法洛四联症修复术后成年晚期出现不明心律失常患者的超声心动图评估。

Echocardiographic evaluation of patients with undocumented arrhythmias occurring in adults late after repair of tetralogy of Fallot.

作者信息

Rosianu S, Paprika D, Osztheimer I, Temesvari A, Szili-Torok T

机构信息

Gottsegen Gyorgy, Hungarian Institute of Cardiology, Haller u. 29, H-1096 Budapest, Hungary.

出版信息

Eur J Echocardiogr. 2009 Jan;10(1):139-43. doi: 10.1093/ejechocard/jen199. Epub 2008 Jul 8.

DOI:10.1093/ejechocard/jen199

PMID:18611966

Abstract

AIMS

Arrhythmias occurring late after repair of tetralogy of Fallot (ToF) are common. Due to the risk of sudden cardiac death, attention is focused towards ventricular tachycardias (VT). The aims of this study were to determine the clinical profile of patients with known benign and malignant arrhythmias and to assess patients with palpitations without documented arrhythmias.

METHODS AND RESULTS

Fifty-two patients with prior ToF repair were included in this study (mean follow-up: 18+/-7.3 years). Echocardiographic measurements such as left ventricular ejection fraction, left and right atrial (LA and RA) diameters, left and right ventricular diameters (LVEDD and RVEDD), pulmonary and tricuspid regurgitation (TI and PI) and electrocardiographic parameters such as QRS duration, P-wave duration, P-wave dispersion were obtained and compared in patients with and without a history of palpitations. The same comparisons were performed between patients with documented supraventricular tachycardias (SVT) and VT. Twenty-seven of 52 patients had a clinical history of palpitations. The remaining 25 patients served as controls. Eleven patients had documented SVT and 6 patients had documented VT. In patients with documented SVT, the RA size and the QRS durations were significantly higher than in the controls (RA: 55.3+/-5.6 vs. 47.4+/-4.8 mm, P=0.03, QRS: 160.0+/-25.9 vs. 131.8+/-26.1 ms, P=0.01). In patients with VT, the LVEDD, LA, and QRS durations showed significantly higher values compared with the control patients (LVEDD: 53.5+/-4.7 vs. 45.6+/-6.8 mm; LA: 56.0+/-3.4 vs. 48.5+/-4.8 mm, P=0.01; QRS: 169.5+/-29.7 ms vs. 131.8+/-26.1 ms; P=0.001). The only significant differences between patients with and without palpitations were the RA size (58.2+/-3.9 vs. 50.5+/-5.2 mm, P=0.02) and the P-wave dispersion (26.8+/-15.2 vs. 16.6+/-4.3 ms, P=0.04).

CONCLUSION

Our present data suggest that undocumented arrhythmias are most likely SVTs and are associated with increased RA size.

摘要

目的

法洛四联症（ToF）修复术后晚期发生心律失常很常见。由于存在心源性猝死风险，关注重点在于室性心动过速（VT）。本研究旨在确定已知良性和恶性心律失常患者的临床特征，并评估有心悸但无心律失常记录的患者。

方法与结果

本研究纳入了52例既往接受过ToF修复术的患者（平均随访时间：18±7.3年）。获取并比较了有心悸病史和无心悸病史患者的超声心动图测量值，如左心室射血分数、左心房和右心房（LA和RA）直径、左心室和右心室直径（LVEDD和RVEDD）、肺动脉反流和三尖瓣反流（TI和PI），以及心电图参数，如QRS时限、P波时限、P波离散度。对有记录的室上性心动过速（SVT）患者和VT患者也进行了同样的比较。52例患者中有27例有心悸的临床病史。其余25例患者作为对照。11例患者有记录的SVT，6例患者有记录的VT。在有记录的SVT患者中，RA大小和QRS时限显著高于对照组（RA：55.3±5.6 vs. 47.4±4.8 mm，P = 0.03；QRS：160.0±25.9 vs. 131.8±26.1 ms，P = 0.01）。在VT患者中，LVEDD、LA和QRS时限与对照患者相比显著更高（LVEDD：53.5±4.7 vs. 45.6±6.8 mm；LA：56.0±3.4 vs. 48.5±4.8 mm，P = 0.01；QRS：169.5±29.7 ms vs. 131.8±26.1 ms；P = 0.001）。有心悸和无心悸患者之间唯一显著的差异是RA大小（58.2±3.9 vs. 50.5±5.2 mm，P = 0.02）和P波离散度（26.8±15.2 vs. 16.6±4.3 ms，P = 0.04）。