Nademanee K, Veerakul G, Nimmannit S, Chaowakul V, Bhuripanyo K, Likittanasombat K, Tunsanga K, Kuasirikul S, Malasit P, Tansupasawadikul S, Tatsanavivat P
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033, USA.
Circulation. 1997 Oct 21;96(8):2595-600. doi: 10.1161/01.cir.96.8.2595.
Between 1981 and 1988, the Centers for Disease Control and Prevention reported a very high incidence of sudden death among young male Southeast Asians who died unexpectedly during sleep. The pattern of death has long been prevalent in Southeast Asia. We carried out a study to identify the clinical markers for patients at high risk of developing sudden unexplained death syndrome (SUDS) and long-term outcomes.
We studied 27 Thai men (mean age, 39.7+/-11 years) referred because they had cardiac arrest due to ventricular fibrillation, usually occurring at night while asleep (n=17), or were suspected to have had symptoms similar to the clinical presentation of SUDS (n=10). We performed cardiac testing, including EPS and cardiac catheterization. The patients were then followed at approximately 3-month intervals; our primary end points were death, ventricular fibrillation, or cardiac arrest. A distinct ECG abnormality divided our patients who had no structural heart disease (except 3 patients with mild left ventricular hypertrophy) into two groups: group 1 (n=16) patients had right bundle-branch block and ST-segment elevation in V1 through V3, and group 2 (n=11) had a normal ECG. Group 1 patients had well-defined electrophysiological abnormalities: group 1 had an abnormally prolonged His-Purkinje conduction time (HV interval, 63+/-11 versus 49+/-6 ms; P=.007). Group 1 had a higher incidence of inducible ventricular fibrillation (93% for group 1 versus 11% for group 2; P=.0002) and a positive signal-averaged ECG (92% for group 1 versus 11% for group 2; P=.002), which was associated with a higher incidence of ventricular fibrillation or death (P=.047). The life-table analysis showed that the group 1 patients had a much greater risk of dying suddenly (P=.05).
Right bundle-branch block and precordial injury pattern in V1 through V3 is common in SUDS patients and represents an arrhythmogenic marker that identifies patients who face an inordinate risk of ventricular fibrillation or sudden death.
1981年至1988年间，美国疾病控制与预防中心报告称，东南亚年轻男性中猝死发生率极高，这些男性常在睡眠中意外死亡。这种死亡模式在东南亚长期存在。我们开展了一项研究，以确定有发生不明原因猝死综合征（SUDS）高风险患者的临床标志物及长期预后情况。
我们研究了27名泰国男性（平均年龄39.7±11岁），这些患者因室颤导致心脏骤停前来就诊，室颤通常发生在夜间睡眠时（n = 17），或被怀疑有与SUDS临床表现相似的症状（n = 10）。我们进行了心脏检查，包括心内电生理检查（EPS）和心导管检查。然后对患者进行大约每3个月一次的随访；我们的主要终点是死亡、室颤或心脏骤停。一种独特的心电图异常将无结构性心脏病（除3例轻度左心室肥厚患者外）的患者分为两组：第1组（n = 16）患者有右束支传导阻滞及V1至V3导联ST段抬高，第2组（n = 11）心电图正常。第1组患者有明确的电生理异常：第1组希氏束-浦肯野纤维传导时间异常延长（HV间期，63±11毫秒对49±6毫秒；P = 0.007）。第1组可诱导性室颤发生率更高（第1组为93%，第2组为11%；P = 0.0002），信号平均心电图阳性率更高（第1组为92%，第2组为11%；P = 0.002），这与室颤或死亡发生率更高相关（P = 0.047）。生存分析表明，第1组患者猝死风险大得多（P = 0.05）。
V1至V3导联右束支传导阻滞和胸前导联损伤模式在SUDS患者中常见，代表一种致心律失常标志物，可识别面临室颤或猝死极高风险的患者。
