下壁导联心电图异常改变:Brugada综合征患者预后不良的信号?

Abnormal inferior wall lead ECG changes:a sign of poor prognosis for Brugada syndrome?

目的寻找评估和预测Brugada综合征猝死风险的手段。方法使用维普全文数据库检阅文献,获取87例Brugada综合征原始文献,符合入选标准的Brugada综合征25例,根据患者有无死亡及其家族中有无猝死病史,分为猝死组(n=10)和非猝死组(n=15),比较两组肢体导联QRS波电压和形态变化。结果猝死组Ⅱ、aVF和aVR导联QRS波电压显著低于非猝死组。猝死组下壁导联1型(至少一个导联T波宽而平坦,升支僵直及ST段不可辩认)和/或2型(至少一个导联QRS波矮小,连同T波和P波形成老鹰飞翔样)变化显著高于非猝死组。结论Brugada综合征患者的体表肢导联,特别是下壁导联心电图可能包含着患者的预后信息。

Objective To explore methods for evaluation and prediction of Brugada syndrome patients at high risk of sudden cardiac death. Methods Literature retrieval was completed by using the Chongqin VIP data bank. A totaX of 87 Brugada syndrome patients were enrolled, out of which 25 patients met the inclusion criteria. The 25 patients were divided into sudden death group （ n = 10） and non-sudden death group （ n = 15 ） on the basis of presence or absence of sudden cardiac death of patients and/or their family members. QRS complex amplitudes in limb leads and two type distributions over inferior wall leads were compared between two groups. Results QRS complex amplitudes of Ⅱ , aVF and aVR leads in sudden death group were significantly lower than those in non sudden death group. Type 1 （ the combination of a loss of ST segment, a stiff up-slope limb of T wave and a wide, flattened T wave in at least one of limb leads） and/or type 2 （ the combination of P wave, T wave and reduced QRS complex amplitude being like a flying eagle in at least one of limb leads） changes of inferior wall leads in sudden death group were significantly higher than those in non sudden death group. Conclusion Surface limb leads, in particular, inferior wall lead ECGs, probably have prognostic implications for Brugada syndrome patients.