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目的探讨碎裂QRS波(fQRS)对心脏再同步治疗除颤器(CRT-D)患者术后1年内再发室性心律失常的预测价值。方法连续入选2015年1月至2017年4月在安徽省立医院住院明确诊断为心衰并植入CRT-D患者208人
根据入院时心电图是否存在fQRS波分为两组
比较两组患者基线、心电指标以及心脏彩超指标等
观察两组患者术后1年内室性心律失常的发生情况。并对12导心电图存在完全性左束支阻滞患者进行亚组分析
探讨fQRS的出现与术后室性心律失常的关系。结果①与非fQRS组比较
fQRS组QRS宽度、SPAP更大
射血分数更低
NYHA心功能分级更高(p<0.05);②Pearson相关分析显示
心电图是否存在fQRS与术后室性心律失常、SPAP、NYHA心功能分级、射血分数、QRS宽度、左室舒张末内径有关;③多因素Logistic回归分析显示
fQRS(OR=4.304
p=0.001)、射血分数(OR=0.884
p=0.003)、QRS宽度(OR=1.111
p=0.002)与术后室性心律失常独立相关;④亚组分析显示
fQRS组相较于非fQRS组
NHYA心功能分级更高、QRS宽度更宽(p<0.05)
随访1年室性心律失常发生率更高(p<0.05)。结论 fQRS可作为心衰患者CRT-D植入后室性心律失常发生的预测指标。
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