陈旧心梗碎裂QRS波与室性心律失常的关系

Relationship of the fragmented QRS and ventricular arrhythmia in old myocardial infarction

目的探讨陈旧性心肌梗死碎裂QRS波(Fragmented QRS complex,fQRS)及其时限与室性心律失常的关系。方法回顾性分析150例明确诊断陈旧性心肌梗死患者,根据常规心电图fQRS的有无,将研究对象分为fQRS组(A组,75例)和非fQRS组(B组,75例),A组根据fQRS时限,化分为N组(时限<0.12s,58例)、W组(≥0.12s,17例)。所有病例均进行动态心电图检查,分别统计室性心律失常的发生率。结果 fQRS组24h室性早搏的发生率明显高于非fQRS组[66.7%vs.29.3%,p<0.01],复杂室性心律失常的发生率明显高于非fQRS组[33.3%vs.8.0%],p<0.01)。N组室性心律失常发生率与W组比较差异无明显统计学意义(67.2%vs.64.7%,p>0.05)。W组恶性室性心律失常的发生率明显高于与N组(17.6%vs.0%,p<0.01)。结论陈旧性心肌梗死伴fQRS者较不伴fQRS者室性心律失常发生率明显增加,随着fQRS时限的增宽,其室性期前收缩的总发生率无明显增加,但室速、室颤等恶性心律失常的发生率明显增加。

Objective To explore the relationship of the fragmented QRS（fQRS） and ventricular arrhythmia in old myocardial infarction（OMI）. Methods We contrasted the incidence of ventricular arrhythmia in OMI patients with or without fQRS. We also compare the incidence of ventricular arrhythmia in different fQRS duration. According to the routine electrocardiogram, 150 OMI patients were divided into group A（fQRS appearance, 75 cases） and group B（fQRS non-appearance, 75 cases）. According to the fQRS duration, the patients in group A were divided into 2 groups： group N（0.120s, 58cases）, group W（≥0.120s 17cases）. All the patients were continuously monitored with 24 hours dynamic electrocardiogram,and the incidence of ventricular arrhythmia was analyzed. Results The incidence of ventricular arrhythmia in groupA[66.7%（50/75）] was higher than that in groupB[29.3%（22/75）]（p0.01）. The incidence of Lown 3-5 grades PVC was 33.3%（25/75） in group A,8.0%（6/75） in group B, there were significant differences between two groups（p0.01）. The incidence of ventricular arrhymia in group N [67.2%（39/58）] and group W [64.7%（11/17）]was no significant difference（p0.05）, however, the incidence of ventricular fibrillation were significant differences between two groups（17.6% vs. 0%, p0.01）. Conclusions OMI patients with fQRS have higher incidence and severe degree in ventricular arrhythmia than those without fQRS. With the fQRS dimension widened, the incidence of ventricular fibrillation was higher. So fQRS is a new predicting index of OMI, and fQRS duration has definite value in predicting the heart event for OMI patients.