T波电交替预测心力衰竭病人心源性猝死价值的新分歧

有半数的心力衰竭病AN致命性室性心律失常事件死于心源性猝死。T波电交替是公认的预测心源性猝死的重要指标。早在许多年前就发现T波电交替与心源性猝死有关，近年来新建了频域和时域测量方法。跨室壁复极离散度异常增大是T波电交替的机制。最近研究发布的用微伏级T波电交替进行心肌梗死后危险性分层的初步结果否定心肌梗死后左室射血分数〈30％的病人发生致死性快速室性心律失常的价值。但体内除颤器置入前T波电交替的对心源性猝死一级预防试验和非缺血性心肌病心力衰竭T波电交替的预测价值试验则强有力地支持T波电交替能预测心律失常。

New Controversy for TWA Predicting Sudden Cardiac Death in Patients with Heart Failure

As a result of life-threatening ventricular arrhythmias about 50% of patients with heart failure died from sudden cardiac death. T wave alternans （TWA） is recognized as an important marker to predict sudden cardiac death. In 1948 it was discovered that TWA is related to sudden cardiac death. Recently, it was also found that TWA was utilizing both frequency domain and time domain. It is a mechanism whereby the dispersion of repolarization through the ventricular wall is augmented. MASTERI trial suggested that TWA was not a predictor of life-threatening ventricular arrhythmia events in patients after myocardial infarction with left ventricular ejection fraction 〈 30%. However, ABCD and ALPHA trials strongly suggest that TWA can predict life-threatening ventricular arrhythmias event.