不同部位陈旧性心肌梗死伴碎裂QRS波与室性心律失常的关系

Relationship between different parts of old myocardial infarction complicating fQRS and types of ventricular arrhythmias

目的通过分析不同部位陈旧性心肌梗死（old myocardial infarction,OMI）伴碎裂QRS波（fQRS）患者室性心律失常的发生情况,探讨OMI患者梗死部位与室性心律失常的关系。方法根据心电图及彩色多普勒特征,选择147例伴fQRS与室性心律失常的OMI患者,分为前壁梗死组（A组）、下壁梗死组（B组）、侧壁梗死组（C组）,并对所有病例进行24 h动态心电图检查,分别进行室性心律失常结果对比分析。结果A组与B组对比,短阵室速发生率（P〈0.05）、室早Lown分级35级发生率（P〈0.05）的差异有统计学意义;A组与C组对比,室早总数〈720个/24 h（P〈0.05）发生率差异有统计学意义;B组与C组比较差异无统计学意义。结论伴fQRS与室性心律失常的OMI患者中,梗死部位不同,室性心律失常的常见类型不同,进一步增加了fQRS波对OMI的诊断灵敏度,以便进行早期干预,降低心源性猝死的发生率。

Objective By analyzing the incidence of ventricular arrhythmias in patients with old myocardial infarction （OMI ）in different parts complicating fragmented QRS complex （fQRS ）,to explore the relationship between parts of infarction in OMI patients and arrhythmias.Methods One hundred and forty-seven OMI patients with fQRS and ventricular arrhythmia were divided into anteri-or infarction group（group A）,inferior infarction group（group B）and lateral wall infarction group （group C）by ECG and colored Doppler characteristics.All of the enrolled cases underwent 24-hour Holter inspections and their results about ventricular arrhythmias were separately made comparative analysis.Results Comparing between group A and group B,the differences of incidences of non-sustained ventricular tachycardia and PVCs Lown grade 3 to 5 were statistically significant （P〈0.05）.Comparing between group A and group C,the incidence of total number of PVCs〈720/24 h was statistically significantly different（P〈0.05 ）.There was no statistically significant difference between group B and group C.Conclusion Among the OMI patients complicated by fQRS and ventricular arrhythmias,the usual type of ventricular arrhythmia differs with the parts of infarction,which increases the diagnostic sensitivity of fQRS for OMI further so as to make early in-tervention and reduce the incidence of sudden cardiac death.