第26课 aVR征与Brugada综合征的危险度分层

Lesson Twenty-six aVR Sign and Risk Stratification in Brugada Syndrome

背景Bmgada综合征（Bs）的危险度分层尚有争议，尤其在无症状的患者更是如此。目的本研究目的为评价aVR导联在Bmgada综合征患者中的意义。 方法将24例患有Bmgada综合征心电图图形的病人（均为男性，平均年龄32．1±13．6岁）作为研究组和24名年龄、性别相匹配的健康人作为对照组进行了研究。结果13例Bmgada综合征患者有症状（10例晕厥，3例为猝死幸存者），有症状复发史的患者aVR导联的R波振幅或R／q比例明显大于无复发的患者。aVR征是界定于该导联的R波振幅1〉0．3mV或R/q〉0．75，极大多数有反复发作史的患者呈现aVR征（图1）；在随访的50个月中，伴有aVR征的Bmgada综合征患者84％发生了心血管事件。在有症状的患者中，12例于随访期内症状复发[10例检测到多形性室性心动过速和／或心室颤动，由ICD及时放电而转复（窦性）心律，2例发生了晕厥]。而与其对比，没有aVR征的Bmgada综合征患者在随访期内仅有27％发生了心血管事件（2例患者均为多形性室性心动过速和／或心室颤动）。费歇尔精确概率检验有意义（P=0．01）。 结论本研究显示了在aVR导联有优势的R波（aVR征）与Bmgada综合征患者发生心律失常的危险之间有明显的相关性。在呈现Bmgada综合征时，aVR导联优势的R波可能反映了右心室的传导较为延缓和随之发生较显著的（生物）电异质性，后者又与较高的心律失常危险相关。

Background Risk stratification in Brugada syndrome（BS） is controversial,cespevially in asymptomatic individuals. Objective The aim of this study was to evaluate the significance of lead aVR in patients with BS. Methods Twenty-four patients with the electrocardiogram pattren of BS （24 male, mean age 32.1±13.6 years） as research group and 24 healthy age - and gen- der-matched controls were studied. Results Thirteen patients with BS were symptomatic （10 had syncope and 3 had aborted sudden death）. The R-wave amplitude or R/q ratio in lead aVR was significantly greater in patients esperiencing a recur-rence compared with those who did not. the aVR sign was defined as R wave ≥ 0.3mV or R / q ≥ 0.75 in lead aVR. Most of the recurrences （78%）were in patients with present aVR sign （Figure 1 ）; 84% of BS patients with present aVR sign had events during 50 months of fol- low-up, Of the symptomatic patients,12 suffered a recurrence during the follow-up period （10 had polymorphic VT and / or VF that was detected and converted by appropriate discharge of the ICD, and 2 had syncope）. In contrast, only 27% of BS patients with absent aVR sign had events during follow-up （2 had polymorphic VT and/or VF）, Values are Fisher Exact test （P=0.01）. Conclusion Our study shows significant correla tion between a prominent R wave in lead aVR（aVR sign） and risk for development of arrhythmic events in BS. In the presence of BS, promient R wave in lead aVR may reflect more fight ventricular conduction delay and subsequently more electrical heterogeneity,which in turn is responsible for higher risk of arrhythmia.