J波、JTc、Tp-ec间期对心脏再同步治疗除颤器患者术后触发治疗的预测价值

摘要

目的：探讨置入心脏再同步治疗除颤器( CRT-D)患者术前标准12导联心电图中J波、校正JT间期( JTc)、校正Tp-e间期( Tp-ec)对术后触发治疗的预测价值及其相关性。方法选取CRT-D置入患者192例,留取术前标准12导联心电图。读取最长JTc导联中JTc、Tp-ec间期,记录J波阳性病例数。所有患者进行术后随访,程控仪观察识别腔内电图图形并完善体表心电图收集。结果其中接受过触发治疗者(抗心动过速起搏和除颤)44例(触发治疗组),未接受过触发治疗者148例(未触发治疗组),触发治疗组J波阳性率大于未触发治疗组(P<0．05),JTc(P<0．05)、Tp-ec(P<0．001)显著延长。当 JTc≥358．50 ms、Tp-ec≥116．47 ms时,患者术后接受CRT-D触发治疗的风险显著增加,且与术后恶性心律失常的发生有一定相关性,影响患者预后,而J波的预测价值不确定。结论慢性心力衰竭患者术前JTc、Tp-ec的增大增加了CRT-D术后恶性心律失常的发生风险,当JTc≥358．50 ms、Tp-ec≥116．47 ms时,患者发生恶性心律失常的风险显著增加,并可能作为是否接受触发治疗的预测指标。%Objective To explore the predictive value of J wave,JTc,Tp-ec frompreoperative 12-lead electrocardio-gram (ECG)on triggered treatment in patients with cardiac resynchronization therapy defibrillator(CRT-D). And the association of these indicators with triggered therapy was also analyzed. Methods 192 patients with CRT-D, were selected. JTc and Tp-ec from the lead which had the longest JTc of each patient and the number of J wave-positive cases were recorded. All patients were completed follow-up. Intraelectrocardiogram was determined based on routine and directed device interrogations and 12-lead electrocardiogram was made. Results 44 patients re-ceived triggered treatment( triggered group) and other 148 patients did not( non-triggered group) in the end of 1 year follow-up. The result showed that triggered group the J wave positive(P<0. 05),JTc(P<0. 05),Tp-ec(P<0. 001) were significantly higher than non-triggered group. After adjustment for other related factors,like left ven-tricular ejection fraction( LVEF) ,left ventricular end diastolic diameter( LVEDD) ,history of malignant arrhythmia, the result showed that patients received triggered treatment had increased JTc,Tp-ec than those who did not receive triggered treatment,especially when JTc≥358. 50 ms,Tp-ec≥116. 47 ms. They were associated with malignant ar-rhythmia and prognosis. But J wave positive had no significant difference between the two groups. Conclusion In the indicators from preoperative ECG representatived ventricular repolarization,JTc,Tp-ec are positively related to malignant arrhythmia. Especially when JTc≥358. 50 ms,Tp-ec≥116. 47 ms,patients with CRT-D have higher risks for malignant arrhythmia and these two indicators could be used to predict triggered treatment.