健康的、近期戒断可卡因的慢性可卡因使用者的信号平均心电图。

From the Department of Health and Human Services (PK, MLC, RAN, SJB, DAG), Office of the Scientific Director, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health; and Division of Cardiology (RCZ), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

J Addict Med. 2009 Sep;3(3):128-33. doi: 10.1097/ADM.0b013e318199ab27.

OBJECTIVES

: Cocaine use is associated with cardiac arrhythmias. Markers of ventricular late potentials, which may be a precursor to malignant ventricular arrhythmias, can be detected by signal-averaged electrocardiography (SA-ECG) but not by standard ECG.

METHODS

: We evaluated SA-ECG parameters in 60 medically screened, physically healthy, recently abstinent cocaine users (53 males, mean [SD] age, 34.0 [4.6] years; 10.1 [6.0] years of use) and 54 nondrug-using controls (21 males, mean [SD] age 28.4 [7.8] years). SA-ECGs were done periodically for ≤12 weeks of monitored abstinence in 25 cocaine users. We analyzed 3 SA-ECG parameters considered markers of ventricular late potentials: duration of filtered QRS complex, duration of low-amplitude potentials during terminal 40 ms of QRS complex (LAS40), and root mean square voltage during terminal 40 ms of QRS complex (RMS40).

RESULTS

: Cocaine users differed significantly from controls in filtered QRS complex (118.5 [11.2] ms versus 111.9 [11.4] ms; P = 0.03) but not in LAS40 (28.9 [8.2] ms versus 30.8 [8.3] ms; P = 0.40) or RMS40 (40.0 [19.8] μV versus 30.2 [20.1] μV; P = 0.06) values. The proportion of subjects with abnormal SA-ECG parameters did not differ significantly between male cocaine users and male controls. There were no significant changes over time in either the mean values or proportion of subjects with abnormal values for any SA-ECG parameter. There were significant gender differences among controls but not among cocaine users.

CONCLUSION

: These findings suggest that chronic cocaine use is not associated with a higher prevalence of abnormal SA-ECG parameters in physically healthy users.

目的

可卡因的使用与心律失常有关。心室晚电位的标志物可能是恶性室性心律失常的前兆，可以通过信号平均心电图（SA-ECG）检测到，但不能通过标准心电图检测到。

方法

我们评估了 60 名经过医学筛选的、身体健康的、最近戒断可卡因的患者（53 名男性，平均年龄为 34.0[4.6]岁；使用可卡因 10.1[6.0]年）和 54 名非药物使用者的 SA-ECG 参数（21 名男性，平均年龄为 28.4[7.8]岁）。在 25 名可卡因使用者中，进行了≤12 周的监测性戒断的定期 SA-ECG。我们分析了 3 个被认为是心室晚电位标志物的 SA-ECG 参数：滤波 QRS 复合体的持续时间、QRS 复合体终末 40ms 时的低振幅电位持续时间（LAS40）以及 QRS 复合体终末 40ms 时的均方根电压（RMS40）。

结果

与对照组相比，可卡因使用者的 QRS 复合体的滤波值（118.5[11.2]ms 与 111.9[11.4]ms；P=0.03）差异显著，但 LAS40（28.9[8.2]ms 与 30.8[8.3]ms；P=0.40）或 RMS40（40.0[19.8]μV 与 30.2[20.1]μV；P=0.06）值差异不显著。男性可卡因使用者和男性对照组之间，异常 SA-ECG 参数的比例没有显著差异。在任何 SA-ECG 参数的平均值或异常值的比例方面，均未随时间发生显著变化。在对照组中存在显著的性别差异，但在可卡因使用者中则没有。