基于新开发的 PC 程序的 RR 间期分析作为植入式心脏复律除颤器患者干预的预测指标。

RR interval analysis based on a newly developed PC program as a predictor of interventions in implantable cardioverter-defibrillator patients.

机构信息

National Institute of Cardiology, Warszawa, Poland.

出版信息

Adv Clin Exp Med. 2021 Mar;30(3):279-288. doi: 10.17219/acem/131747.

DOI:10.17219/acem/131747

PMID:33754502

Abstract

BACKGROUND

Prediction of sudden cardiac death remains a significant challenge. There is some evidence that ventricular ectopic activity could be regarded as a predictive marker.

OBJECTIVES

We carried out an analysis to explore whether premature ventricular complexes (PVCs) are a risk factor in implantable cardioverter-defibrillator (ICD) interventions.

MATERIAL AND METHODS

The study method was a RR interval series analysis (n = 184) of arrhythmic events and controls from the ICD. Study group consisted of patients with a mean age of 55 ±27 years; 74% of them were male, 85% were secondary prevention patients, 62% had coronary artery disease (CAD), 15% hypertropic cardiomyopathy (HCM), 15% dilated cardiomyopathy (DCM), and 8% diseases of other etiology. The mean follow-up time was 64 months (range: 3-126 months). The study population was divide into patients with at least 1 appropriate intervention ventricular tachycardia/ventricular fibrillation (VT/VF) (group A, n = 101) and controls without interventions (group B, n = 83). The number of PVC/4000 RR cycles, the shortest coupling intervals between a PVC and preceding R as well as the number of PVCs of very short (180-220 ms), short (220-280 ms) and different cycle lengths (CL) as well as the incidence of short-long-short (SLS) sequences were compared.

RESULTS

The number of PVCs/4000 RR cycles was significantly higher in group A (263 ±32 compared to 43 ±17, p < 0.0001). The mean shortest PVC CL was significantly shorter in group A (320 ±13 compared to 400 ±38, p = 0.029). The number of PVCs with a very short CL was 1 ±0.4 compared to 0.1 ±0.1 (p = 0.028). The number of PVCs with a short CL was 5 ±1.2 compared to 0.6 ±0.4 (p = 0.0007) in groups A and B, respectively. The incidence of SLS sequences was significantly higher in group A than in group B (67 (94% of patients) and 4 (33% of patients) respectively (p < 0.0001)).

CONCLUSIONS

Significant differences were found in the characteristics of PVCs and SLS sequences between patients with appropriate ICD interventions and controls. A newly developed basic computer program called PCRR was applied for RR interval analysis. This simple method could be a predictor of PVC burden and life-threatening arrhythmias in different populations.

摘要

背景

预测心脏性猝死仍然是一个重大挑战。有一些证据表明室性异位活动可以作为预测标志物。

目的

我们进行了一项分析，以探讨频发室性早搏（PVCs）是否是植入式心脏复律除颤器（ICD）干预的危险因素。

材料和方法

本研究方法为 RR 间期序列分析（n = 184），分析心律失常事件和 ICD 中的对照。研究组包括平均年龄为 55 ± 27 岁的患者；其中 74%为男性，85%为二级预防患者，62%有冠状动脉疾病（CAD），15%肥厚型心肌病（HCM），15%扩张型心肌病（DCM），8%为其他病因。平均随访时间为 64 个月（范围：3-126 个月）。研究人群分为至少有 1 次适当 ICD 干预的室性心动过速/心室颤动（VT/VF）患者（A 组，n = 101）和无干预患者（B 组，n = 83）。比较 PVC/4000 RR 周期数、PVC 与前一个 R 波之间的最短耦合间隔以及极短（180-220 ms）、短（220-280 ms）和不同周长（CL）的 PVC 数量，以及短-长-短（SLS）序列的发生率。

结果

A 组的 PVC/4000 RR 周期数明显高于 B 组（263 ± 32 比 43 ± 17，p < 0.0001）。A 组的最短 PVC CL 明显短于 B 组（320 ± 13 比 400 ± 38，p = 0.029）。极短 CL 的 PVC 数量为 1 ± 0.4，而 B 组为 0.1 ± 0.1（p = 0.028）。A 组的短 CL PVC 数量为 5 ± 1.2，而 B 组为 0.6 ± 0.4（p = 0.0007）。A 组 SLS 序列的发生率明显高于 B 组（分别为 67（94%的患者）和 4（33%的患者）（p < 0.0001））。