Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men
Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men
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DOI：
10.1161/01.cir.96.8.2595
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发表时间：
1997-10-21
期刊：
影响因子：
37.8
通讯作者：
Tatsanavivat, P
中科院分区：
文献类型：
--
作者：
Nademanee, K;Veerakul, G;Tatsanavivat, P
1981年至1988年，疾病控制和预防中心报告了东南亚年轻男性在睡眠中意外死亡的猝死发生率非常高。这种死亡模式在东南亚长期以来一直很普遍。我们进行了一项研究，以确定发生不明原因猝死综合征（SUDS）的高风险患者的临床标志物和长期结局。（平均年龄，39.7 ± 11岁），因为室颤导致心脏骤停，通常发生在夜间睡眠时（n=17），或怀疑有与SUDS临床表现相似的症状（n=10）。我们进行了心脏检查，包括EPS和心导管插入术。然后每隔大约3个月对患者进行随访;我们的主要终点是死亡、室颤或心脏骤停。一个明显的心电图异常分为两组，我们的病人谁没有结构性心脏病（除了3例轻度左心室肥大）：组1（n=16）的患者有右冠状支传导阻滞和ST段抬高的V-1至V-3，和组2（n=11）有正常的心电图。第1组患者有明确的电生理异常：第1组有异常延长的希氏-浦肯野传导时间（HV间期，63+/-11 vs 49+/-6 ms; P=.007）。第1组诱导性室颤的发生率较高（第1组为93%，第2组为11%; P=.0002），平均ECG信号阳性（第1组为92%，第2组为11%; P=.002），这与室颤或死亡的发生率较高相关（P=.047）。生命表分析表明，第1组患者有更大的风险突然死亡（P= 0.05）。结论右冠状动脉分支阻滞和心前区损伤模式在V，通过V;是常见的SUDS患者，并代表一个致心律失常的标志物，识别患者谁面临着过度的心室颤动或猝死的风险。
Background Between 1981 and 1988, the Centers for Disease Control and Prevention reported a very high incidence of sudden death among young male Southeast Asians who died unexpectedly during sleep. The pattern of death has long been prevalent in Southeast Asia. We carried out a study to identify the clinical markers for patients at high risk of developing sudden unexplained death syndrome (SUDS) and long-term outcomes.Methods and Results We studied 27 Thai men (mean age, 39.7+/-11 years) referred because they had cardiac arrest due to ventricular fibrillation, usually occurring at night while asleep (n=17), or were suspected to have had symptoms similar to the clinical presentation of SUDS (n=10). We performed cardiac testing, including EPS and cardiac catheterization. The patients were then followed at approximate to 3-month intervals; our primary end points were death, ventricular fibrillation, or cardiac arrest. A distinct ECG abnormality divided our patients who had no structural heart disease (except 3 patients with mild left ventricular hypertrophy) into two groups: group 1 (n=16) patients had right bundle-branch block and ST-segment elevation in V-1 through V-3, and group 2 (n=11) had a normal ECG. Group 1 patients had well-defined electrophysiological abnormalities: group 1 had an abnormally prolonged His-Purkinje conduction time (HV interval, 63+/-11 versus 49+/-6 ms; P=.007). Group 1 had a higher incidence of inducible ventricular fibrillation (93% for group 1 versus 11% for group 2; P=.0002) and a positive signal-averaged ECG (92% for group 1 versus 11% for group 2; P=.002), which was associated with a higher incidence of ventricular fibrillation or death (P=.047). The life-table analysis showed that the group 1 patients had a much greater risk of dying suddenly (P=.05).Conclusions Right bundle-branch block and precordial injury pattern in V, through V; is common in SUDS patients and represents an arrhythmogenic marker that identifies patients who face an inordinate risk of ventricular fibrillation or sudden death.