摘要
本文对271例室性早搏(室早)病例进行了常规心电图、基础疾病和左室形态结构的研究、证实宽大挫折型(QRS≥0.14秒且存在宽度≥0.04秒的切迹,或QRS>0.16秒)室早(B 型室早,n=54)组几乎100%存在器质性心脏病,左室重量(165±42g/m^2,132±34g/m^2,P<0.01)和左室舒张末期内径(54±11mm 对47±8mm,P<0.01)均显著大于普通室早(A 型室早)组。讨论了B 型室早与复杂心律失常的关系及其发生机理,暗示:(1)宽大挫折型(B 型)室早患者多有基础器质性心脏病,且常合并左室肥大(阳性正确率83%)或左室扩大(阳性正确率70%);(2)B 型室早可能属潜在恶性室早;(3)临床拟用阻滞钠通道抗心律失常药尤其是IC 类时,检出B 型室早用药者宜持慎重态度。
The Routine electrocardiogram,underlying disease and left ventri-cular structure were studied in 271patients with premature ventricularcommplex(PVC).It was demons-trated that group Type B PVC(n=54),which had broad(≥0.04 sec)notching of long duration(≥0.14sec)or had longer duration(>0.16sec),nearly 100% had organiccardiac disease.Left ventr icularmass(165±42g/m^2vs.132±34g/m^2,p<0.01)and left ventricular internaldiameter at end diastole(54±11mmvs.47±8mm,p<0.01)significantlydiscriminated between group Type Band group common(Type A)PVC.The relationship with complex PVCand mechanism of Type B PVC werediscussed and the suggestions are(1)pationts with a broadly notchedPVC of long duration(Type B)always had un-derlying organiccardiac disease and left ventricularhypertrophy(positive predictivevalue 83%)or left ventric ular dila-tation(positive predictive value70%):(2)Type B PVC can,probably,be considered as potentiallymalignant PVC;(3)Type B PVCperhaps can serve to prompt additi-onal caution when con templating theuse antiarrhythmic drrugs withsodium channel blocking,especiallyclass IC agents.
