局部去极化异常是 1 型 Brugada 综合征心电图的主要病理生理机制：一项关于心电图、向量心电图和哇巴因激发时体表电位图的研究。

Local depolarization abnormalities are the dominant pathophysiologic mechanism for type 1 electrocardiogram in brugada syndrome a study of electrocardiograms, vectorcardiograms, and body surface potential maps during ajmaline provocation.

机构信息

Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.

出版信息

J Am Coll Cardiol. 2010 Feb 23;55(8):789-97. doi: 10.1016/j.jacc.2009.11.033.

DOI:10.1016/j.jacc.2009.11.033

PMID:20170818

Abstract

OBJECTIVES

We sought to obtain new insights into the pathophysiologic basis of Brugada syndrome (BrS) by studying changes in various electrocardiographic depolarization and/or repolarization variables that occurred with the development of the signature type 1 BrS electrocardiogram (ECG) during ajmaline provocation testing.

BACKGROUND

BrS is associated with sudden cardiac death. Its pathophysiologic basis, although unresolved, is believed to reside in abnormal cardiac depolarization or abnormal repolarization.

METHODS

Ajmaline provocation was performed in 269 patients suspected of having BrS with simultaneous recording of ECGs, vectorcardiograms, and 62-lead body surface potential maps.

RESULTS

A type 1 ECG was elicited in 91 patients (BrS patients), 162 patients had a negative test result (controls), and 16 patients had an abnormal test result. Depolarization abnormalities were more prominent in BrS patients and were mapped to the right ventricle (RV) by longer right precordial filtered QRS complex durations (142 +/- 23 ms vs. 125 +/- 14 ms, p < 0.01) and right terminal conduction delay (60 +/- 11 ms vs. 53 +/- 9 ms, p < 0.01). Repolarization abnormalities remained concordant with depolarization abnormalities as indicated by steady low nondipolar content (12 +/- 8% vs. 8 +/- 4%, p = NS), lower spatial QRS-T integrals (33 +/- 12 mV.ms vs. 40 +/- 16 mV.ms, p < 0.05), similar spatial QRS-T angles (92 +/- 39 degrees vs. 87 +/- 31 degrees , p = NS), similar T(peak)-T(end) interval (143 +/- 36 ms vs. 138 +/- 25 ms, p = NS), and similar T(peak)-T(end) dispersion (47 +/- 37 ms vs. 45 +/- 27 ms, p = NS).

CONCLUSIONS

The type 1 BrS ECG is characterized predominantly by localized depolarization abnormalities, notably (terminal) conduction delay in the RV, as assessed with complementary noninvasive electrocardiographic techniques. We could not define a separate role for repolarization abnormalities but suggest that the typical signs of repolarization derangements seen on the ECG are secondary to these depolarization abnormalities.

摘要

目的

通过研究在阿义马林激发试验中出现特征性 1 型 Brugada 综合征（BrS）心电图时各种心电图去极化和/或复极化变量的变化，我们试图深入了解 BrS 的病理生理基础。

背景

BrS 与心源性猝死有关。尽管其病理生理基础尚未解决，但据信存在异常心脏去极化或异常复极化。

方法

对 269 例疑似 BrS 患者进行阿义马林激发试验，同时记录心电图、向量心电图和 62 导体表电位图。

结果

91 例患者（BrS 患者）诱发 1 型心电图，162 例患者试验结果阴性（对照组），16 例患者试验结果异常。与对照组相比，去极化异常在 BrS 患者中更为明显，且通过更长的右胸前滤波 QRS 复合波时限（142 ± 23 ms 比 125 ± 14 ms，p < 0.01）和右心尖终端传导延迟（60 ± 11 ms 比 53 ± 9 ms，p < 0.01）定位于右心室（RV）。复极异常与去极化异常一致，表现为稳定的低非极性含量（12 ± 8%比 8 ± 4%，p = NS）、较低的空间 QRS-T 积分（33 ± 12 mV.ms 比 40 ± 16 mV.ms，p < 0.05）、相似的空间 QRS-T 角度（92 ± 39 度比 87 ± 31 度，p = NS）、相似的 T(peak)-T(end) 间期（143 ± 36 ms 比 138 ± 25 ms，p = NS）和相似的 T(peak)-T(end) 离散度（47 ± 37 ms 比 45 ± 27 ms，p = NS）。