Schueller Per Otto, Hennersdorf Marcus Guenter, Strauer Bodo Eckehard
Department of Cardiology, Heinrich Heine University, Duesseldorf, Germany.
J Interv Card Electrophysiol. 2006 Mar;15(2):125-30. doi: 10.1007/s10840-006-8345-9.
Recent experimental and clinical trials have provided evidence that increased duration of right ventricular electrogram in response to premature extrastimuli correlates with the risk of ventricular fibrillation in noncoronary heart disease. The aim of the present study was to investigate the duration of the surface QRS complex at short coupling intervals of extrastimuli as a new indicator for major arrhythmic events.
32 patients all with nonischemic heart diseases and well preserved left ventricular function in sinusrhythm were included into the study. Fifteen had witnessed sudden death due to ventricular fibrillation or polymorphic ventricular tachycardia (VF/VT group). The control group comprised seventeen patients without a history of ventricular arrhythmias (control group). All subjects underwent programmed ventricular stimulation and QRS-durations S1-S2-S3 directly above the ventricular refractory period were analyzed.
Both groups had a comparable basic QRS complex of 85 +/- 9 (VF/VT) vs. 87 +/- 13 ms (control), p = 0.83. The stimulated QRS complex S3 was significantly wider in the VF/VT group compared to the control group at pacing rates of 500 and 430 ms (500 ms: 256 +/- 22 vs. 235 +/- 32 ms, p = 0.04; 430 ms: 258 +/- 23 vs. 226 +/- 27 ms, p = 0.001). No differences with regard to the ventricular effective refractory period and the ventriculoatrial conduction could be observed beween the groups.
Our results indicate that the duration of the paced QRS complex may be a valuable parameter to predict arrhythmic risk in patients with nonischemic heart disease. Further prospective studies in larger trials are necessary to corroborate this investigation.
近期的实验和临床试验已提供证据表明，在非冠心病中，对过早期外刺激的右心室心电图持续时间增加与室颤风险相关。本研究的目的是探究在短耦合间期的外刺激下体表QRS波群的持续时间，作为主要心律失常事件的新指标。
32例患有非缺血性心脏病且窦性心律下左心室功能良好的患者纳入本研究。其中15例曾目睹因室颤或多形性室性心动过速导致的猝死（室颤/室速组）。对照组包括17例无室性心律失常病史的患者（对照组）。所有受试者均接受程控心室刺激，并分析心室不应期之上的QRS波群持续时间（S1-S2-S3）。
两组的基础QRS波群相当，室颤/室速组为85±9毫秒，对照组为87±13毫秒，p = 0.83。在起搏频率为500毫秒和430毫秒时，室颤/室速组的刺激后QRS波群S3明显宽于对照组（500毫秒：256±22毫秒对235±32毫秒，p = 0.04；430毫秒：258±23毫秒对226±27毫秒，p = 0.001）。两组之间在心室有效不应期和室房传导方面未观察到差异。
我们的结果表明，起搏后的QRS波群持续时间可能是预测非缺血性心脏病患者心律失常风险的一个有价值的参数。需要在更大规模的试验中进行进一步的前瞻性研究来证实本研究结果。
