Yiginer Omer, Kilicaslan Fethi, Aparci Mustafa, Isilak Zafer, Uz Omer, Bayrak Fatih, Eroglu Elif, Uzun Mehmet, Kardesoglu Ejder, Kirilmaz Ata, Cebeci Bekir Sitki
GMMA, Haydarpasa Training Hospital, Cardiology Division, Istanbul-TURKEY.
Indian Pacing Electrophysiol J. 2010 Oct 31;10(10):454-63.
We aimed to report the clinical features related to torsades de pointes (TdP) in patients with complete AV block (CAVB).
Patients with CAVB who were admitted to our instituition between January 2007 and January 2010 were retrospectively evaluated in terms of the occurence of TdP. The clinical features were compared in patients with and without TdP using the software of SPSS.
Sixty-four patients were determined to have CAVB. Three of them had documented episodes of TdP. All three patients experiencing TdP were females, whereas 48% of the patients with CAVB were females. The mean age of patients with TdP was significantly greater than the mean age of the other patients (85 ±3 vs. 78±7.6, respectively; p<0.05). In our archives, bradycardia exposure time could be determined in only 49 patients without TdP. Among them, just 10 patients had been exposed to bradycardia over 48 hours, whereas all of the 3 patients with TdP had been exposed to bradycardia over 48 hours (p<0.05). Additionally, in two patients with TdP, we demonstrated that QT and QTc prolongation increases as the duration of bradycardia is extended. Furthermore, all patients with TdP had notched T waves in the ECG on the occurrence day of TdP, whereas they did not have any notched T wave in their ECG on the admission day.
Among the patients with CAVB, elderly females are more susceptible to development of TdP. Delay in institution of physiological heart rate leads to further QT prolongation and thereby to TdP. Besides QT prolongation, the finding of T wave notching on ECG may also have a predictive value for TdP.
我们旨在报告完全性房室传导阻滞（CAVB）患者中与尖端扭转型室速（TdP）相关的临床特征。
对2007年1月至2010年1月期间入住我院的CAVB患者进行回顾性评估，分析TdP的发生情况。使用SPSS软件比较发生和未发生TdP患者的临床特征。
确定64例患者患有CAVB。其中3例有记录的TdP发作。所有3例发生TdP的患者均为女性，而CAVB患者中48%为女性。发生TdP患者的平均年龄显著高于其他患者（分别为85±3岁和78±7.6岁；p<0.05）。在我们的档案中，仅49例未发生TdP的患者可确定心动过缓暴露时间。其中，只有10例患者心动过缓暴露时间超过48小时，而所有3例发生TdP的患者心动过缓暴露时间均超过48小时（p<0.05）。此外，在2例发生TdP的患者中，我们发现QT和QTc延长随心动过缓持续时间延长而增加。此外，所有发生TdP的患者在TdP发作当天的心电图上有T波切迹，而入院当天的心电图上没有T波切迹。
在CAVB患者中，老年女性更易发生TdP。生理性心率建立延迟会导致QT进一步延长从而引发TdP。除QT延长外，心电图上T波切迹的发现对TdP可能也有预测价值。
