特发性J波伴心室颤动一例

患者男性 ,19岁 ,因 1个月内尿失禁 2次于 2 0 0 1年 6月 4日入院。既往健康 ,无遗传病家族史 ,父母亲非近亲结婚。近 2个月内无上呼吸道和肠道感染史。体格检查 :体温 36 0℃ ,脉搏 70次 /ｍｉｎ ,呼吸 2 0次 /ｍｉｎ ,血压 10 5 /70ｍｍＨｇ (1ｍｍＨｇ =0 133ｋＰａ)。发育正常 ,营养中等 ,神志清醒 ,心肺正常 ,神经系统正常。头颅ＣＴ、脑电图、血电解质、和肾功能正常。血液心肌酶 :肌酸激酶 肌红蛋白 (ＣＫ ＭＢ) 36Ｕ/Ｌ (正常 2 5Ｕ/Ｌ) ,天冬氨酸转氨酶(ＡＳＴ) 6 1Ｕ/Ｌ (正常 5 0Ｕ/Ｌ)。在记录心电图 (9∶0 2 ,图1)时患者突…     

早期复极变异与特发性室颤

既往认为早期复极变异是一种正常的心电图变异,属于良性变化。最近的一项多中心研究显示,下侧壁导联J波抬高的早期复极变异患者与特发性室颤以及心脏性猝死的发生有关。本文拟对近几年来早期复极变异与特发性室颤相关的一些最新进展做一综述。     

下侧壁导联早复极综合征与特发性心室颤动

早复极(early repolarization)综合征是一种临床常见的心电图现象,人群发生率高达2%～5%,多见年轻人和男性,并且该综合征在运动员和黑色人种中更为常见.自从被发现60多年来,早复极综合征一直被认为是一种预后良性的心电图表现,其临床意义主要在于和临床上其他病理性ST段抬高的情况,如急性心肌梗死或者心包炎等进行鉴别诊断.然而,近10年来,有关该综合征预后良好的观念正在经受越来越多的挑战.     

J波与J波综合征

J波是指心电图上QRS波与ST段之间的圆顶状或驼峰状电位变化。新近临床研究表明，在早期复极综合征、Brugada综合征和特发性心室颤动等心电图中，均存在J波形态、时限和幅度的显著改变，上述与J波密切相关的一系列临床综合征统称为J波综合征。本文详尽阐述了J波的细胞电生理和离子流机制，分析了早期复极综合征、Brugada综合征、心电图下壁导联高大J波相关的心脏性猝死的临床特点及内在机制。     

Spatiotemporal electrocardiographic characterization of ventricular depolarization and repolarization abnormalities in long QT syndrome

Background and Purpose

If only a standard electrocardiogram (ECG) is available, at least 25% of patients with long QT syndrome (LQTS) may be missed. Our goal is to quantify abnormal electrical activity and to develop an ECG decision rule for the patients with LQTS.

Methods

One hundred forty-one subjects were included in this study (71 patients with LQTS and 70 healthy subjects). A 12-lead digital ECG was recorded for each subject and analyzed using the CAVIAR (comparative analysis of ECG-VCG and their interpretation with auto-reference to the patient) method.

Results

A decision tree involving criteria based on 3 spatiotemporal ECG measurements—the QT interval and the maximum amplitude of the T wave, both corrected from heart rate, and the loss of planarity of the end of QRS—identified patients with LQTS from healthy subjects with a sensitivity of 89%, a specificity of 96%, and a total accuracy of 92%.

Conclusions

This study suggests that 3-dimensional ECG analysis may improve the detection of patients with LQTS.     

J wave elevation to monitor quinidine efficacy in early repolarization syndrome

We present the case of a 14-year-old female with early repolarization syndrome who presented with recurrent ventricular fibrillation and ICD shocks which were refractory to multiple drugs and catheter ablation. Treatment with quinidine, an Ito blocker, resulted in a normalization of J waves and suppression of VF. Interestingly, J wave amplitude correlated with the ventricular arrhythmia susceptibility and quinidine levels. The case highlights the importance of quinidine for management of ventricular arrhythmias in the context of early repolarisation and suggests that J wave amplitude may be an important indicator of therapeutic drug levels and arrhythmia susceptibility.     

Ablation of premature ventricular contraction triggering ventricular fibrillation in a patient with early repolarization syndrome

Early repolarization syndrome is associated with an increased risk of arrhythmic death caused by ventricular fibrillation (VF). VF is usually initiated by premature ventricular contractions (PVCs), and PVCs commonly arise from Purkinje system, the ventricular outflow tract, and papillary muscles. We report the case of a patient with J wave syndromes and recurrent VF, triggered by PVCs originating from the tricuspid annular region. VF was successfully suppressed by catheter ablation of the triggering PVCs, and there has been no recurrence of VF during a follow-up period of 6 months.     

Malignant fascicular ventricular tachycardia degenerating into ventricular fibrillation in a patient with early repolarization syndrome

A 45-year-old man was hospitalized for syncope due to fascicular ventricular tachycardia degenerating into ventricular fibrillation (VF). The electrocardiogram showed an early repolarization syndrome. The arrhythmia was repetitive and disappeared after oral hydroquinidine. An implantable cardioverter-defibrillator (ICD) was implanted; subsequently, the patient was arrhythmia free at 9 months follow-up.