心脏再同步治疗对复极离散度和室性心律失常的影响

摘要

目的：探讨心脏再同步治疗（CRT）对复极离散度和室性心律失常的影响。　　方法：入选86例CRT植入患者，根据术后6个月左心室射血分数（LVEF）绝对值是否较基线水平提高≥10%，分为反应组（n=43）和无反应组（n=43）。比较两组患者CRT植入后不同时期QRS间期、校正的QT间期（QTc间期）、T波峰末间期（TpTe间期）等复极离散度指标变化及室性心律失常事件情况。　　结果：反应组患者术后1年QRS间期和TpTe间期较术前和术后<24 h明显缩短（P均<0.05），而无反应组各时期上述指标差异均无统计学意义（P>0.05）。在术后1年中，反应组室性早搏（PVCs）和室性早搏连发（PVC runs）的发生次数，明显少于无反应组[ lgPVCs：（1.78±0.77）vs（2.73±0.61）；lgPVC runs：（0.64±0.48）vs（1.98±0.72）， P<0.05]。分别对CRT术后lg（PVCs）和lg（PVC runs）的多重线性回归分析发现，术后<24 h的TpTe间期是lg（PVCs）和lg（PVC runs）的独立预测因素（B=0.143,比值比=1.154，P=0.001；B=0.122,比值比=1.047，P=0.001）。　　结论：CRT心室逆重构可以减小复极离散度，降低患者室性心律失常事件发生风险，改善预后。术后当天的TpTe间期时限对CRT术后室性心律失常事件有预测意义。%Objective: To explore the effects of cardiac resynchronization therapy (CRT) in patients with dispersion of re-polarization and ventricular arrhythmia. Methods: A total of 86 consecutive patents with CRT implantation were enrolled. According to weather absolute value of LVEF increased≥10% from baseline at 6 months after CRT implantation, the patients were divided into 2 groups: Response group and Non-response group,n=43 in each group. Dispersion of re-polarization indexes as QRS duration, QTc interval, TpTe interval and the events of ventricular arrhythmia were compared between 2 groups at different time points after CRT. Results:①In Response group, compared with pre-operation, QRS duration and TpTe interval were shorter at 1 year and within 24h after CRT implantation, allP<0.05, while the above indexes were similar in Non-response group, allP>0.05.②During 1 year after CRT implantation, the incidences of PVCs and PVC runs in Response group were much less than those in Non-response group, for lgPVCs: (1.78 ± 0.77) vs (2.73 ± 0.61), for lgPVC runs: (0.64 ± 0.48) vs (1.98 ± 0.72),P<0.05.③Multi liner regression analysis demonstrated that TpTe interval within 24h after CRT implantation was an independent predictor for both lgPVCs: (B=0.143, OR=1.154,P=0.001) and lgPVC runs: (B=0.122, OR=1.047,P=0.001). Conclusion: CRT ventricular reverse remodeling may reduce dispersion of re-polarization and the risk of ventricular arrhythmia, therefore improve the prognosis in relevant patients; TpTe interval within 24h after CRT had the predictive value for ventricular arrhythmia.