酒精消融室间隔治疗肥厚型梗阻性心肌病对QT离散度的影响

The effect on QT dispersion of hypertrophic obstructive cardiomyopathy with the therapy of alcohol septal ablaton

目的观察酒精消融室间隔(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)术前、术后及远期QTd、QTcd及心功能变化,探讨其是否影响HOCM患者恶性心律失常及心脏性猝死.方法对2001年3月至2003年12月辽宁省人民医院收治的辽东地区经超声诊断并符合酒精消融术标准的HOCM患者27例.男性15例,女性12例;年龄(47±12)岁;NYHA分级3.1±0.9.利用Sigwart法行酒精消融室间隔术(经皮经腔间隔心肌消融术,PTSMA).术前,术后1周、6月、12月作12导联体表静息心电图.术中及术后连续心电监护48～72 h,分别测定QTd,并根据Bazett公式校正为QTcd.结果术前平均左室压力阶差(LVOTG)为(72.4±24.6)mmHg,术中球囊加压后为(30.6±18.5)mmHg,术后为(24.3±17.6)mmHg,差异均有显著性(P<0.001).术中心电监测,无严重室性心律失常发生.术后所有病人主观症状减轻,随访期间1例患者于6月后出现新发室早,无室速及室颤.27例患者中,5例由于通信地址迁移随访失败.QTd(QTcd)术前,术后1周、6月、12月分别为71±33(73±35)ms,74±18(72±17)ms,68±31(81±38)ms,69±29(74±32)m,比较不同时期QTd与QTcd,无统计学意义(P>0.05),QT(QTc)术前、术后1周分别为433±22(439±32)ms,475±23(470±23)ms,术前与术后比较有显著性差异(P<0.01).术前、术后1周心功能分级分别为3.1±0.9、1.6±0.7,随访6月、12月分别为1.5±0.8、1.7±0.6,术前与术后不同时期比较有显著性差异,其中2例6个月后心功能恢复正常.HT、JTc、JTd、JTcd术前与术后各时期比较无显著性差异.结论PTSMA改善HOCM患者心功能及临床症状,QTd、QTcd无显著性变化,可能对恶性心律失常及预后没有影响.

Objective To discuss whether the therapy of alcohol septal ablation can reduce the serious ventri cular arrhythmias and sudden death by observing the change of QT, QTe dispersion and heart function in patients with hypertrophic obstructive eardiomyopathy（HOCM） before and after the procedure of alcohol ablation on ventri eular septum. Methods 27 patients with HOCM underwent pereutaneous septal ablation from February 2001 to December 2003. The ECGs before and after procedure and 24 hours ambulatory monitoring up to one year were analyzed. ECG data were related to left ventri eular outflow tract pressure gradients（ LVOTG）. The heart function before and after the procedure was evaluated by the standard of New York Heart Association with one year follow - up. Results Acute reduction of the mean LVOTG was achieved from （72. 8 ± 24. 6 ） mmHg to （24. 3 ± 17.6 ） mmHg （ P 〈 0. 001 ）. There was significant but transient prolongation of QT - mean and QTe - mean intervals （ P 〈 0. 05 ）. QT dispersion （ QTd ） , QTe dispersion （ QTed ） , and JT, JTc, JTd, jTcd were not affected. Either before or after the procedure no serious ventrieular arrhythmias were recorded during holter monitoring, but ventrieular premature was recorded in one patient after 6 months. Total patients showed clinical improvement to NYHA - class 1.6 ±0. 7 after 1 week, 1.5 ± 0. 8 after 6 months, and 1.7 ±0. 6 after 1 year respectively （ P 〈 0. 001, each）. Two patients became normal after six months. Conclusion Alcohol septal ablation for HOCM does not affect QTd, QTed while the heart function and clinical symptoms have improved. Therefore, alcohol septal ablation probably does not reduce the occurrence of serious ventrieular arrhythmias and sudden death.