Ist Department of Medicine-Cardiology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Heart Rhythm. 2012 Aug;9(8):1295-300. doi: 10.1016/j.hrthm.2012.03.006. Epub 2012 Mar 7.
For years early repolarization (ER) has been considered as a benign electrocardiographic finding. However, recent reports show that ER is associated with a higher incidence of ventricular fibrillation (VF) and sudden cardiac death in patients without structural heart disease. Sporadic case studies have pointed out that ER might be related to an adverse outcome in patients with stable coronary artery disease.
To evaluate the incidence of ER in patients with acute myocardial infarction complicated by VF.
The study population consisted of 60 patients (80% men; mean age 61.8 ± 13.1 years) with acute myocardial infarction. Thirty consecutive patients (80% men; mean age 63.3 ± 12 years) admitted to our hospital had documented VF during myocardial infarction and were successfully resuscitated before hospital admission. A matched control group consisted of 30 patients (80% men; mean age 60.2 ± 14.2 years) with myocardial infarction without ventricular tachyarrhythmias. Twelve-lead electrocardiograms were analyzed for ER defined as J-point elevation ≥ 0.1 mV and "notching" and "slurring" of the terminal part of the QRS complex in at least 2 lateral or inferior leads.
The ER pattern was observed in 18 of the 60 patients with acute myocardial infarction. Mean elevation of the J point was 0.151 ± 0.46 mV. Notching of the J wave was observed in 14 of the 18 patients and slurring in 4 of the 18 patients. ER was more common in patients with myocardial infarction complicated by VF than in patients with myocardial infarction without ventricular tachyarrhythmias (47% vs 13%; P = .005). There have been no statistical differences in the distribution of ER in the 12-lead electrocardiogram (inferior 39% vs lateral 33% vs inferolateral 28%; P >.05).
Early repolarization pattern seems to be associated with ventricular tachyarrhythmias in the setting of acute myocardial infarction.
多年来，早期复极（ER）被认为是一种良性心电图表现。然而，最近的报告显示，ER 与无结构性心脏病患者室颤（VF）和心源性猝死的发生率较高有关。零星的病例研究指出，ER 可能与稳定性冠状动脉疾病患者的不良预后有关。
评估急性心肌梗死并发 VF 患者 ER 的发生率。
研究人群包括 60 例患者（80%为男性；平均年龄 61.8±13.1 岁），均患有急性心肌梗死。30 例连续患者（80%为男性；平均年龄 63.3±12 岁）在入院前因心肌梗死后发生记录到 VF，并在入院前成功复苏。匹配对照组包括 30 例（80%为男性；平均年龄 60.2±14.2 岁）心肌梗死无室性心动过速的患者。对 12 导联心电图进行分析，以确定 ER，定义为 J 点抬高≥0.1 mV 和 QRS 综合终末部分的“切迹”和“模糊”，至少在 2 个外侧或下侧导联中出现。
在 60 例急性心肌梗死患者中，有 18 例观察到 ER 模式。J 点平均抬高 0.151±0.46 mV。18 例患者中有 14 例出现 J 波切迹，18 例中有 4 例出现 J 波模糊。急性心肌梗死并发 VF 的患者中 ER 更为常见（47%比 13%；P=0.005）。在 12 导联心电图中，ER 的分布无统计学差异（下侧 39%比外侧 33%比下外侧 28%；P>0.05）。
ER 模式似乎与急性心肌梗死后的室性心动过速有关。
