致心律失常性右心室心肌病心电图和动态心电图临床分析

目的：探讨致心律失常性右心室心肌病（ ARVC）的心电图和动态心电图特点，并对其心电图按病变程度加以分析。方法回顾性分析34例已确诊的ARVC患者的临床资料和辅助检查资料。按心脏磁共振成像（MRI）所示的病变累及部位将34例患者分为3组：A组（右心室局部病变组）11例、B组（右心室弥漫病变组）15例和C组（双心室病变组）8例，比较分析3组患者的临床症状、心电图和24 h动态心电图表现。结果6种临床表现心悸、胸闷、晕厥、室性期前收缩≥1000次、持续室性心动过速（ VT）、非持续VT的发生率在A、B、C 3组间比较差异均无统计学意义（ P均＞0.05）。与A组比较， C组Epsilon 波（4/8 vs．2/11）、V1～V3导联QRS波时限≥110 ms（3/8 vs．1/11）、病理性Q波（3/8 vs．1/11）和V1～V3 S波升支≥55 ms（4/8 vs．2/11）的发生率均明显升高（P＜0.05或P＜0.01）。与A组比较，B组和C组V1导联T波倒置的发生率均明显降低（3/15、1/8 vs．5/11），超过V3导联的T波倒置发生率均明显增加（6/15、6/8 vs．1/11， P＜0.05和P＜0.01）。24 h动态心电图显示：10例患者为单形性室性期前收缩，发生率29.4％（10/34），无不良事件出现；24例患者为多形性室性期前收缩，发生率70.6％（24/34），8例出现不良事件。结论根据心电图中T波倒置的导联位置可以判断ARVC的病变范围及严重程度，而临床症状并无诊断其严重程度的特异性。

Clinical analysis of electrocardiogram and dynamic electrocardiogram with arrhythmogenic right ventricular cardiomyopathy

Objective To explore the feature of electrocardiogram and dynamic electrocardiogram in patients with arrhythmogenic right ventricular cardiomyopathy .Methods The 34 patients with arrhythmogenic right ventricular cardiomyopathy were retrospectively analyzed .They were divided into three groups：11 patients with local involvement of right ventricle in group A ,15 patients with diffuse involvement of right ventricle in group B and 8 patients with involvement of both right and left ventricles in group C .The clinical symptom , the feature of electrocardiogram and dynamic electrocardiogram were compared in three groups .Results There were no statistically significant in the incidence rates of clinical manifestations such as palpitations ,chest tightness,syncope,ventricular premature contraction≥1000 times,sustained ventricular tachycardia （ VT） and non-sustained ventricular tachycardia between the three groups（P＆gt;0.05）.In group C,the incidence rates of Epsilon wave,QRS duration was prolonged≥110 ms,pathological Q wave and V1-V3 leads ascending branch of S-wave≥55 ms were significantly higher than that in group A（4/8 vs.2/11,3/8 vs.1/11,3/8 vs.1/11,4/8 vs.2/11 respectively P＆lt;0.05）.Compared with group A,the incidence rates of T wave inversion in V1 lead were markedly lower in group B and C（A：5/11,B：3/15,C：1/8,respectively）and significant increased in V3 lead（A：1/11,B：6/15,C：6/8,P＆lt;0.05）.10 patients（10/34）with monomorphic ventricular premature contractions had not happened adverse event and 24 patients （ 24/34 ） with polymorphic ventricular premature contractions happened 8 adverse events .Conclusion The positions of T-wave inversions in lead were benefit to judgment the area and severity of ARVC .Nevertheless ,the clinical symptom was no specificity to diagnosis the severity of ARVC .