Patel Nikhil, O'Neal Wesley T, Whalen S Patrick, Soliman Elsayed Z
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Ann Noninvasive Electrocardiol. 2018 Mar;23(2):e12467. doi: 10.1111/anec.12467. Epub 2017 Jun 29.
Although abnormalities of the QT interval are associated with atrial fibrillation (AF), it is unclear whether ventricular depolarization (QRS duration) or repolarization (JT interval) is a more important marker of AF risk.
This analysis included 4,181 (95% white; 59% women) participants from the Cardiovascular Health Study (CHS) who were free of baseline AF and major intraventricular delay. A linear scale was used to compute heart rate adjusted QT (QTa), QRS (QRS ), and JT (JT ) intervals. Prolonged QT , QRS , and JT were defined by values greater than the sex-specific 95th percentile for each measurement. AF events were ascertained during the annual study electrocardiograms and from hospitalization discharge data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the associations of prolonged QT , QRS , and JT with AF, separately.
Over a mean follow-up of 12.1 years, a total of 1,236 (30%) AF events were detected. An increased risk of AF (HR = 1.50. 95% CI = 1.20, 1.88) was observed with prolonged QT . When we examined the association between individual components of the QT interval and AF, the risk of AF was limited to prolonged JT (HR = 1.31, 95% CI = 1.04, 1.65) and not prolonged QRS (HR = 1.00, 95% CI = 0.77, 1.30). Similar results were obtained per 1-SD increase in QT (HR = 1.07, 95% CI = 1.01, 1.13), QRS (HR = 0.99, 95% CI = 0.94, 1.06), and JT (HR = 1.07, 95% CI = 1.01, 1.13).
The JT interval is a more important marker of AF risk in the QT interval among persons who do not have ventricular conduction delays.
尽管QT间期异常与心房颤动（AF）相关，但尚不清楚心室去极化（QRS波时限）或复极化（JT间期）哪个是更重要的AF风险标志物。
该分析纳入了心血管健康研究（CHS）的4181名参与者（95%为白人；59%为女性），这些参与者无基线AF及严重室内传导延迟。采用线性量表计算心率校正的QT（QTa）、QRS（QRS ）和JT（JT ）间期。QT 、QRS 和JT延长定义为各测量值大于性别特异性第95百分位数。通过年度研究心电图及住院出院数据确定AF事件。分别采用Cox回归计算QT 、QRS 和JT延长与AF关联的风险比（HR）及95%置信区间（CI）。
平均随访12.1年期间，共检测到1236例（30%）AF事件。QT延长时观察到AF风险增加（HR = 1.50，95%CI = 1.20，1.88）。当我们检查QT间期各组成部分与AF之间的关联时，AF风险仅限于JT延长（HR = 1.31，95%CI = 1.04，1.65），而QRS未延长（HR = 1.00，95%CI = 0.77，1.30）。QT、QRS和JT每增加1个标准差也得到类似结果（QT：HR = 1.07，95%CI = 1.01，1.13；QRS：HR = 0.99，95%CI = 0.94，1.06；JT：HR = 1.07，95%CI = 1.01，1.13）。
在无心室传导延迟的人群中，JT间期是QT间期中更重要的AF风险标志物。
