Guo Hangyuan, Wang Ping, Xing Yangbo, Peng Fang, Jiang Jun, Yang Biao, You Binquan, Qiu Yufang, Lee Jong-Dae
Department of Cardiology, Shaoxing People's Hospital, The First Affiliated Hospital of Shaoxing, University of China, Shaoxing, Zhejiang, China.
J Electrocardiol. 2007 Oct;40(4):356.e1-6. doi: 10.1016/j.jelectrocard.2006.12.003. Epub 2007 Feb 20.
This work aimed to study the delayed electrocardiographic changes, including Q-T interval, corrected Q-T dispersion, and heart rate variability (HRV) 3 years after percutaneous transluminal septal myocardial ablation (PTSMA), in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM).
In 26 patients (11 women, 15 men; average age, 37.4 +/- 11.2 years) with symptomatic and medically refractory HOCM, 1.4 +/- 0.5 septal branches were occluded with an injection of 3.8 +/- 1.3 mL of alcohol (95%) to ablate the hypertrophied interventricular septum. Baseline and 3 days and 3 years postprocedure 24-hour Holter electrocardiographic findings were determined.
One patient developed complete atrioventricular block requiring permanent pacing. The PR interval was significantly prolonged 3 days after ablation, but recovered 3 years postprocedure. Three days after the procedure, all patients developed right bundle branch block, which was present in 24 patients after 3 years. The QRS duration was significantly prolonged 3 days after ablation and during 3 years of follow-up. There was significant and persistent prolongation of QT interval and transient prolongation of corrected QT dispersion 3 days after ablation and returned to preablation values 3 years postprocedure, but JT interval and corrected JT dispersion were not significantly changed after PTSMA. Heart rate variability data (time domain and frequency domain) 3 days and 3 years after PTSMA, including low frequency, high frequency, root mean squared successive difference interval, and the percent of sinus cycles differing from the preceding cycle by more than 50 milliseconds, significantly increased compared to that before the procedure. Low frequency/high frequency, SD of all normal-to-normal intervals, and SD of 5-minute average normal-to-normal intervals were not significantly changed after PTSMA.
Percutaneous transluminal septal myocardial ablation for HOCM induces significant delayed electrocardiographic changes in most patients. The changes include QRS prolongation, new right bundle branch block, persistent QT prolongation, transient QT dispersion and PR prolongation, and changes in HRV data. Electrocardiographic long-term follow-up of a larger series of patients is required to determine the conclusive therapeutic significance.
本研究旨在探讨经皮腔内室间隔心肌消融术（PTSMA）3年后，肥厚性梗阻性心肌病（HOCM）有症状患者的延迟心电图变化，包括Q-T间期、校正Q-T离散度和心率变异性（HRV）。
对26例有症状且药物治疗无效的HOCM患者（11例女性，15例男性；平均年龄37.4±11.2岁），注射3.8±1.3 mL酒精（95%）闭塞1.4±0.5支间隔支，以消融肥厚的室间隔。测定基线、术后3天和3年的24小时动态心电图结果。
1例患者发生完全性房室传导阻滞，需要永久起搏。消融后3天PR间期显著延长，但术后3年恢复。术后3天，所有患者均出现右束支传导阻滞，3年后24例患者仍存在。消融后3天及随访3年期间QRS时限显著延长。消融后3天QT间期显著且持续延长，校正QT离散度短暂延长，术后3年恢复至消融前值，但PTSMA后JT间期和校正JT离散度无显著变化。PTSMA后3天和3年的心率变异性数据（时域和频域），包括低频、高频、逐次差值均方根间期以及窦性周期与前一周期相差超过50毫秒的百分比，与术前相比显著增加。PTSMA后低频/高频、所有正常RR间期标准差和5分钟平均正常RR间期标准差无显著变化。
HOCM患者经皮腔内室间隔心肌消融术可导致大多数患者出现显著的延迟心电图变化。这些变化包括QRS增宽、新发右束支传导阻滞、持续性QT延长、短暂性QT离散度和PR延长以及HRV数据变化。需要对更多患者进行心电图长期随访，以确定其确切的治疗意义。
