vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»vestar-624Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESИСПОЛЬЗОВАНИЕ АНАЛИЗА QRS ДЛЯ ОПРЕДЕЛЕНИЯ РИСКА ЖЕЛУДОЧКОВЫХ АРИТМИЙ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА И ИМПЛАНТИРОВАННЫМИ КАРДИОВЕРТЕРАМИ-ДЕФИБРИЛЛЯТОРАМИQRS COMPLEX ANALYSIS FOR VENTRICULAR ARRHYTHMIA RISK STRATIFICATION IN PATIENTS WITH CORONARY ARTERY DISEASE AND IMPLANTED CARDIOVERTERS-DEFIBRILLATORSГромыкоГ. А.GromykoG. A.noemail@neicon.ruКазаковА. И.KazakovA. I.noemail@neicon.ruЧетвериковС. Ю.ChetverikovS. Yu.noemail@neicon.ruДиденкоМ. В.DidenkoM. V.noemail@neicon.ruПасеновГ. С.PasanovG. S.noemail@neicon.ruЯшинС. М.YashinS. M.noemail@neicon.ruСПбГМУ им. акад. И.П.ПавловаRussian FederationХанты-Мансийская областная клиническая больницаRussian FederationВМА им. С.М.КироваRussian Federation2013230920200721417Copyright © Громыко Г.А., Казаков А.И., Четвериков С.Ю., Диденко М.В., Пасенов Г.С., Яшин С.М., 20202020Громыко Г.А., Казаков А.И., Четвериков С.Ю., Диденко М.В., Пасенов Г.С., Яшин С.М.Gromyko G.A., Kazakov A.I., Chetverikov S.Y., Didenko M.V., Pasanov G.S., Yashin S.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/624

С целью оценки корреляции между процентом рубцовой ткани в левом желудочке (ЛЖ), определенным по электрокардиограмме (ЭКГ), и вероятностью возникновения желудочковых аритмий (ЖА) у пациентов с ишемической болезнью сердца (ИБС) и имплантированным кардиовертером-дефибриллятором (ИКД) обследованы 49 пациентов 46 мужчин и 3 женщины, средний возраст 63±12 лет). В исследование включались только пациенты с ишемической кардиомиопатией (фракция выброса - ФВ ЛЖ менее 45%). До имплантации ИКД 48 пациентам было выполнено аортокоронарное шунтирование либо коронароангиопластика. Всем пациентам до имплантации ИКД выполнялась эхокардиография, анализ ЭКГ с использованием метода расчетных таблиц (метод R.H.Silvester et al. для оценки площади рубцовой ткани). Пациенты были разделены на 2 группы; первая группа - без срабатываний ИКД (25 пациентов), вторая группа - со срабатываниями ИКД (24 пациента). Процент рубцовой ткани в группе 1 составил 17,3±8,8%, в группе 2 - 25,5±13,4% (р=0,014). Средняя ширина комплекса QRS в группах сравнения статистически не различались (группа 1 - 127,6±35,6; группа 2 - 121,9±34,6; p=0,58). Это может быть связано с тем, что расширение комплекса QRS у пациентов с ишемической кардиомиопатией может быть предиктором смерти от декомпенсации сердечной недостаточности. Статистически достоверно меньшая ФВ ЛЖ среди пациентов без срабатываний ИКД (1 группа), вероятно связана с большим числом больных с ИКД, имплантированным для первичной профилактики внезапной смерти. Основными ограничениями нашего исследования стали небольшой объем выборки и ретроспективный характер исследования. Таким образом, оценка ЭКГ по методу R.H.Silvester et al. может быть использована для стратификации риска срабатываний ИКД по поводу ЖА.

To assess correlation between the portion (percentage) of the scar tissue in the left ventricle (LV) and the risk of ventricular arrhythmias in patients with coronary artery disease and implanted cardioverter-defibrillator (ICD), 49 patients (46 men and 3 women) aged 63±12 years were examined. Only patients with ischemic cardiomyopathy were included into the study (LV ejection fraction less than 45%). Prior to the ICD implantation, 48 patients underwent aorto-coronary bypass grafting or percutaneous coronary intervention. In all patients, prior to the ICD implantation performed were echocardiography and ECG analysis using the computational tables (method by R.H. Selvester et al. for assessment of the scar tissue area). The patients were distributed into two following groups: Group I included patients without the ICD activity (n=25) and Group II, patients with the episodes of ICD activation (n=24). The percentage of scar tissue was 17.3±8.8ΰ/ο in Group I and 25.5±13.4ΰ/ο in Group II (p=0.014). The QRS complex width did not statistically significantly differ in both groups (127.6±35.6 ms in Group I and 121.9±34.6 ms in Group II; p=0.58). It could be related to fact that the QRS widening in the patients with ischemic cardiomyopathy can be considered a predictor of death due to heart failure deterioration. A statistically significantly lower LV ejection fraction in the patients without episodes of ICD activity (Group I) is possible related to a greater number of patients with ICDs implanted for the primary sudden death prevention. Principal limitations of the current study were a small sample and the retrospective nature of the study. Thus, ECG assessment using the technique by R.H. Selvester et al. can be used for the risk stratification of ICD activity due to ventricular arrhythmias.

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The authors declare that there are no conflicts of interest present.