尖端扭站转性室速.pptVIP

心搏暂停和心动过速依赖性尖端扭转性室速 * LQTS患者24小时动态心电图监测到的QT间期和心动周期的关系 QT 间期 (ms) RR间期 (ms) LQT3 患者 LQT1 患者 对照 LQT2 患者 LQTS患者QT/RR斜率与正常个体不同，且不同基因型的LQTS斜率也不同。 LQT1患者 LQT2患者 LQT3患者 KVLQT1突变 HERG突变 SCN5A突变 LQTS患者心率-依赖性QT间期 不同基因型的LQT综合征的QT/RR 斜率不同，LQT1斜率较平 (心率增快时QT缩短较少)，LQT3斜率较陡(心率增快时QT缩短较多，心率减慢时QT延长较多)。 不同基因型LQT综合征患者QT昼夜变异性 Stramba Badiale et al, It Heart J 2000 LQT3患者的夜间(心率较慢时)QTc延长更显著，此类患者多在夜间睡眠时发生心脏不良事件；LQT 1患者，白天(心率较快时) QTc延长更显著，此类患者多在活动或激动时发生心脏不良事件，这一现象与我们的预期结果一致。 QT 动态变化的临床应用 ü 筛选具有发生恶性心律失常潜在危险的患者 ü 检测抗心律失常药和非心脏病药物的 促心律失常效应 ü 评价先天性离子通道病（ LQTS） * Quinindine increased the late component of the QT interval (QTU wave) and favor the onset of torsades-de-pointes following a short-long sequence. * * Other non-cardiac drugs, such as Erithromicine, can have major effect on QT interval duration. Several of such drugs can interact and have addictive effects potentially very dungerous (e.g., antiarrhythmic + antidepressant + antibiotics + diuretics inducing hypokalemia) * * QTc interbal is prolonged in its late component in a young mane with idiopathic potassion depletion due to Bartter’syndrome, and frequent polymorphic unsustained ventricular tachycardias are also observed. * * During hemodyalisis, fast K+ and Mg++ decrease are observed, with modest but uniform increase of QT and QTc interval duration and QT dispersion. * * Individual changes of QTc and QT dispersion in 30 normal subjects during hemodyalis. * * Effect of Quinindine on QT and QTc interval duration and QT morphology at the same cycle lenght in the same normal subject. * * * As expected from the use-dependent effect of Quinindine, in a normal subject the blockage is more evident at faster heart rates, and QT and QTc interval prolongation are more evident at shorter cycle lenghts * * Therefore the slope of the QT/RR regression, particularly