致心律失常性右心室心肌病右胸导联QRS时间延长的临床意义

Clinical value of localized right precordial QRS prolongation in patients with arrhythmogenic right ventricular cardiomyopathy

目的探讨致心律失常性右心室心肌病右胸导联QRS时间延长的临床意义。方法收集致心律失常性右心室心肌病25例,分析临床和常规体表心电图特征,测量QRS时间、Q-T间期等各项参数,计算右胸导联(V1～V3)和左胸导联(V4～V6)QRS时间的平均值及两者之比。结果25例致心律失常性右心室心肌病病例的年龄(37.1±15.0)岁,其中男性12例,女性13例。常规心电图中Epsilon波阳性(第1组)11例(44.0%),其中63.6%(7/11)见于V1～V3导联;Epsilon波阴性14例(第2组)。所有患者的平均QRS离散度为36.3±27.2ms,Q-T离散度为57.2±27.1ms。平均QRS时间右胸导联[QRS1=(V1+V2+V3)/3]为0.13±0.03s,而左胸导联[QRS2=(V4+V5+V6)/3]为0.11±0.02s,差异有非常显著性意义(P<0.01)。QRS1/QRS2值为1.0～1.9,其中16例(61.5%)≥1.2。发生晕厥第1组8例(72.7%),而第2组4例(28.6%)(P<0.05)。两组的QRS1分别为0.14±0.04s、0.13±0.02s,QRS2分别为0.12±0.03s和0.11±.017s,QRS1/QRS2值为1.22±0.26和1.21±0.13,差异均无显著性意义(P>0.05)。结论右胸导联平均QRS时间延长有助于诊断致心律失常性右心室心肌病,但能否作为致心律失常性右心室心肌病预后的不良因素尚须进一步研究。

Objective To investigate clinical value of QRS prolongation in right precordial leads in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Clinical and ECG data were reevaluated in 25 patients (12 male and 13 female, average age 37.1±15.0 years) with ARVC. Duration of QRS complex, QT interval, mean values of QRS in right precordial leads (QRS1) or left precordial leads (QRS2), and QRS1 / QRS2 were measured and calculated, respectively. Results Of 25 patients, 11 patients (group 1) had Epsilon wave, and 63.6%(7 / 11)of them were found Epsilon waves in right precordial leads(V1～V3). Other 14 of 25 patients (group 2) had no Epsilon wave. QRS and QT dispersion in these patients were 36.3±27.2ms and 57.2±27.1ms, respectively. Mean QRS duration was 0.13±0.03 s in QRS1 [(V1+V2+V3) / 3] and 0.11±0.02 s in QRS2 [(V4+V5+V6) / 3](P<0.01). QRS1 / QRS2 was 1.2±0.2(1.0～1.9). QRS prolongation in right precordial leads(QRS1 / QRS2≥1.2)was presented in 16 patients (61.5%). Eight patients(72.7%)had histories of syncope in group 1 and 4 patients (28.6%) in group 2 (P<0.05). Values of QRS1,QRS2 and QRS1 / QRS2 in group 1(0.14±0.04s, 0.13±0.02s and 1.22±0.26s) were similar to that in group 2 (0.13±0.02s,0.11±.017s, and 1.21±0.13)(all P>0.05). Conclustion QRS prolongation in right precordial leads maybe useful in clinical diagnosis of ARVC,especially in patients with no epsilon waves.