胎儿心脏磁共振成像在评估产前有心脏性猝死风险胎儿中的应用。
Magnetocardiography in the evaluation of fetuses at risk for sudden cardiac death before birth.
作者信息
Cuneo Bettina F, Strasburger Janette F, Wakai Ronald T
机构信息
The Heart Institute for Children, Hope Children's Hospital, Rush Medical College, Chicago, IL, USA.
出版信息
J Electrocardiol. 2008 Mar-Apr;41(2):116.e1-6. doi: 10.1016/j.jelectrocard.2007.12.010.
BACKGROUND
We hypothesized that fetuses at risk for sudden death may have abnormal conduction or depolarization, ischemia, or abnormal heart rate variability (HRV) detectable by magnetocardiography.
METHODS
Using a 37-channel biomagnetometer, we evaluated 3 groups of fetuses at risk for sudden death: group 1, critical aortic stenosis (AS); group 2, arrhythmias; and group 3, heart failure and in utero demise. Five to 10 recordings of 10-minute duration were recorded, and signal was averaged to determine rhythm, conduction intervals, HRV, and T-wave morphology.
RESULTS
In group 1, 2 of 3 had atrial and ventricular strain patterns. In (n = 53) group 2, 15% had prolonged QTc and 17% had T-wave alternans (TWA). Of 23 group 2 fetuses with atrioventricular block, 74% had ventricular ectopy, 21% had junctional ectopic tachycardia, and 29% had ventricular tachycardia. Group 3 (n = 2) had abnormal HRV and TWA.
CONCLUSION
Repolarization abnormalities, unexpected arrhythmias, and abnormal HRV suggest an arrhythmogenic mechanism for "sudden cardiac death before birth."
背景
我们推测，通过心磁图可检测出有猝死风险的胎儿可能存在传导或去极化异常、缺血或心率变异性（HRV）异常。
方法
我们使用一台37通道生物磁强计，评估了3组有猝死风险的胎儿：第1组，严重主动脉瓣狭窄（AS）；第2组，心律失常；第3组，心力衰竭和宫内死亡。记录了5至10次时长为10分钟的记录，并对信号进行平均，以确定心律、传导间期、HRV和T波形态。
结果
在第1组中，3例中有2例出现心房和心室应变模式。在第2组（n = 53）中，15%的胎儿QTc延长，17%的胎儿有T波交替（TWA）。在第2组的23例患有房室传导阻滞的胎儿中，74%有室性早搏，21%有交界性异位性心动过速，29%有室性心动过速。第3组（n = 2）有异常的HRV和TWA。
结论
复极异常、意外心律失常和异常HRV提示“出生前心源性猝死”存在致心律失常机制。
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