36例致心律失常性右室心肌病的心电图特征和临床观察

目的探讨致心律失常性右室心肌病(ARVC)的心电图特征和临床表现。方法回顾分析符合欧洲心脏病协会ARVC诊断标准的36例患者的心电图参数、临床表现、超声心动图、腔内电生理检查等临床资料。结果36例中男26例、女10例,年龄37±13岁;33例表现为心悸、胸闷,11例同时伴有晕厥,2例有家族性猝死史。心电图研究发现10例(28%)出现Epsilon波,29例(81%)右胸(V1～V3)导联QRS波时限≥110ms;在29例无右束支传导阻滞的患者中,右胸导联分别有16例(55%)出现T波倒置、18例(62%)出现S波升支时间≥55ms;17例(47%)QRSd1/QRSd2(V1～V3导联与V4～V6导联QRS波时间平均值之比)≥1.2;24例(67%)出现室壁阻滞;27例(75%)记录到持续性或非持续性室性心动过速。29例超声心动图表现为严重的右室受累。25例行腔内电生理检查,20例诱发出右室起源的室性心动过速,即刻射频消融成功11例。结论ARVC好发于青年男性,是引起晕厥、室性心律失常和室壁运动异常的重要原因,Epsilon波、右胸导联QRS波时限≥110ms与T波倒置、右室起源的室性心律失常为其特征性的心电图改变,QRSd1/QRSd2≥1.2、室壁阻滞、右胸导联S波升支时间≥55ms有助于该病的诊断,经导管射频消融治疗室性心动过速成功率低。

The electrocardiographic features and clinical observation in 36 patients with arrhythmogenic right ventricular cardiomyopathy

Objective To investigate the electrocardiographic(ECG)characteristics and clinical manifestation of arrhythmogenic right ventricular cardiomyopathy(ARVC).Methods Thirty-six patients with ARVC were involved in our study according to the diagnosis criteria published by European Society of Cardiology.The clinical data including ECG,cardiac echo and electrophysiology study was investigated retrospectively.Results The average age was 37±13 years in these 36 patients(26 males,10 females).The palpitation and chest distress were present in 33 patients,syncope in 11 patients,and family history of sudden cardiac death in 2 patients.The ECG study found that Epsilon waves were seen in 10 patients(28%),a QRS duration≥110 ms in right precordial leads(V1～V3)in 29 patients(81%).In 29 patients without right bundle branch block,T-wave inversions and S-wave upstroke≥55 ms in right precordial leads were found in 16(55%)and 18(62%)patients respectively,QRSd1/QRSd2(QRSd1=the mean value of QRS durations in V1～V3,QRSd2= the mean value of QRS durations in V4～V6)≥1.2 in 17 patients(47%),parietal intraventricular block in 24 patients(67%),sustained or non-sustained ventricular tachycardia in 27(75%)patients.The cardiac echo showed severe right ventricle involvement in 29 patients.25 patients underwent electrophysiological study;sustained ventricular tachycardia originating from the right ventricle was induced in 20 patients,only ablated by radiofrequency catheter at first procedure in 11 patients.Conclusions ARVC is an important reason of syncope,ventricular arrhythmias and right ventricular wall motion abnormalities in young man patients.The main characteristics in ECG included Epsilon waves,a QRS duration ≥110 ms and T-wave inversions in right precordial leads,ventricular arrhythmia originating from right ventricle.Our study suggests that QRSd1/QRSd2≥1.2,parietal intraventricular block and S-wave upstroke≥55 ms in right precordial leads are helpful for diagnosis.The successful rate of ventricular tachycardia ablation in ARVC is relatively low by our experience.