摘要
目的报道10例疑诊Brugada综合征(BS)患者的普罗帕酮激发试验的结果,并探讨高位右侧胸前导联心电图在普罗帕酮激发试验中的价值。方法对心室颤动(室颤)获救、晕厥或晕厥先兆者,以及无症状但有阳性猝死家族史者,经详细的病史询问、体格检查、心电图、X线胸片和超声心动图检查排除器质性心脏病,收集10例疑诊BS患者(观察组)。将同期因阵发性室上性心动过速行射频导管消融术、无器质性心脏病依据和猝死家族史的15例患者设为对照(对照组)。观察组与对照组均进行普罗帕酮激发试验。在普罗帕酮激发试验中同时描记常规12导联心电图与高位右侧胸前导联心电图。结果观察组10例患者中普罗帕酮试验阳性者8例。常规与高位右侧胸前导联同时呈阳性改变者1例;常规导联阳性、高位右侧胸前导联阴性者3例;常规导联阴性或可疑、高位右侧胸前导联阳性者4例。若仅凭常规胸前导联心电图,阳性例数为4例,结合常规导联与高位右侧胸前导联心电图,阳性例数增加为8例。对照组无一例达阳性诊断标准。结论普罗帕酮激发试验用于诊断BS的敏感性与特异性均较好,加做高位右侧胸前导联心电图可提高诊断阳性率,且极为便捷。普罗帕酮试验中可考虑加做高位右侧胸前导联心电图,以避免漏诊。
Objective To report the result of propafenone challenge test in 10 patients who were suspected of Brugada syndrome （BS）, and evaluate the effectiveness of right precordial leads at higher intercostals space position to diagnose Brugada syndrome. Methods Ten patients who were suspected of BS （ group A） with a history of ventricular fibrillation or syncope, or presyncope, or a family history of sudden death, were submitted to extensive evaluations, including history, physical examination, ECG, echocardiogram. Fifteen patients who were referred for radiofrequency ablation because of paroxysmal supraventricular tachycardia （PSVT） and had no a family history of sudden death were as controls （ group B）. Propafenone challenge test was performed and a standard ECG was recorded in 4th, 3rd and 2nd intercostals space in right precordium in all subjects （group A and B）. Results In group A,8 cases reached the diagnostic criteria in ESC Consensus Report. There was only one patient who had a positive ECG change in routine leads and the leads of higher intercostals space position in right precordium. There were 3 patients who had a positive ECG change in routine leads and a negative ECG change in leads of higher intercostals space position in right precordium, and 4 cases a negative ECG change in the routine leads and a positive ECG change in the leads of higher intercostals space position. Four patients were diagnosed as BS by recording the ECG in the routine leads, and 8 by recording the ECG in the routine leads and the leads of higher intercostals space position in right precordium. None of the patients in group B reached the diagnostic criteria. Conclusions Propafenone challenge test is effective and specific in the diagnosis of BS, and recording the ECG of right precordial leads at higher intercostals space position safely and expediently unmasked or accentuated the J-ST elevation in Brugada syndrome in propafenone challenge test. We suggest that the ECG of right precordial leads at higher intercostals space position should be recorded routinely in propafenone challenge test.
出处
《中华心律失常学杂志》
2006年第6期428-432,共5页
Chinese Journal of Cardiac Arrhythmias
基金
国家211重点实验室建设项目资助
