CAJ | 학술논문

目的：心脏再同步治疗除颤器（CRT-D）增加了心室复极离散度（TDR），本研究旨在评价心肌跨壁复极离散度指标中的QTc间期，T波顶点（T p）T波终点（Te）之间的时限（TpTe）和TpTe /QTc是否与CRT-D患者需治疗的快速室性心律失常相关。方法：2011-01至2013-01连续选取160例于我院行CRT-D植入的患者，所选资料为术后即刻心电图，分析其V5导联的QTc间期，TpTe，TpTe/QTc值以评估其TDR，所有植入CRT-D患者均于我中心常规随访，随访时间为（20±10）个月。快速室性心律失常的发生均采自程控仪调取的CRT-D记录。结果：其中因持续性室性心动过速、心室颤动接受CRT-D治疗的患者为30例（治疗组，18.7%），未治疗的患者为未治疗组（130例，81.3%）。治疗组的TpTe/QTc (0.24±0.05 vs 0.20±0.04，P<0.001)和 TpTe [(119±30) ms vs (95±20) ms，P<0.001]较未治疗组明显增加，但两组间QTc间期差异无统计学意义[（480±60）ms vs (470±70) ms，P=0.6]。QTc间期与CRT-D治疗的风险无相关性。TpTe/QTc ≥0.25预测CRT-D患者室性心律失常风险的敏感性和特异性分别为47%和91%，而TpTe≥120 ms预测CRT-D患者室性心律失常风险的敏感性和特异性分别为40%和95%。CRT-D术后患者生存曲线分析表明，TpTe/QTc和TpTe均能有效预测患者的预后情况（P<0.001）。结论：TpTe和TpTe/QTc 的增加显著增加再同步治疗除颤器患者术后需CRT-D治疗的风险。
목적：심장재동보치료제전기（CRT-D）증가료심실복겁리산도（TDR），본연구지재평개심기과벽복겁리산도지표중적QTc간기，T파정점（T p）T파종점（Te）지간적시한（TpTe）화TpTe /QTc시부여CRT-D환자수치료적쾌속실성심률실상상관。방법：2011-01지2013-01련속선취160례우아원행CRT-D식입적환자，소선자료위술후즉각심전도，분석기V5도련적QTc간기，TpTe，TpTe/QTc치이평고기TDR，소유식입CRT-D환자균우아중심상규수방，수방시간위（20±10）개월。쾌속실성심률실상적발생균채자정공의조취적CRT-D기록。결과：기중인지속성실성심동과속、심실전동접수CRT-D치료적환자위30례（치료조，18.7%），미치료적환자위미치료조（130례，81.3%）。치료조적TpTe/QTc (0.24±0.05 vs 0.20±0.04，P<0.001)화 TpTe [(119±30) ms vs (95±20) ms，P<0.001]교미치료조명현증가，단량조간QTc간기차이무통계학의의[（480±60）ms vs (470±70) ms，P=0.6]。QTc간기여CRT-D치료적풍험무상관성。TpTe/QTc ≥0.25예측CRT-D환자실성심률실상풍험적민감성화특이성분별위47%화91%，이TpTe≥120 ms예측CRT-D환자실성심률실상풍험적민감성화특이성분별위40%화95%。CRT-D술후환자생존곡선분석표명，TpTe/QTc화TpTe균능유효예측환자적예후정황（P<0.001）。결론：TpTe화TpTe/QTc 적증가현저증가재동보치료제전기환자술후수CRT-D치료적풍험。
Objective: Cardiac resynchronization therapy defibrillator (CRT-D) increases ventricular transmural dispersion of repolarization (TDR). Our work evaluated the relationship between QTc interval of TDR indicators, TpTe, TpTe/QTc ratio and rapid ventricular arrhythmia in patients with CRT-D. Methods: A total of 160 consecutive patients who received CRT-D implantation in our hospital from 2011-01 to 2013-03 were studied. The immediate post operative ECG was collected to analyze lead V5 QTc interval, TpTe and TpTe/QTc ratio for assessing its TDR. The patients were divided into 2 groups: Treatment group, the patients with ventricular tachycardia or ventricular ifbrillation received CRT-D,n=30 (18.7%) and Non-treatments group,n=130 (81.3%). All patients were followed-up for (20 ± 10) months and the rapid ventricular arrhythmia was recorded by CRT-D devices. Results: The patients in Treatment group had increased TpTe/QTc (0.24 ± 0.05) vs (0.20 ± 0.04, and TpTe (119 ± 30) ms vs (95 ± 20) ms, bothP<0.001. The QTc interval was similar between 2 groups (480 ± 60) ms vs (470 ± 70) ms,P=0.6 and QTc interval was not related to the risk of CRT-D requirement. The sensitivity and speciifcity for TpTe/QTc ≥ 0.25 predicting the risk of ventricular arrhythmia in CRT-D patients were at 47% and 91%, while TpTe ≥ 120 ms were at 40% and 95%respectively. The post CRT-D surviving curve analysis indicated that TpTe/QTc ratio and TpTe could predict the prognosis in relevant patients,P<0.001. Conclusion: The elevated TpTe and TpTe/QT ratio may increase the incidence of CRT-D requirement in patients with ventricular arrhythmia after resynchronization.