获得性长 QT 综合征患者中房性心律失常在尖端扭转型室性心动过速中的触发作用。
Roles of Atrial Arrhythmias in Triggering Torsade de Pointes in Patients With Acquired Long QT Syndrome.
机构信息
Gifu University Hospital (N.T., S.E., R.T., A.Y., T.W., T.K., Y.Y., H.K., H.U., H.O.).
Matsunami General Hospital, Gifu, Japan (M.T.).
出版信息
Circ Arrhythm Electrophysiol. 2024 Oct;17(10):e012675. doi: 10.1161/CIRCEP.123.012675. Epub 2024 Sep 5.
BACKGROUND
Little is known about the role of atrial arrhythmias (AAs) in triggering Torsade de Pointes (TdP) in patients with long QT syndrome (LQTS). The aim of this study was to examine the contribution of AAs to the development of TdP in acquired LQTS patients.
METHODS
The initiation patterns of 81 episodes of TdP obtained from 34 consecutive acute acquired LQTS patients (14 men, median age, 69 years; median QTc, 645.5 ms) with documented TdP were analyzed. The initiation mode of TdP was divided into 3 categories: (1) preceding short-long sequence (SLS); (2) sudden R-on-T phenomenon without preceding SLS; and (3) increased atrial rate. The patients were divided into 2 groups based on the presence or absence of AAs-induced TdP; AAs-induced (n=18) and non-AAs-induced (n=16) groups. The association of clinical/ECG characteristics and TdP frequency after initiating conventional therapy with AAs-induced TdP was evaluated. The groups were compared using the Mann-Whitney test or Fisher exact test.
RESULTS
AAs-induced group comprised 52.9% (18/34) of the patients studied. TdP was preceded by AAs-initiated SLSs in 41.2% (14/34) of the patients and was directly induced by R-on-T AAs (AAs coincidentally encountered a vulnerable repolarizing region during the T wave) in 23.5% (8/34). AAs triggered 48 (59.3%) of the 81 TdP episodes. AAs initiated SLSs in 67.8% (40/59) of the SLS-induced TdP episodes. R-on-T AAs accounted for 23.5% (19/81) of the TdP episodes. AAs-induced group experienced TdP after initiating therapy more frequently than non-AAs-induced group (2.5 versus 1 event, =0.008). AAs-induced group exhibited macroscopic T-wave alternans more frequently than non-AAs-induced group (6 versus 0 event, =0.02).
CONCLUSIONS
AAs play a key role in triggering TdP in more than half of patients with acute acquired LQTS and can increase TdP frequency after initiating therapy. Thus, AAs are not benign but rather can be life-threatening in patients with acute acquired LQTS.
背景
关于房性心律失常（AAs）在长 QT 综合征（LQTS）患者中引发尖端扭转型室性心动过速（TdP）的作用知之甚少。本研究旨在探讨获得性 LQTS 患者中 AAs 对 TdP 发展的贡献。
方法
分析了 34 例连续急性获得性 LQTS 患者（14 名男性，中位年龄 69 岁；中位 QTc 645.5ms）中 81 例 TdP 获得的发作模式。TdP 的起始模式分为 3 类：（1）短长序列（SLS）前；（2）无 SLS 前突然 R-on-T 现象；（3）心房率增加。根据是否存在 AAs 引起的 TdP 将患者分为两组；AAs 引起的（n=18）和非 AAs 引起的（n=16）组。评估了临床/心电图特征与起始常规治疗后 AAs 引起的 TdP 之间的关联。使用 Mann-Whitney 检验或 Fisher 确切检验比较组间差异。
结果
AAs 引起的组占研究患者的 52.9%（18/34）。TdP 前 AAs 引发 SLS 占 41.2%（14/34），23.5%（8/34）直接由 R-on-T AAs 引起（AAs 在 T 波期间偶然遇到易损复极化区域）。AAs 触发了 81 次 TdP 发作中的 48 次（59.3%）。SLS 诱导的 TdP 发作中，AAs 引发 SLS 占 67.8%（40/59）。R-on-T AAs 占 TdP 发作的 23.5%（19/81）。与非 AAs 引起的组相比，AAs 引起的组在起始治疗后更频繁地发生 TdP（2.5 次与 1 次，=0.008）。AAs 引起的组比非 AAs 引起的组更频繁地出现宏观 T 波交替（6 次与 0 次，=0.02）。
结论
AAs 在超过一半的急性获得性 LQTS 患者中发挥关键作用，可增加起始治疗后的 TdP 频率。因此，AAs 在急性获得性 LQTS 患者中并非良性，而是有生命危险。
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