Hooft van Huysduynen Bart, Henkens Ivo R, Swenne Cees A, Oosterhof Thomas, Draisma Harmen H M, Maan Arie C, Hazekamp Mark G, de Roos Albert, Schalij Martin J, van der Wall Ernst E, Vliegen Hubert W
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
Int J Cardiol. 2008 Mar 14;124(3):301-6. doi: 10.1016/j.ijcard.2007.02.006. Epub 2007 Apr 11.
To assess the effect of pulmonary valve replacement (PVR) on the repolarization of patients with tetralogy of Fallot.
Pulmonary valve regurgitation may cause right ventricular failure in adult patients with Fallot's tetralogy. In these patients, prolonged depolarization and disturbed repolarization are associated with ventricular arrhythmias and sudden cardiac death.
Thirty Fallot patients (age 32+/-9 years, 19 male) eligible for PVR were studied with cardiac magnetic resonance imaging (CMR) before and 6 months after PVR. Electrocardiograms obtained during initial and follow-up CMR were analyzed and occurrence of ventricular arrhythmias was studied.
Right ventricular end-diastolic volume (RV EDV) decreased from 322+/-87 to 215+/-57 ml after PVR (P<0.0001). The spatial QRS-T angle normalized from 117+/-34 to 100+/-35 degrees , P=0.0004 (normal angle <105 degrees). QT dispersion and T-wave complexity did not change significantly. T-wave amplitude decreased from 376+/-121 to 329+/-100 microV (P=0.01). T-wave area decreased from 43+/-15 to 38+/-13 microV s (P=0.02). Decreases in T-wave amplitude and area were most prominent in the right precordial leads overlying the RV. Three patients had sustained ventricular arrhythmias and one patient died suddenly. These patients had a QRS duration >160 ms. No severe ventricular arrhythmias were found in patients with a RV EDV <220 ml, QRS-T angle <100 degrees , QT dispersion <60 ms or T-wave complexity <0.30.
Normal repolarization indices may be associated with the absence of severe ventricular arrhythmias. PVR in Fallot patients with dilated right ventricles has a beneficial effect on electrocardiographic indices of repolarization heterogeneity.
评估肺动脉瓣置换术（PVR）对法洛四联症患者复极的影响。
肺动脉瓣反流可能导致成年法洛四联症患者发生右心室衰竭。在这些患者中，去极化延长和复极紊乱与室性心律失常及心源性猝死相关。
对30例适合进行PVR的法洛四联症患者（年龄32±9岁，男性19例）在PVR术前及术后6个月进行心脏磁共振成像（CMR）检查。分析初次及随访CMR期间获得的心电图，并研究室性心律失常的发生情况。
PVR术后右心室舒张末期容积（RV EDV）从322±87 ml降至215±57 ml（P<0.0001）。空间QRS-T角从117±34度恢复正常至100±35度，P = 0.0004（正常角度<105度）。QT离散度和T波复杂性无显著变化。T波振幅从376±121 μV降至329±100 μV（P = 0.01）。T波面积从43±15 μV·s降至38±13 μV·s（P = 0.02）。T波振幅和面积的降低在右心室上方的右胸前导联最为明显。3例患者发生持续性室性心律失常，1例患者猝死。这些患者的QRS时限>160 ms。在RV EDV<220 ml、QRS-T角<100度、QT离散度<60 ms或T波复杂性<0.30的患者中未发现严重室性心律失常。
正常的复极指标可能与无严重室性心律失常相关。对右心室扩张的法洛四联症患者进行PVR对复极异质性的心电图指标有有益影响。
