Classification and mechanism of Torsade de Pointes initiation in patients with congenital long QT syndrome
Classification and mechanism of Torsade de Pointes initiation in patients with congenital long QT syndrome
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DOI：
10.1016/j.ehj.2004.08.020
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发表时间：
2004-12-01
影响因子：
39.3
通讯作者：
Kamakura, S
中科院分区：
文献类型：
--
作者：
Noda, T;Shimizu, W;Kamakura, S
目的探讨先天性QT间期综合征(LQTS)患者尖端扭矩(TDP)的诱发方式。方法与结果对24例LQTS患者的心电图记录111次TDP进行分析。明确了起搏方式、连续三个RR间期(C-2、C-1、C-0)、模拟室性早搏(PVC)的时机和TDP的周期长度(CL)。观察到三种不同的起搏模式：(1)“短-通-短”(SLS)模式(23例，72例TDP，65%)，定义为一个或多个短-长周期，然后启动短耦合PVC(C-1和GT；C-2和C-0)；(2)“窦性心率增加”(ISR)模式(8例，28 TDP，)。(3)“改变的去极化”(CD)模式(5例患者，11例TDP，10%)，定义为突然的钳状或融合搏动，随后是短对偶的PVC。ISR、SLS和CD的C-0较短(平均C-0：488，分别为587和603 ms；P<；0.05)。因此，起始性室性心动过速出现在ISR前最后一次搏动的T波峰附近，而SLS和CD则出现在T波峰之后。结论先天性LQTS患者存在三种主要的TDP启动模式，提示每种启动模式的启动机制不同。(C)2004年欧洲心脏病学会。爱思唯尔有限公司出版。版权所有。
Aims To examine the initiating mode of Torsade de Pointes (TdP) in patients congenital tong QT syndrome (LQTS).Methods and results We evaluated 111 episodes of TdP recorded on the electrocardiograms of 24 patients with congenital LQTS. and clarified the initiating mode, three consecutive preceding RR intervals defined as C-2, C-1, and C-0, the timing of imitiating premature ventricular contraction (PVC) and the cycle length (CL) of TdP. Three different initiating patterns were observed: (1) a "short-tong-short" (SLS) pattern (23 patients, 72 TdP, 65%) defined as one or more short-long cycles followed by an initiating short-coupled PVC (C-1 > C-2 and C-0), (2) an "increased sinus rate" (ISR) pattern (8 patients, 28 TdP,. 25%) defined as a gradual increase sinus rate with or without T-wave alternans (C-2 greater than or equal to C-1 greater than or equal to C-0), and (3) a "changed depolarization" (CD) pattern (5 patients, 11 TdP, 10%) defined as a sudden tong PVC or fusion beat followed by short-coupled PVC. The C-0 was shorter in ISR SLS and CD (mean C-0: 488 vs. 587 and 603 ms, respectively; P < 0.05). Therefore, the initiating PVC appeared near the T-wave peak of the last beat before onset ISR, while it occurred after the T-wave peak in SLS and CD. The CL of TdP was in ISR than in SLS (256 vs. 295 ms, P < 0.05).Conclusions Our data show the existence of three predominant initiating modes TdP in patients with congenital LQTS and suggests a differential mechanism of initiation of TdP for each mode. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All reserved.