先天性长QT综合征的动态心电图监测

The dynamic electrical cardiogram monitor in Long QT syndrome patients

目的研究12导动态心电图在先天性长QT综合征（LQTS）动态监测中的作用。方法 LQTS患者和健康对照者各9例,监测动态心电图,动态评价静息和运动中QTc间期和QT离散度（QTcd）的变化以及心律失常发生情况。结果 LQTS组,最大QTc0.60±0.07s,正常对照组,最大QTc0.45±0.03s（p〈0.05）;平均QTc0.52±0.05s而对照组为0.42±0.02s（p〈0.05）;QTcd0.17±0.07s而对照组为0.06±0.04s（p〈0.05）。LQTS组1例尖端扭转型室速发作,发作前可见T波电交替现象。5例患者监测动态心电图4~9年,QTc间期和QTc离散度没有明显变化。结论 LQTS患者,QTc均明显延长,QTcd明显增加,且不受心率影响;长期监测动态心电图没有发现QTc的逐年变化,病情加重期间动态心电图记录到T波电交替和尖端扭转型室速。动态心电图是LQTS的评估、监测必不可少的无创性手段。

Objective To evaluate the 12 leads dynamic electrical cardiogram changes in Long QT syndrome （LQTS）. Methods Dynamic electrical cardiogram was delivered to nine clinical conformed LQTS patients and nine normal control to monitor QTc and QTc dispersion （QTcd） changes in the rest and during exercise and detect arrhythmias episodes. Dynamic ECG had been monitored more than 4 years to observe the dynamic changes of QTc and QTcd in five LQTS cases. Results The maximum QTc was 0.60i-0.07s in LQTS and 0.45i-0.03s in control（p〈0.05）. The average QTc was 0.52±0.05s in LQTS and 0.42±0.02s in control （p〈0.05）. QTcd was 0.17±0.07s in LQTS and 0.06±0.04s in control （p〈0.05）. Torsade de Point （TdP） was recorded in one LQTS case preceding with T wave alternas. Conclusions QTc and QTcd were prolonged in LQTS regardless of rate changes. QTc was relatively stable in LQTS with long term Dynamic monitor. T wave alternans was recorded before Tdp. Dynamic monitor was reliable in the diagnosis and evaluation of LQTS.