背景:心电图异常在致心律失常性右室心肌病中很常见,并被纳入2010年工作组标准。他们的时间进程,然而,仍然不确定。在这项回顾性观察研究中,我们旨在评估心电图特征的长期演变及其与室性心律失常的关系.
结果:根据2010年特别工作组标准,共纳入353例心律失常性右心室心肌病患者,使用6871例自动处理的12导联数字心电图。从第一次心电图开始10年,评估了心电图参数与室性心律失常风险之间的关系。比较首次接触心电图的心电图参数,诊断时的心电图,和最新的心电图。第一次和最近一次心电图的中间时间为6[四分位距,1-14]年。QRS电压的降低,R-和T-波振幅之间的第一个,诊断,并且在心前导联和四肢导联中观察到最新的心电图。平均QRS持续时间从96ms增加到102ms(P<0.001),终末激活持续时间(V1)从47到52ms(P<0.001),QTc从419到432ms(P<0.001)。首次ECG时V3导联至V6和aVF的T波倒置与室性心律失常相关(调整后的危险比[HRadj][V3],2.03[95%CI,1.23-3.34]和HRadj[aVF],1.87[95%CI,1.13-3.08])。
结论:致心律失常性右心室心肌病患者的去极化和复极化参数随时间而变化,支持致心律失常性右心室心肌病的进行性。心电图异常可能在诊断前被检测到,虽然没有达到2010年工作队的标准,是早期疾病的标志。诊断前V3导联或aVF中的T波倒置与随访期间的室性心律失常有关。
BACKGROUND: Electrocardiographic abnormalities are common in arrhythmogenic right ventricular cardiomyopathy and are included in the 2010 Task Force Criteria. Their time course, however, remains uncertain. In this retrospective observational study, we aimed to assess the long-term evolution of electrocardiographic characteristics and their relation to ventricular arrhythmias.
RESULTS: Three hundred fifty-three patients with arrhythmogenic right ventricular cardiomyopathy as per the 2010 Task Force Criteria with 6871 automatically processed 12-lead digital ECGs were included. The relationship between the electrocardiographic parameters and the risk of ventricular arrhythmias was assessed at 10 years from the first ECG. Electrocardiographic parameters were compared between the first contact ECG, the ECG at diagnosis, and the most recent ECG. Median time between the first and the latest ECG was 6 [interquartile range, 1-14] years. Reductions of QRS voltage, R- and T-wave amplitudes between the first, diagnostic, and the latest ECGs were observed across precordial and extremity leads. Mean QRS duration increased from 96 to 102 ms (P<0.001), terminal activation duration (V1) from 47 to 52 ms (P<0.001), and QTc from 419 to 432 ms (P<0.001). T-wave inversions in leads V3 to V6 and aVF at first ECG were associated with ventricular arrhythmias (adjusted hazard ratio [HRadj][V3], 2.03 [95% CI, 1.23-3.34] and HRadj[aVF], 1.87 [95% CI, 1.13-3.08]).
CONCLUSIONS: Depolarization and repolarization parameters evolved over time in patients with arrhythmogenic right ventricular cardiomyopathy, supporting the progressive nature of arrhythmogenic right ventricular cardiomyopathy. Electrocardiographic abnormalities may be detected before diagnosis and might, although not fulfilling the 2010 Task Force Criteria, be markers of early disease. T-wave inversion in leads V3 or aVF before diagnosis was associated with ventricular arrhythmias during follow-up.