Chorin Ehud, Hochstadt Aviram, Viskin Sami, Rozovski Uri, Havakuk Ofer, Baranchuk Adrian, Enriquez Andres, Strasberg Boris, Guevara-Valdivia Milton E, Márquez Manlio F, González-Pacheco Héctor, Hasdemir Can, Rosso Raphael
Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Heart Rhythm. 2017 Jan;14(1):90-95. doi: 10.1016/j.hrthm.2016.09.013. Epub 2016 Sep 17.
Female gender increases the risk of torsades de pointes (TdP) in the long QT syndrome, and this increased risk is assumed to be due to their longer QT interval.
The purpose of this study was to study the interplay between gender, duration of the QT interval, and risk of TdP during AV block.
We studied 250 patients (48% women) with AV block. QT interval was measured at the time of most severe bradycardia. We then constructed different receiver operating characteristic curves for the QTc of males and females for predicting TdP.
As expected, patients with TdP had longer QTc intervals than did patients with uncomplicated AV block (564 ± 81 ms vs 422 ± 62 ms, P < .001). This correlation between longer QTc and higher risk of TdP was true for both genders. However, the QT of females with TdP was shorter than the respective value for males with TdP. Despite similar severity of bradycardia, the QT was shorter for females (QT 672 ± 88 ms vs 727 ± 57 ms for females with TdP vs males with TdP, P = .022). The QTc/TdP risk curve for females was shifted to the left in comparison to the pertinent graph for males. Female gender was an independent predictor of TdP.
Women are at increased risk for developing TdP during AV block, but this increased risk is independent of their longer QT interval. Females develop TdP with QT intervals that are not necessarily arrhythmogenic for males.
女性会增加长QT综合征中尖端扭转型室速（TdP）的风险，且这种风险增加被认为是由于其QT间期较长。
本研究的目的是探讨性别、QT间期时长与房室传导阻滞期间TdP风险之间的相互作用。
我们研究了250例房室传导阻滞患者（48%为女性）。在最严重心动过缓时测量QT间期。然后我们针对男性和女性的QTc构建了不同的预测TdP的受试者工作特征曲线。
正如预期的那样，TdP患者的QTc间期比无并发症房室传导阻滞患者更长（564±81毫秒对422±62毫秒，P<.001）。QTc延长与TdP风险增加之间的这种相关性在两性中均成立。然而，发生TdP的女性的QT比发生TdP的男性的相应值更短。尽管心动过缓的严重程度相似，但女性的QT更短（发生TdP的女性QT为672±88毫秒，发生TdP的男性为727±57毫秒，P = .022）。与男性的相关曲线相比，女性的QTc/TdP风险曲线向左偏移。女性性别是TdP的独立预测因素。
女性在房室传导阻滞期间发生TdP的风险增加，但这种风险增加与其较长的QT间期无关。女性发生TdP时的QT间期对男性不一定有致心律失常性。
