopathy characterized on ECG by coved ST‐segment elevation (≥2 mm) in the right precordial leads and is associated with an increased risk of malignant ventricular arrhythmias. The term Brugada phenocopy is proposed to describe conditions that induce Brugada‐like ECG manifestations in patients without true Brugada syndrome. An extensive review of the literature identified case reports that were classified according to their suspected etiological mechanism. Future directions to learn more about these intriguing cases is discussed.     

Type 1 electrocardiographic burden is increased in symptomatic patients with Brugada syndrome

Background

Spontaneous type 1 electrocardiographic (ECG) is a risk factor for arrhythmic events in Brugada patients but the importance of the proportion of time with a type 1 ECG is unknown.

Patients and Methods

Thirty-four Brugada patients (15 symptomatic) underwent a 24-hour 12-lead ECG recording. One-minute averaged waveforms displaying ST-segment elevation above 200 μV, with descending ST-segment and negative T-wave polarity on leads V₁-V₃ were considered as type 1 Brugada ECG. The burden was defined as the percentage of type 1 Brugada waveforms.

Results

Type 1 ECG on lead V2 was more frequent in symptomatic patients (median 80.6% [15.7-96.7] vs 12.4% [0.0-69.7], P = .05). Patients with a permanent type 1 pattern on lead V₂ were more likely to be symptomatic (5/6) than patients without type 1 ECG during a 24-hour period (2/9) (P < .05).

Conclusion

Type 1 pattern is more prevalent across a 24-hour period in symptomatic Brugada patients.     

Postprandial augmentation of bradycardia-dependent ST elevation in patients with Brugada syndrome

Introduction : In patients with Brugada syndrome, the circadian variation of ST elevation could be modulated by the autonomic nervous activity and RR interval. Recently, glucose-induced insulin secretion was also reported to contribute to fluctuation of ST elevation. Therefore, we assessed the effects of taking meals on the ST-RR relationship in the daily life of patients with Brugada syndrome.
Methods and Results: Twenty-eight patients with Brugada syndrome, who had the type I ST elevation, were categorized into 12 symptomatic and 16 asymptomatic patients. Unipolar lead (V₂) Holter ECG was recorded and ST-RR relationships for a 2-hour period were compared before and after each meal. From ST-RR linear regression lines, ST-RR slope (mm/sec) and ST(mm) at RR intervals of both 0.6 seconds and 1.2 seconds (ST_(0.6) and ST_(1.2)) were determined. The ST-RR slope increased significantly after lunch (2.6 ± 0.4 vs 4.4 ± 1.2, P < 0.05) and dinner (2.1 ± 1.0 vs 5.2 ± 1.9, P < 0.01) in symptomatic patients, but not in asymptomatic patients. In both groups, ST_(0.6) was not different before or after each meal. However, ST_(1.2) increased after each meal in symptomatic patients. After dinner, ST_(1.2) was significantly higher in symptomatic patients than in asymptomatic patients (5.0 ± 2.7 vs 3.6 ± 0.8, P < 0.05). Postprandial increase in both ST-RR slope and ST_(1.2) was greatest at dinner in symptomatic patients; however, this tendency was not seen in asymptomatic patients.
Conclusions: In symptomatic patients with Brugada syndrome, bradycardia-dependent augmentation of ST elevation was enhanced for the postprandial period, especially after dinner. This could be related to occurrence of ventricular fibrillation in the late evening.     

心脏病室性心律失常患者Tp-e间期、Tp-e/Q-T比值的研究

目的探讨器质性心脏病患者Tp-e间期、Tp-e/Q-T比值与室性心律失常的关系。方法选择器质性心脏病患者85例,分为两组,器质性心脏病室性心律失常组(A组)43例,并进一步按LOWN分级分为两个亚组,A1组(LOWN2-3级)20例,A2组(LOWN3级以上)23例;器质性心脏病无室性心律失常组(B组)42例。另选择健康体检者40例为正常对照组(C组)。采用常规12导联同步心电图及24小时动态心电图分析比较各组的Q-T间期、Q-Tc间期、Tp-e间期、Tp-ec间期和Tp-e/Q-T测值。结果 A组Q-T间期、Q-Tc间期、Tp-e间期、Tp-ec间期、Tp-e/Q-T测值比C组显著升高,差异有统计学意义(P<0.05),而Q-Tc间期、Tp-e间期、Tp-ec间期、Tp-e/Q-T比B组显著升高,差异有统计学意义(P<0.05)。上述各测值A2组比A1组显著升高,差异有统计学意义(P<0.05或P<0.01)。结论 Tp-e间期、Tp-e/Q-T等心电学指标与室性心律失常的发生有关,对室性心律失常的发生具有预测意义。