Extramiana F, Maison-Blanche P, Haggui A, Milliez P, Cauchemez B, Beaufils P, Leenhardt A
Service de cardiologie, hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris 10.
Arch Mal Coeur Vaiss. 2005 Dec;98 Spec No 5:21-6.
The duration of repolarisation is the main determinant of the refractory period and therefore plays a major electrophysiological role. Ventricular repolarisation can be influenced or modified by very many extrinsic factors responsible for so-called secondary changes or anomalies. On the contrary, primary anomalies of ventricular repolarisation correspond to intrinsic anomalies of ionic conduction which in turn affect repolarisation. Primary anomalies of ventricular repolarisation are the consequences of vascular disease, which is the origin of both electrocardiographic anomalies and rhythm disorders, and which can result in sudden death from ventricular fibrillation. Three clinical syndromes correspond with these definitions: long QT syndrome, short QT syndrome, and Brugada syndrome. Much of the experimental work seems to show that arrhythmogenic action results mostly from an increase in the heterogeneity of the refractory periods, whether this involves a prolonged, short or even normal repolarisation time. The various experimental models also give a better understanding of the repolarisation changes observed on the electrocardiogram. Knowledge of the mechanisms responsible for arrhythmias due to primary anomalies of ventricular repolarisation could provide a model for secondary anomalies.
复极化的持续时间是不应期的主要决定因素，因此起着重要的电生理作用。心室复极化会受到许多外在因素的影响或改变，这些因素会导致所谓的继发性改变或异常。相反，心室复极化的原发性异常对应于离子传导的内在异常，而这又反过来影响复极化。心室复极化的原发性异常是血管疾病的结果，血管疾病是心电图异常和节律紊乱的根源，并且可能导致心室颤动猝死。有三种临床综合征符合这些定义：长QT综合征、短QT综合征和Brugada综合征。许多实验工作似乎表明，致心律失常作用主要源于不应期异质性的增加，无论这涉及延长、缩短甚至正常的复极化时间。各种实验模型也能更好地理解心电图上观察到的复极化变化。了解心室复极化原发性异常导致心律失常的机制可为继发性异常提供一个模型。
