Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Poongnap-dong 388-1, Songpa-gu, Seoul, Republic of Korea.
Eur Heart J. 2010 Feb;31(3):330-9. doi: 10.1093/eurheartj/ehp423. Epub 2009 Oct 29.
The aim of the present study was to identify specific electrocardiogram (ECG) features that predict the development of multiple episodes of ventricular fibrillation (VF) in patients with an early repolarization (ER) pattern and to compare the mode of VF initiation with that observed in typical cases of Brugada syndrome (BrS).
The mode of the onset and the coupling intervals of the premature ventricular contractions (PVCs) initiating VF episodes were analysed in patients with BrS (n = 8) or ER who experienced sudden cardiac death/syncope or repeated appropriate implantable cardioverter defibrillator shocks. Among the 11 patients with ER, 5 presented with electrical storm (ES, four or more recurrent VF episodes/day). The five ES patients displayed a dramatic but very transient accentuation of J waves across the precordial and limb leads prior to the development of ES. Ventricular fibrillation episodes were more commonly initiated by PVCs with a short-long-short (SLS) sequence in ER (42/58, 72.4%) vs. BrS patients (13/86, 15.1%, P < 0.01). Coupling intervals were significantly shorter in the ER group compared with those with BrS [328 (320, 340) ms vs. 395 (350, 404) ms, P < 0.01].
Our study provides additional evidence in support of the hypothesis that ER pattern in the ECG is not always benign. Transient augmentation of global J waves may be indicative of a highly arrhythmogenic substrate heralding multiple episodes of VF in patients with ER pattern. Ventricular tachycardia/VF initiation is more commonly associated with an SLS sequence, and PVCs display a shorter coupling interval in patients with ER pattern compared with those with BrS.
本研究旨在确定具有早期复极（ER）模式的患者发生多次室颤（VF）的特定心电图（ECG）特征，并比较VF 发作的模式与典型 Brugada 综合征（BrS）病例观察到的模式。
分析了具有 BrS（n = 8）或 ER 的患者中引发 VF 发作的 PVC 起始的发作模式和偶联间期，这些患者发生了心脏性猝死/晕厥或反复植入式心脏复律除颤器电击除颤。在 11 名 ER 患者中，5 名患者出现电风暴（ES，每天发生 4 次或更多次反复 VF 发作）。在发生 ES 之前，这 5 名 ES 患者的胸前和肢体导联上的 J 波明显但非常短暂地加重。ER 患者中更常见的是由 PVC 触发 VF 发作，具有短-长-短（SLS）序列（42/58，72.4%），而 BrS 患者（13/86，15.1%），P < 0.01）。与 BrS 患者相比，ER 组的偶联间期明显缩短[328（320，340）ms 与 395（350，404）ms，P < 0.01]。
我们的研究提供了额外的证据支持这样一种假设，即 ECG 中的 ER 模式并不总是良性的。全局 J 波的短暂增强可能表明具有 ER 模式的患者存在高度致心律失常的基质，预示着多次 VF 发作。与 BrS 患者相比，ER 患者的室性心动过速/VF 发作更常见与 SLS 序列相关，而 PVC 显示较短的偶联间期。
