Brugada综合征患者室性心律失常诱发及其与临床电生理关系

Inducible ventricular arrhythmia correlated with other clinical electrophysiological factors in Brugada syndrome

目的 测定Brugada综合征患者持续性室性心律失常诱发及与其他临床电生理因素的关系。方法 连续观测 5 1例Brugada综合征患者 (包括无症状性 2 2例 ) ,各例有Brugada综合征静息或钠通道阻滞剂揭示的ECG征象。测定各项临床电生理数据 ,并对右心室作程序刺激。结果 18例(35 .3% )诱发持续室性心动过速 /心室颤动 (VT/VF) (诱发组 )其H V间期 [(5 6 .5± 10 .7ms) ]明显大于未诱发组 [(48.9± 6 .8ms) ,33例 ,P =0 .0 1];H V间期 >5 5ms患者诱发组中 5例 (2 7.8% ) ,未诱发组中3例 (9.1% ,P =0 .0 9) ;钠通道阻滞剂注射后诱发组H V间期 (6 9.9± 11.2ms)显著大于未诱发组 (6 1.7± 10 .4ms ,P =0 .0 3)。多元Logistic回归分析提示 ,持续VT/VF诱发与H V间期密切相关 (β系数 =0 .10± 0 .0 4 ,Odds比 =1.11,95 %CI =1.0 6～ 1.16 ,P =0 .0 1)。结论 1/ 3以上Brugada综合征患者 (包括无症状者 )可诱发恶性室性心律失常 ,H V间期延长 ,则可能诱发室性心律失常。

Objective Patients with Brugada syndrome (BS) may have life threatening ventricular arrhythmias presumably because of dispersion of repolarization. This study was to induce sustained ventricular arrhythmias by programmed ventricular stimulations in Brugada syndrome and analyze the relationship of the inducibility of sustained ventricular arrhythmias with other clinical eletrophysiological factors.Methods Fifty one consecutive patients (including 22 asymptomatic patients) with a rest ECG Brugada' sign or a pharmacological ECG change by sodium blocker underwent electrophysiological study and programmed ventricular stimulation. Results The sustained ventricular tachycardia/ventricular fibrillations (VT/VFs) were induced in 18 patients (35.3%). H V interval in the group with inducible VT/VFs (group I, 56.5±10.7ms), was longer than that in the group without inducible sustained VT/VFs (group II, 48.9±6.8ms, P =0.01), H V interval >55ms occurred in 5 patients (27.8%) of group I and 3 patients (9.1%) in group II ( P =0.09). After intravenous injection of sodium blocker H V interval showed also longer in the group I (69.9±11.2ms) than in group II (61.7±10.4ms, P =0.03). Multivariate logistic regression analysis revealed that the induced sustained VT/VFs were significantly reluted with H V interval ( β =0.10±0.04,Odds ratio=1.11,95% CI =1.06～1.16, P =0.01). Conclusions Consistent VT/VFs may be induced by programmed ventricular stimulation in about more than one third patients with BS. Inducible ventricular tachyar rhythmias may be in relation with prolonged H V interval in patients with BS.