Electrocardiographic measures of repolarization revisited: Why? What? How?
Electrocardiographic measures of repolarization revisited: Why? What? How?
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DOI：
10.1054/jelc.2001.28909
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发表时间：
2001-01-01
影响因子：
1.3
通讯作者：
Brockmeier, K
中科院分区：
文献类型：
--
作者：
Lux, RL;Hilbel, T;Brockmeier, K
心室复极对于临床心脏病学家和心脏电生理学家来说仍然是一个谜。一方面，一个世纪的经验证明，异常 T 波形态、QT 延长和离散、T 波交替和非特异性 ST-T 波与心律失常风险或负面预后结果之间存在关联。另一方面，分子电生理学的最新进展明确表明，与复极相关的心脏离子通道的异常功能和结构是长 QT 综合征、布鲁格达综合征、特发性心室颤动和室性心动过速的主要致心律失常机制。尽管拥有丰富的临床经验和新建立的机械知识，但用于可靠评估风险和预测心律失常发生的可靠复极测量和敏感算法仍然难以实现。对心电图波形的新见解反映并捕获了复极的潜在空间和动态特征，这为设计复极临床指标提供了机会，这些指标可能比目前使用的指标更能预测风险或结果。实验和模型数据表明，复极损伤的位置和大小可以从 T 波形推断出来。由激活序列改变引起的复极变化以及周期长度介导的复极改变提供了额外的方法来评估与心律失常风险增加相关的此类病变的程度和重要性。本文探讨了对复极及其变化敏感的复极指数，这些指数为更好地表征和评估复极的风险分层提供了机会。
Ventricular repolarization continues to be an enigma to clinical cardiologists and cardiac electrophysiologists. on the one hand, a century of experience has documented an association between abnormal T-wave morphology, QT prolongation and dispersion, T-wave alternans, and nonspecific ST-T waves with arrhythmia risk or negative prognostic outcome. On the other hand, recent advances in molecular electrophysiology have definitively implicated abnormal function and Structure of cardiac ion channels associated with repolarization as primary arrhythmogenic mechanisms in long QT syndrome, Brugada's Syndrome, and idiopathic ventricular fibrillation and ventricular tachycardia. In spite of this extensive clinical experience and newly established mechanistic knowledge, robust measurements of repolarization and sensitive algorithms for reliable assessment of risk and prediction of arrhythmia occurrence have remained elusive. New insights into electrocardiographic waveform that reflect and capture the underlying spatial and dynamic characteristics of repolarization offer opportunity to devise clinical indices of repolarization that might be more predictive of risk or outcome than those currently used. Experimental and model data show evidence that the location and size of repolarization lesions may be deduced from T waveform. The changes of repolarization induced by altered activation sequence, and cycle length mediated alterations to repolarization offer additional means to assess the magnitude and significance of such lesions that are linked to increased arrhythmogenic risk. This article explores indices of repolarization that are sensitive to repolarization and its change and that provide opportunity to better characterize and assess repolarization for risk stratification.