Haïssaguerre Michel, Derval Nicolas, Sacher Frederic, Jesel Laurence, Deisenhofer Isabel, de Roy Luc, Pasquié Jean-Luc, Nogami Akihiko, Babuty Dominique, Yli-Mayry Sinikka, De Chillou Christian, Scanu Patrice, Mabo Philippe, Matsuo Seiichiro, Probst Vincent, Le Scouarnec Solena, Defaye Pascal, Schlaepfer Juerg, Rostock Thomas, Lacroix Dominique, Lamaison Dominique, Lavergne Thomas, Aizawa Yoshifusa, Englund Anders, Anselme Frederic, O'Neill Mark, Hocini Meleze, Lim Kang Teng, Knecht Sebastien, Veenhuyzen George D, Bordachar Pierre, Chauvin Michel, Jais Pierre, Coureau Gaelle, Chene Genevieve, Klein George J, Clémenty Jacques
Université Bordeaux, Hôpital Haut-Lévêque, Bordeaux-Pessac, France.
N Engl J Med. 2008 May 8;358(19):2016-23. doi: 10.1056/NEJMoa071968.
Early repolarization is a common electrocardiographic finding that is generally considered to be benign. Its potential to cause cardiac arrhythmias has been hypothesized from experimental studies, but it is not known whether there is a clinical association with sudden cardiac arrest.
We reviewed data from 206 case subjects at 22 centers who were resuscitated after cardiac arrest due to idiopathic ventricular fibrillation and assessed the prevalence of electrocardiographic early repolarization. The latter was defined as an elevation of the QRS-ST junction of at least 0.1 mV from baseline in the inferior or lateral lead, manifested as QRS slurring or notching. The control group comprised 412 subjects without heart disease who were matched for age, sex, race, and level of physical activity. Follow-up data that included the results of monitoring with an implantable defibrillator were obtained for all case subjects.
Early repolarization was more frequent in case subjects with idiopathic ventricular fibrillation than in control subjects (31% vs. 5%, P<0.001). Among case subjects, those with early repolarization were more likely to be male and to have a history of syncope or sudden cardiac arrest during sleep than those without early repolarization. In eight subjects, the origin of ectopy that initiated ventricular arrhythmias was mapped to sites concordant with the localization of repolarization abnormalities. During a mean (+/-SD) follow-up of 61+/-50 months, defibrillator monitoring showed a higher incidence of recurrent ventricular fibrillation in case subjects with a repolarization abnormality than in those without such an abnormality (hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.5; P=0.008).
Among patients with a history of idiopathic ventricular fibrillation, there is an increased prevalence of early repolarization.
早期复极是一种常见的心电图表现，通常被认为是良性的。实验研究推测其可能导致心律失常，但尚不清楚它与心脏骤停是否存在临床关联。
我们回顾了22个中心的206例因特发性室颤导致心脏骤停后复苏的病例数据，并评估了心电图早期复极的发生率。后者定义为下壁或侧壁导联中QRS-ST段连接处较基线至少抬高0.1 mV，表现为QRS波顿挫或切迹。对照组包括412名无心脏病的受试者，他们在年龄、性别、种族和体力活动水平方面相匹配。所有病例受试者均获得了随访数据，包括植入式除颤器的监测结果。
特发性室颤病例受试者中早期复极的发生率高于对照组（31%对5%，P<0.001）。在病例受试者中，有早期复极的患者比没有早期复极的患者更可能为男性，且有晕厥或睡眠中心脏骤停史。在8名受试者中，引发室性心律失常的异位搏动起源部位与复极异常的定位一致。在平均（±标准差）61±50个月的随访期间，除颤器监测显示有复极异常的病例受试者中复发性室颤的发生率高于无此类异常的受试者（风险比为2.1；95%置信区间为1.2至3.5；P=0.008）。
在有特发性室颤病史的患者中，早期复极的发生率增加。
