室性心律失常的危险分层及评价方法

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1、室性心律失常的危险分层及评价方法浙江大学医学院附属第一医院陶谦民背景对于个人和家庭而言，因恶性室性心律失常导致的心脏性猝死完全可以称之是一次“地震”！目前对于心脏性猝死的预测，虽然经过了四十多年的努力，仍然没有实质性的、确切有效的方法。我们只是通过检出高危人群，预防性应用ICD，尽力去避免不幸的发生。其实，在我们的身边，经常在出现……图动态心电图记录的心脏性猝死非侵入性检查评估方法心电学及相关检查是对室性心律失常危险分层的常用方法。常规12导联心电图、心电图运动试验、动态心电图用以确定心律失常的诊断，QT间期的改变、ST改变、T波电交替等反映复极

2、的影响，对某些状况下的危险分层具有重要意义。T波电交替是唯一能判断是否发展到致命性室性心律失常的危险分层指标（IIa类推荐、A级证据）；信号平均心电图、心率变异、压力反射敏感性及心率紊乱仅能作为不十分可靠的检测技术指标推荐（IIb类推荐、B级证据）MicrovoltT-wavealternanstestingforventriculararrhythmiariskstratificationT-wavealternanstest'sprognostichorizonexceedstwoyearsinanalysisThefindingaddres

3、sesapersistingquestionaboutthetestusedtoscreencandidatesforprimary-preventionICDs:ifit'snegative,howsoonshoulditberepeated?(ChanPSetal.AmJCardiol2008;102:280-284.)Coulditbethateasy?Clinical-riskscoremayfurtherstratifylow-LVEFICDcandidatesAretrospectiveanalysisofnoneotherthant

4、heMADIT-2trialidentifiedfivefamiliarmarkersthatcouldpotentiallybeusedtoscreenoutpost-MI,low-LVEFpatientsunlikelytoneedthedevices.(GoldenbergIetal.JAmCollCardiol2008:51:288-296.)Markersofautonomictoneadvanceinpost-MIriskassessmentsIntwostudies,long-termprognosticmeasuresinclud

5、edbaroreflexsensitivity,heart-ratevariability,andheart-rateturbulence.Onefoundthattheriskassessmentdidn'tpredictCVeventsunlessitwasperformedlaterthanusual,10to14weeksaftertheMI.(DeFerrariGMetal.ExnerDVetal.JAmCollCardiol2007;50:2285-2290,2275-2284.)Trial'smixedmessagechalleng

6、esTWAtest'simageforpredictingsudden-deathriskAmountainofdatasupportsarisk-stratificationroleformicrovoltTWAtestingincandidatesforprimary-preventionICDs,sohowcouldtheMASTER1trialsuggestthatitdoesn'tpredictlife-threateningventriculararrhythmiasinpost-MIpatientswithpoorLVfunctio

7、n?(AmericanHeartAssociation2007ScientificSessions.)MASTERI:DisappointmentforT-wavealternanstestingThetestdidnotpredictlife-threateningventriculartachyarrhythmiceventsinpatientswithMADIT-2criteriaforICDimplantationandthereforeshouldnotbeusedtostratifyICDuseinthisgroup,research

8、erssaid.(AmericanHeartAssociation2007ScientificSessions.)ALPHAstreng