Prognostic value of T-wave alternans in survivors of ventricular fibrillation or hemodynamically unstable ventricular tachycardia
Prognostic value of T-wave alternans in survivors of ventricular fibrillation or hemodynamically unstable ventricular tachycardia
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T 波交替对心室颤动或血流动力学不稳定室性心动过速幸存者的预后价值
DOI：
10.1016/j.joa.2014.02.010
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发表时间：
2014
影响因子：
2
通讯作者：
Takeishi Y
中科院分区：
文献类型：
--
作者：
Yamada S;Suzuki H;Kaneshiro T;Kamiyama Y;Saitoh S;Takeishi Y
研究背景T波电交替可用于预测各种心脏疾病中室性快速心律失常和心源性猝死的发生。然而，鲜为人知的是，T波电交替测量的幸存者的心室颤动（VF）或血流动力学不稳定的室性心动过速（VT）的临床意义。MethodsWe研究了28例器质性心脏病谁幸存VF或血流动力学不稳定的VT（20名男性，平均年龄63岁）。在植入式心律转复除颤器（ICD）前进行超声心动图、心电图（QRS时限和QTc间期）和霍尔特监测（心率变异性、心率震荡和T波电交替）。阳性T波电交替定义为>65 μV。在随访期间（10.2±6.2个月），8名患者（29%）发生了需要适当电击治疗的室性快速性心律失常。根据是否需要适当的电击治疗（n=8，A组）或不需要（n=20，B组），将受试者分为两组。比较两组患者的超声心动图、心电图和霍尔特监测参数与ICD植入后休克治疗发生率的关系。结果A组患者T波电交替阳性率明显高于B组（88%vs.15%，P =0.004）。单因素考克斯比例风险分析显示，在测量的变量中，只有T波电交替对复发性室性快速性心律失常有预测力（风险比，13.17; 95%置信区间：1.606-108.1,P=0.016）。结论T-通过霍尔特监测的波电交替对于预测VF或血流动力学不稳定VT幸存者的复发性室性快速性心律失常是有用的。
BackgroundT-wave alternans is useful for predicting the occurrence of ventricular tachyarrhythmias and sudden cardiac death in various heart diseases. However, little is known about the clinical significance of T-wave alternans measurement in survivors of ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT).MethodsWe studied 28 patients with organic heart disease who survived VF or hemodynamically unstable VT (20 males, mean age 63 years). Echocardiography, electrocardiogram (QRS duration and QTc intervals), and Holter monitoring (heart rate variability, heart rate turbulence and T-wave alternans) were performed before implantable cardioverter-defibrillator (ICD) implantation. Positive T-wave alternans was defined as >65 μV. During the follow-up period (10.2±6.2 months), ventricular tachyarrhythmias requiring appropriate shock therapy occurred in eight patients (29%). The subjects were divided into two groups, based on whether appropriate shock therapy was required (n=8, Group A) or not (n=20, Group B). Parameters from echocardiography, electrocardiogram, and Holter monitoring were compared between the two groups in order to investigate their relationship with the incidence of shock therapy after ICD implantation.ResultsThe prevalence of positive T-wave alternans was significantly higher in Group A than in Group B (88% vs. 15%,P=0.004). Univariate Cox proportional hazard analysis showed that, among the variables measured, only T-wave alternans had predictive power for recurrent ventricular tachyarrhythmias (hazard ratio, 13.17; 95% confidence interval: 1.606–108.1,P=0.016).ConclusionsThese results suggest that T-wave alternans by Holter monitoring is useful for predicting recurrent ventricular tachyarrhythmias in survivors of VF or hemodynamically unstable VT.