Bun Sok-Sithikun, Heme Nathan, Asarisi Florian, Squara Fabien, Scarlatti Didier, Moceri Pamela, Ferrari Emile
Faculty of Medicine, Pasteur University Hospital, 06000 Nice, France.
J Clin Med. 2023 Jan 30;12(3):1067. doi: 10.3390/jcm12031067.
Female gender, degree of QT prolongation, and genetic susceptibility are known risk factors for developing torsades de pointes (TdP) during high-grade atrioventricular block (HG-AVB). Our objective was to analyze the prevalence and clinical characteristics of patients presenting with TdP and AVB (TdP [+]) in comparison with non-TdP patients with AVB (TdP [-]).
All the ECGs from patients prospectively admitted for AVB (2 to 1, HG, and complete) at the University Hospital of Nice were analyzed. Automated corrected QT (QTc), manual measurements of QT and JT intervals, and Tpeak-to-end were performed at the time of the most severe bradycardia.
From September 2020 to November 2021, 100 patients were admitted for HG-AVB. Among them, 17 patients with TdP were identified (8 men; 81 ± 10 years). No differences could be identified concerning automated QTc, manual QTc (Bazett correction), baseline QRS width, or mean left ventricular ejection fraction between the two groups. Potassium serum level on admission and mean number of QT-prolonging drugs per patient were not significantly different between the two groups, respectively: 4.34 ± 0.5 mmol/L in TdP [+] versus 4.52 ± 0.6 mmol/L ( = 0.33); and 0.6 ± 0.7 in TdP [+] versus 0.3 ± 0.5 ( = 0.15). In contrast, manual QTc (Fridericia correction), JT (Fridericia correction), Tpeak-to-end, and Tpe/QT ratio were significantly increased in the TdP [+] group, respectively: 486 ± 70 ms versus 456 ± 53 ms ( = 0.04); 433 ± 98 ms versus 381 ± 80 ms ( = 0.02); 153 ± 57 ms versus 110 ± 40 ms ( < 0.001); and 0.27 ± 0.08 versus 0.22 ± 0.06 ( < 0.001).
The incidence of TdP complicating acquired AVB was 17%. Longer QTc, JT, and Tpeak-to-end were significantly increased in the case of TdP but also in the presence of permanent AVB during the hospitalization.
女性性别、QT 间期延长程度和遗传易感性是已知的在高度房室传导阻滞（HG-AVB）期间发生尖端扭转型室速（TdP）的危险因素。我们的目的是分析出现 TdP 和房室传导阻滞（TdP[+]）的患者与未出现 TdP 的房室传导阻滞患者（TdP[-]）的患病率和临床特征。
对在尼斯大学医院前瞻性收治的房室传导阻滞（二度房室传导阻滞、高度房室传导阻滞和完全性房室传导阻滞）患者的所有心电图进行分析。在最严重心动过缓时进行自动校正 QT（QTc）、QT 和 JT 间期的手动测量以及 T 波峰末间期测量。
2020 年 9 月至 2021 年 11 月，100 例患者因高度房室传导阻滞入院。其中，17 例患者被诊断为 TdP（8 名男性；年龄 81±10 岁）。两组在自动 QTc、手动 QTc（Bazett 校正）、基线 QRS 宽度或平均左心室射血分数方面未发现差异。两组患者入院时的血清钾水平和每位患者使用延长 QT 间期药物的平均数量分别无显著差异：TdP[+]组为 4.34±0.5 mmol/L，TdP[-]组为 4.52±0.6 mmol/L（P = 0.33）；TdP[+]组为 0.6±0.7，TdP[-]组为 0.3±0.5（P = 0.15）。相比之下，TdP[+]组的手动 QTc（Fridericia 校正）、JT（Fridericia 校正）、T 波峰末间期和 Tpe/QT 比值显著增加，分别为：486±70 ms 对 456±53 ms（P = 0.04）；433±98 ms 对 381±80 ms（P = 0.02）；153±57 ms 对 110±40 ms（P < 0.001）；0.27±0.08 对 0.22±0.06（P < 0.001）。
TdP 并发获得性房室传导阻滞的发生率为 17%。在 TdP 患者以及住院期间存在永久性房室传导阻滞时 QTc、JT 和 T 波峰末间期均显著延长。
