St Antonius-Hospital Gronau, Gronau, Germany.
Eur Heart J Acute Cardiovasc Care. 2012 Sep;1(3):236-9. doi: 10.1177/2048872612453922.
Patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and complete right bundle branch block (RBBB) very often have recurrent ventricular tachycardia and develop biventricular heart failure in the follow up, requiring heart transplantation and/or diuretics. In other patients with ARVC/D excluding RBBB, QRS fragmentation in the S wave of right precordial leads identifies patients with recurrent ventricular tachycardia, primary ventricular fibrillation, and recurrent implantable cardioverter defibrillator discharges; QRS fragmentation ≥3 leads characterized patients who died from sudden cardiac death.
In a cohort of 374 patients with ARVC/D (208 males; mean±SD age 46.5±14.8 years), there were 22 patients with complete RBBB: 17 patients with ARVD/C developed complete RBBB and had biventricular heart failure in a follow up of 4-6 years. In five patients with ARVC/D, complete RBBB was initially evident. In all patients with ARVC/D and RBBB, QRS fragmentation ≥3 of all 12 ECG leads and QRS fragmentation in the S wave of right precordial leads were analysed.
QRS fragmentation ≥3 of all 12 ECG leads and in the S wave of right precordial leads were present in 16/17 patients who developed RBBB and none of the five patients with initial RBBB. In one patient with initial RBBB, QRS fragmentation ≥3 leads was present (r=17.45; p<0.0001).
Patients with recurrent ventricular tachycardia who develop biventricular heart failure requiring heart transplantation and/or diuretics are characterized by QRS fragmentation in the S wave of right precordial leads and ≥3 of all 12 ECG leads. These results are statistically significant. Patients with initial RBBB have an overall benign prognosis.
患有心律失常性右室心肌病/发育不良（ARVC/D）和完全性右束支传导阻滞（RBBB）的患者经常出现复发性室性心动过速，并在随访中发展为双心室心力衰竭，需要心脏移植和/或利尿剂。在其他不伴 RBBB 的 ARVC/D 患者中，右胸前导联 S 波的 QRS 碎裂可识别出复发性室性心动过速、原发性心室颤动和复发性植入式心脏复律除颤器放电的患者；QRS 碎裂≥3 导联可识别出因心源性猝死而死亡的患者。
在一组 374 例 ARVC/D 患者（208 例男性；平均年龄±标准差为 46.5±14.8 岁）中，有 22 例患者存在完全性 RBBB：17 例 ARVD/C 患者在 4-6 年的随访中发展为完全性 RBBB 并出现双心室心力衰竭。在 5 例 ARVC/D 患者中，最初表现为完全性 RBBB。在所有 ARVC/D 和 RBBB 患者中，分析了所有 12 个心电图导联的 QRS 碎裂≥3 和右胸前导联 S 波的 QRS 碎裂。
在 17 例发展为 RBBB 的患者中，有 16/17 例患者存在所有 12 个心电图导联和右胸前导联 S 波的 QRS 碎裂≥3，而在最初 5 例 RBBB 患者中无一例存在。在最初存在 RBBB 的 1 例患者中，QRS 碎裂≥3 导联存在（r=17.45；p<0.0001）。
复发性室性心动过速发展为需要心脏移植和/或利尿剂的双心室心力衰竭的患者，其特征为右胸前导联 S 波的 QRS 碎裂和所有 12 个心电图导联的 QRS 碎裂≥3。这些结果具有统计学意义。最初存在 RBBB 的患者总体预后良好。
