快速和慢速尖端扭转型室速——心电图特征

Kukla Piotr, Słowiak-Lewińska Teresa, Szczuka Kazimierz, Plato Andrzej, Bromblik Alicja, Hajduk Barbara, Kluczewski Maciej, Przewor Marta

Department of Internal Medicine, Klimontowicz Hospital, Gorlice, Poland.

Kardiol Pol. 2004 Apr;60(4):342-7.

BACKGROUND

Clinical value of electrocardiographic features of torsade de pointes (TdP) has not yet been well established.

AIM

To compare the mode of onset and ECG characteristics of slow (s-TdP) and fast (f-TdP) episodes of TdP.

METHODS

54 episodes of TdP recorded in 6 patients (5 females, one male, mean age 64.4 years) with acquired long QT syndrome were analysed. Baseline rate of TdP (V-V), ventricular rate variability (VRV), coupling interval (CI) at the onset of TdP, prematurity index (PI) and the first cycle length (FCL) were compared between 31 s-TdP (<200 beats/min) and 23 f-TdP (> or =220) episodes of TdP.

RESULTS

Episodes of f-TdP were preceded by a significantly faster basal rhythm than s-TdP (R-R interval: 922 ms vs 1062 ms, p=0.03). QT interval was almost identical in both groups (517 ms vs 515 ms, NS, respectively). No significant differences were noted in the CI of the initiating beat (488 ms vs 472 ms, NS) nor in the PI (0.53 vs 0.47, NS). TdP was most frequently spontaneously terminated by a gradual slowing of the tachycardia rate; 58% of s-TdP and 39% of f-TdP episodes stopped in this way. An acceleration of ventricular rate before termination of TdP was noted in 32% of s-TdP and in 26% of f-TdP episodes. Episodes of f-TdP were longer than s-TdP episodes (mean of 19.7 vs 6.7 ventricular complexes per one episode, p=0.0003). There were significant differences in the VRV parameter (p=0.0005) and FCL (p=0.004) between both types of TdP. Faster TdP were characterised by lower ventricular rate variability (VRV - 19.5 msec) than s-TdP (VRV - 39.4 msec). Of 54 episodes of TdP, 9 (16.6%) degenerated into VF and required DC shock. Of 31 s-TdP episodes, one (3.2%) degenerated into VF compared with 8 (34.7%) episodes of f-TdP (p<0.04).

CONCLUSIONS

Episodes of fast TdP were characterised by a longer duration, shorter first cycle of the arrhythmia and lower ventricular rate variability than episodes of slow TdP. Fast episodes of TdP were preceded by faster baseline rhythm before TdP. Faster TdP more frequently degenerated into VF than slower episodes.

背景

尖端扭转型室速（TdP）的心电图特征的临床价值尚未完全明确。

目的

比较TdP慢型（s-TdP）和快型（f-TdP）发作的起始方式和心电图特征。

方法

分析6例（5例女性，1例男性，平均年龄64.4岁）获得性长QT综合征患者记录到的54次TdP发作。比较31次s-TdP（<200次/分钟）和23次f-TdP（≥220次/分钟）发作的TdP基线心率（V-V）、心室率变异性（VRV）、TdP发作起始时的联律间期（CI）、早搏指数（PI）和第一个心动周期长度（FCL）。

结果

f-TdP发作前的基础心律显著快于s-TdP（R-R间期：922毫秒对1062毫秒，p=0.03）。两组的QT间期几乎相同（分别为517毫秒对515毫秒，无显著性差异）。起始搏动的CI（488毫秒对472毫秒，无显著性差异）和PI（0.53对0.47，无显著性差异）无显著差异。TdP最常通过心动过速速率逐渐减慢而自发终止；58%的s-TdP发作和39%的f-TdP发作以这种方式终止。32%的s-TdP发作和26%的f-TdP发作在TdP终止前出现心室率加速。f-TdP发作比s-TdP发作持续时间更长（每一次发作平均心室复合波数为19.7对6.7，p=0.0003）。两种类型的TdP在VRV参数（p=0.0005）和FCL（p=0.004）方面存在显著差异。较快的TdP特征为心室率变异性（VRV - 19.5毫秒）低于s-TdP（VRV - 39.4毫秒）。在54次TdP发作中，9次（16.6%）恶化为室颤并需要直流电除颤。在31次s-TdP发作中，1次（3.2%）恶化为室颤，而f-TdP发作中有8次（34.7%）恶化为室颤（p<0.04）。