Segawa Kazuhiko, Komaki Hirofumi, Mori-Yoshimura Madoka, Oya Yasushi, Kimura Koichi, Tachimori Hisateru, Kato Naohiro, Sasaki Masayuki, Takahashi Yuji
Department of Cardiology, National Center Hospital, National Center of Neurology and Psychiatry Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry Department of Laboratory Medicine, the Institute of Medical Science, the University of Tokyo Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
Medicine (Baltimore). 2017 Oct;96(42):e8335. doi: 10.1097/MD.0000000000008335.
The majority of patients with Duchenne muscular dystrophy (DMD) have electrocardiographic abnormalities, but the clinical significance of conduction disturbances remains unclear. This study aimed to evaluate age-dependent cardiac conduction disturbances by electrocardiogram (ECG) to identify risks of complete atrioventricular (AV) block in this patient population.In total, 47 patients with DMD (age, ≥20 ys) who recorded ECGs at our hospital from July 2015 to June 2016 were included in this study. The PR interval and QRS duration in their previous ECGs were analyzed retrospectively. Associations between ECG findings and left ventricular (LV) systolic function obtained from the latest echocardiography were examined.The mean age of patients was 27.6 ± 6.0 years, and the mean observation period was 9.8 ± 3.7 years. The PR interval gradually increased with age, but no ECGs showed an abnormally prolonged PR interval. On the other hand, the QRS duration tended to increase progressively with age, and some patients had an abnormally prolonged QRS duration. The QRS duration was not correlated with LV systolic function (P = 0.867). One patient who developed a complete AV block had a drastically prolonged QRS duration before the onset of the disorder.The QRS duration tended to increase progressively with age, irrespective of LV systolic function in patients with DMD. Attention should be paid to the QRS duration as an indicator of risk for complete AV block in older patients.
大多数杜氏肌营养不良症（DMD）患者存在心电图异常，但传导障碍的临床意义仍不明确。本研究旨在通过心电图（ECG）评估年龄依赖性心脏传导障碍，以确定该患者群体中完全房室（AV）传导阻滞的风险。
本研究共纳入了2015年7月至2016年6月在我院记录心电图的47例DMD患者（年龄≥20岁）。回顾性分析他们之前心电图的PR间期和QRS时限。检查心电图结果与最新超声心动图获得的左心室（LV）收缩功能之间的关联。
患者的平均年龄为27.6±6.0岁，平均观察期为9.8±3.7年。PR间期随年龄逐渐增加，但没有心电图显示PR间期异常延长。另一方面，QRS时限倾向于随年龄逐渐增加，一些患者的QRS时限异常延长。QRS时限与LV收缩功能无关（P = 0.867）。一名发生完全性AV传导阻滞的患者在疾病发作前QRS时限急剧延长。
DMD患者的QRS时限倾向于随年龄逐渐增加，与LV收缩功能无关。应将QRS时限作为老年患者完全性AV传导阻滞风险的指标予以关注。
