Tan Alex Y, Nearing Bruce D, Rosenberg Michael, Nezafat Reza, Josephson Mark E, Verrier Richard L
Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Cardiovasc Electrophysiol. 2017 Nov;28(11):1324-1333. doi: 10.1111/jce.13288. Epub 2017 Aug 4.
Nonuniformities in depolarization and repolarization morphology are critical factors in ventricular arrhythmogenesis.
We assessed interlead R-wave heterogeneity (RWH) and T-wave heterogeneity (TWH) in standard 12-lead electrocardiograms (ECGs) using second central moment analysis. This technique quantifies variance about the mean morphology of beats in adjoining precordial leads, V , V , and V in this study. The study was conducted in 120 consecutive patients without an apparent reversible trigger for ventricular tachycardia (VT), recent myocardial infarction, or active ischemia, who presented for electrophysiologic study, implantable cardioverter defibrillator (ICD) placement, or generator change at our institution from 2008 to 2011. Primary outcome was sustained VT/ventricular fibrillation (VF) or appropriate ICD therapies. Secondary outcome was arrhythmic death or resuscitated cardiac arrest. Cutpoints for elevated RWH (>160 μV) and TWH (>80 μV) identified 67% of primary outcome cases and 85% of secondary outcome cases. Cardiomyopathy patients who met the primary outcome (n = 42) had significantly higher TWH than those who did not (n = 28) (TWH: 95 ± 11 μV vs. 44 ± 9 μV, P < 0.002). Likewise, cardiomyopathy patients who met secondary outcome (N = 13) had VT/VF during follow-up and also had significantly higher TWH than survivors (N = 57) (TWH: 105 ± 24 μV vs. 67 ± 8 μV, P < 0.002). Kaplan-Meier analysis revealed significant differences in arrhythmia-free survival (P = 0.012) and total survival (P = 0.011) among cardiomyopathy patients with (n = 37) compared to without (n = 33) elevated RWH and/or TWH independent of age, sex, and left ventricular ejection fraction (LVEF).
Interlead RWH and TWH in 12-lead ECGs predict sustained ventricular arrhythmia, appropriate ICD therapies, and arrhythmic death or cardiac arrest in cardiomyopathy patients independent of LVEF and other standard variables.
去极化和复极化形态的不均匀性是室性心律失常发生的关键因素。
我们使用二阶中心矩分析法评估标准12导联心电图（ECG）中的导联间R波异质性（RWH）和T波异质性（TWH）。该技术量化了本研究中相邻心前区导联V1、V2和V3中搏动平均形态的方差。研究纳入了120例连续患者，这些患者无明显可逆性室性心动过速（VT）触发因素、近期心肌梗死或活动性缺血，于2008年至2011年在我院接受电生理检查、植入式心律转复除颤器（ICD）植入或发生器更换。主要结局为持续性VT/心室颤动（VF）或ICD恰当治疗。次要结局为心律失常性死亡或复苏成功的心脏骤停。RWH升高（>160 μV）和TWH升高（>80 μV）的切点识别出67%的主要结局病例和85%的次要结局病例。达到主要结局的心肌病患者（n = 42）的TWH显著高于未达到主要结局的患者（n = 28）（TWH：95±11 μV对44±9 μV，P < 0.002）。同样，达到次要结局的心肌病患者（N = 13）在随访期间发生VT/VF，其TWH也显著高于存活患者（N = 57）（TWH：105±24 μV对67±8 μV，P < 0.002）。Kaplan-Meier分析显示，与RWH和/或TWH未升高的心肌病患者（n = 33）相比，RWH和/或TWH升高的心肌病患者（n = 37）在无心律失常生存（P = 0.012）和总生存（P = 0.011）方面存在显著差异，且不受年龄、性别和左心室射血分数（LVEF）影响。
12导联ECG中的导联间RWH和TWH可预测心肌病患者的持续性室性心律失常、ICD恰当治疗以及心律失常性死亡或心脏骤停，且不受LVEF和其他标准变量影响。
