Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan.
J Cardiovasc Electrophysiol. 2013 May;24(5):556-61. doi: 10.1111/jce.12074. Epub 2013 Feb 1.
Almost all current investigations on early repolarization syndrome (ERS) have focused on the J-wave characteristics and ST-segment configuration; however, few have reported on ventricular repolarization indexes in ERS.
A total of 145 subjects were enrolled: 10 ERS patients, 45 uneventful ER pattern (ERP) subjects, and 90 healthy controls without J waves or ST-segment elevation. Ambulatory ECG-derived parameters (QT, QTc(B), QTc(F), T peak-Tend(Tpe), and QT/RR slope) were measured and statistically compared. Among the groups, there was no significant difference in the average QT and QTc(B); however, ERS patients had the shortest QTc(F) and longest Tpe (QTc(F): 396.2 ± 19 vs 410.4 ± 20 vs 419.2 ± 19 milliseconds, P = 0.036, Tpe: 84.9 ± 12 vs 70.4 ± 11 vs 66.9 ± 15 milliseconds, P < 0.001, for the ERS, ERP, and control groups, respectively). Importantly, the 24-hour QT/RR slope was significantly smaller in the ERS than ERP and control groups (QT/RR: 0.105 ± 0.01 vs 0.154 ± 0.02 vs 0.161 ± 0.03, respectively; P < 0.001). When analyzing the diurnal and nocturnal QT/RR slopes, ERS patients had small diurnal and nocturnal QT/RR slopes while the ERP and control groups had large diurnal and small nocturnal QT/RR slopes (diurnal QT/RR: 0. 077 ± 0.01 vs 0.132 ± 0.03 vs 0.143 ± 0.03, P < 0.001; nocturnal QT/RR: 0.093 ± 0.02 vs 0.129 ± 0.03 vs 0.130 ± 0.04, P = 0.02 in the ERS, ERP, and control groups, respectively).
ERS patients had a continuously depressed diurnal and nocturnal adaptation of the QT interval to the heart rate. Such abnormal repolarization dynamics might provide a substrate for reentry and be an important element for developing ventricular fibrillation in the ERS cohort.
几乎所有关于早期复极综合征（ERS）的现有研究都集中在 J 波特征和 ST 段形态上；然而，很少有研究报道 ERS 中的心室复极指标。
共纳入 145 例受试者：10 例 ERS 患者、45 例无意外 ER 模式（ERP）患者和 90 例无 J 波或 ST 段抬高的健康对照者。测量并比较了动态心电图衍生参数（QT、QTc（B）、QTc（F）、T 峰-T 末（Tpe）和 QT/RR 斜率）。在这些组中，平均 QT 和 QTc（B）无显著差异；然而，ERS 患者的 QTc（F）最短，Tpe 最长（QTc（F）：396.2±19 比 410.4±20 比 419.2±19 毫秒，P=0.036，Tpe：84.9±12 比 70.4±11 比 66.9±15 毫秒，P<0.001，ERS、ERP 和对照组）。重要的是，ERS 组的 24 小时 QT/RR 斜率明显小于 ERP 和对照组（QT/RR：0.105±0.01 比 0.154±0.02 比 0.161±0.03，P<0.001）。分析昼夜 QT/RR 斜率时，ERS 患者昼夜 QT/RR 斜率均较小，而 ERP 和对照组昼夜 QT/RR 斜率均较大，夜间 QT/RR 斜率较小（日间 QT/RR：0.077±0.01 比 0.132±0.03 比 0.143±0.03，P<0.001；夜间 QT/RR：0.093±0.02 比 0.129±0.03 比 0.130±0.04，P=0.02，ERS、ERP 和对照组）。
ERS 患者的 QT 间期昼夜心率适应性持续降低。这种异常的复极动力学可能为折返提供基质，并成为 ERS 患者发生室颤的重要因素。
