Ahmed Humera, Czosek Richard J, Spar David S, Knilans Timothy K, Anderson Jeffrey B
Heart Institute, Cincinnati Children's Hospital, 3333 Burnet Avenue, ML 2003, Cincinnati, OH, 45206, USA.
Pediatr Cardiol. 2017 Apr;38(4):864-872. doi: 10.1007/s00246-017-1594-9. Epub 2017 Apr 3.
In adults with structurally normal hearts, the early repolarization pattern (ERP) on electrocardiogram (ECG) may be associated with an increased risk of sudden cardiac death. The prevalence and significance of the ERP in children is unknown. This study examines the prevalence of the ERP, the population in which it is found, and whether there exists any correlation with increased LV mass or family history of significant cardiac events. This was a secondary review of data obtained from healthy adolescents undergoing a limited ECG and transthoracic echocardiogram (TTE) as part of a cardiac screening study. Subjects were excluded if ECG revealed known arrhythmic syndromes or TTE revealed structural abnormalities. ERP was defined as (1) notching or slurring of the terminal QRS; (2) elevation of the QRS-ST junction ≥1 mV; and (3) upwardly concave positive T-wave. Left ventricular (LV) mass was defined as mass/height. Patient demographics, LV mass, family history of sudden death, arrhythmia, and/or ICD/pacemaker placement were compared for subjects with and without ERP on ECG. Data from 575 subjects (median age 15, range 13-18; 36% female; 93% Caucasian) were reviewed. The incidence of ERP was 40% (n = 228) and was seen in the inferior, lateral, or combination of these leads in 42, 10, and 48% of subjects with ERP, respectively. There was no difference in gender (p = 0.7), race (p = 0.7), age (p = 0.3), history of syncope (p = 0.2), LV mass (p = 0.8), family history of (a) sudden death (p = 0.5), (b) arrhythmia (p = 0.2), or (c) ICD/pacemaker requirement (p = 0.8) in subjects with ERP versus those without. However, a greater percentage of patients with ERP were noted to play football, when compared to those without ERP (34 vs. 13%, p < 0.001). ERP is common in healthy adolescents, and does not correlate with concerning personal/family history or elevated LV mass. Longitudinal studies are required to determine whether ERP in childhood confers an increased mortality risk.
在心脏结构正常的成年人中，心电图（ECG）上的早期复极模式（ERP）可能与心源性猝死风险增加相关。ERP在儿童中的患病率及意义尚不清楚。本研究调查了ERP的患病率、发现ERP的人群，以及其是否与左心室质量增加或重大心脏事件家族史存在相关性。这是一项对数据的二次回顾分析，数据来自于作为心脏筛查研究一部分而接受有限心电图和经胸超声心动图（TTE）检查的健康青少年。如果心电图显示已知的心律失常综合征或TTE显示结构异常，则将受试者排除。ERP定义为：（1）终末QRS波有切迹或顿挫；（2）QRS - ST段交界处抬高≥1mV；（3）T波向上凹形。左心室（LV）质量定义为质量/身高。比较了心电图有ERP和无ERP受试者的患者人口统计学特征、LV质量、猝死家族史、心律失常和/或植入式心律转复除颤器（ICD）/起搏器植入情况。回顾了575名受试者的数据（中位年龄15岁，范围13 - 18岁；36%为女性；93%为白种人）。ERP的发生率为40%（n = 228），分别在42%、10%和48%的有ERP受试者的下壁、侧壁或这些导联的组合中出现。有ERP与无ERP的受试者在性别（p = 0.7）、种族（p = 0.7）、年龄（p = 0.3）、晕厥史（p = 0.2）、LV质量（p = 0.8）、（a）猝死家族史（p = 0.5）、（b）心律失常家族史（p = 0.2）或（c）ICD/起搏器需求家族史（p = 0.8）方面无差异。然而，与无ERP的患者相比，有ERP的患者中踢足球的比例更高（34%对13%，p < 0.001）。ERP在健康青少年中很常见，且与令人担忧的个人/家族史或LV质量升高无关。需要进行纵向研究以确定儿童期的ERP是否会增加死亡风险。
