ELECTRICAL ALTERNANS AND VULNERABILITY TO VENTRICULAR ARRHYTHMIAS
ELECTRICAL ALTERNANS AND VULNERABILITY TO VENTRICULAR ARRHYTHMIAS
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DOI：
10.1056/nejm199401273300402
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发表时间：
1994-01-27
影响因子：
158.5
通讯作者：
COHEN, RJ
中科院分区：
文献类型：
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作者：
ROSENBAUM, DS;JACKSON, LE;COHEN, RJ
背景虽然电交替（心电图上搏动与搏动之间的交替幅度）在许多临床环境中与室性心律失常相关，但其生理重要性和预后意义仍不清楚。为了验证电交替是室性心律失常的标志这一假设，我们开发了一种技术来检测心电图形态特征的细微变化（这是心电图目视检查无法检测到的）。在一组83例接受诊断性电生理检查的患者中，我们前瞻性地检查交替电位水平是否可预测心律失常的易感性，其定义为电生理检查结果和无心律失常生存率。在32名患者（39%）的电生理测试中诱发了持续性室性心律失常。在该组中，在广泛的生理心率范围内（从每分钟95到150次心跳）检测到低水平电交替（< 15 μ V的搏动到搏动的幅度变化），并且主要涉及ST段和T波（即，复极化阶段）。复极过程中的交替是电生理测试中诱导性心律失常的一个重要和独立的预测因素（敏感性，81%;特异性，84%;相对危险度，5.2）。在66例随访长达20个月的患者中，13例发生了腹泻事件。影响T波的电交替和室性心律失常的诱发率是无心律失常生存率的显著和基本等效的预测因素（P
Background. Although electrical alternans (alternating amplitude from beat to beat on the electrocardiogram) has been associated with ventricular arrhythmias in many clinical settings, its physiologic importance and prognostic implications remain unknown.Methods. To test the hypothesis that electrical alternans is a marker of vulnerability to ventricular arrhythmias, we developed a technique to detect subtle alternation in the morphologic features of the electrocardiogram (which would not be detectable by visual inspection of the electrocardiogram). In a group of 83 patients referred for diagnostic electrophysiologic testing, we prospectively examined whether levels of alternans predicted vulnerability to arrhythmias as defined by the outcome of electrophysiologic testing and arrhythmia-free survival.Results. Sustained ventricular arrhythmias were induced during electrophysiologic testing in 32 of the patients (39 percent). In this group, low-level electrical alternans (a beat-to-beat change in amplitude of < 15 muV) was detected over a broad range of physiologic heart rates (from 95 to 150 beats per minute) and primarily involved the ST segment and the T wave (i.e., the phase of repolarization). Alternans during repolarization was a significant and independent predictor of inducible arrhythmias on electrophysiologic testing (sensitivity, 81 percent; specificity, 84 percent; relative risk, 5.2). Of 66 patients followed for up to 20 months, 13 had arrhythmic events. Alternans affecting the T wave and inducibility of ventricular arrhythmias were significant and essentially equivalent predictors of survival without arrhythmia (P