Brugada综合征室性心律失常发作的时间特征及其临床意义

目的运用Holter和置入式心脏复律除颤器(ICD)研究Brugada综合征(BrS)患者室性心律失常发作的时间特征。方法8例BrS患者和6例特发性BrS心电图征者均为男性,平均年龄(41.07±11.49)岁,根据临床表现分为心室颤动(室颤)组和无室颤组各7例,行Holter检查比较两组间室性早搏(室早)发作的时间特征。根据ICD的随访资料,分析室颤发作的时间特征。结果Holter显示,多数患者室早总数在0~74(9.61±17.23)个/24h,两组间室早的数量差异无统计学意义[(108±269)个/24h与(8±19)个/24h,P>0.05]。室颤组的98.67%的室早发作集中在夜间2200至凌晨700,而无室颤组为44.14%,室颤组明显高于无室颤组(χ2=1480,P<0.01)。5例患者ICD置入后随访9~54(23.80±17.96)个月,75次室颤发作中93.3%集中在夜间2200至凌晨700。结论高危的BrS患者的室早具有夜间和凌晨集中发作的特征,可能是新的无创性危险分层指标。BrS患者的室颤发作多集中在夜间和凌晨,可据此设计给药方案以减少副作用。

Time distribution of ventricular arrhythmias in patients with Brugada syndrome

OBJECTIVE: To study the characterization of time distribution of ventricular arrhythmias in patients with Brugada syndrome (BrS) using Holter monitoring and ICD follow-up. METHODS: Patients with BrS [all male, mean age (41.07 +/- 11.49) years], were divided into ventricular fibrillation (VF) group (n = 7) and no ventricular fibrillation (N-VF) group (n = 7). Premature ventricular capture (PVC) and VF episodes were detected by Holter monitoring and ICD recording. RESULTS: The 24 hours total number of PVCs ranged from 0 to 74 (mean 9.61 +/- 17.23) in most of the patients and were similar between VF group and N-VF group. The percentage of PVC episodes in VF group was significantly higher than that in N-VF group from nocturnal time to early morning (22:00 to 7:00, 98.67% vs. 44.14%, P < 0.01). There were total 75 VF episodes during (23.18 +/- 17.96) months' follow-up in 5 patients with BrS, 93.3% of which occurred from nocturnal time to early morning (22:00 to 7:00). CONCLUSIONS: The episodes of PVC were enriched from nocturnal time to early morning in BrS patients, this time distribution could be a new noninvasive risk stratification factor for BrS. The episodes of VF in BrS patients were also enriched from nocturnal time to early morning and this time characteristic of episodes of VF could be used to guide drug therapy.