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目的观察肥厚型梗阻性心肌病(HOCM)经皮腔内室间隔消融术(PTSMA)对心电图及自主神经功能的影响。方法 1998年1月至2003年10月26例患者[男15例,女11例,平均年龄(37.4±11.2)岁]经心脏超声检查诊断为 HOCM,在我院行 PTSMA,术前3天、术后3天、术后3年分别行体表12导联心电图、24 h 动态心电图检查,分析 PR 间期、传导阻滞情况、QRS 时限、QT、QT 离散度(QTd)、校正 QT 离散度(QTcd)、JT 间期、JT 离散度(JTd)、校正 JT 离散度(JTcd)及心率变异性(HRV)相关指标:RR 间期标准差(SDNN)、RR 间期平均值标准差(SDANN)、相邻 RR 间期差均方根(rMSSD)、相邻 RR 间期差值超过50 ms 的心搏数占 RR 间期总心搏数的百分比(PNN_(50))、低频功率(LF)、高频功率(HF)、LF/HF 比值。结果所有患者均成功行 PTSMA,1例患者术后出现三度房室传导阻滞并植入永久起搏器,PR 间期术后3天显著延长,术后3年恢复正常;术后3天所有患者均表现右束支传导阻滞,术后3年仍有24例患者为右束支传导阻滞;QRS 时限、QT 间期术后3天、3年均明显延长;QTd、QTcd 术后3天明显延长,术后3年恢复至术前水平;JT、JTd、JTcd 术后3天、3年均无明显变化;LF、HF、rMSSD、PNN_(50)术后3天、术后3年均较术前明显增加,而 LF/HF 比值、SDNN、SDANN 术后3天、术后3年无明显变化。结论 PTSMA 治疗 HOCM 是一种安全有效的方法,术后心电图主要改变为右束支传导阻滞,术后短期 QTd、QTcd 明显延长,对中远期的心电学参数无明显影响,其可能通过增高迷走神经张力而改善 HOCM 患者自主神经功能。
Objective To observe the effects of percutaneous transluminal septal ablation (PTSMA) of hypertrophic obstructive cardiomyopathy (HOCM) on ECG and autonomic nervous system function. Methods Twenty-six patients (15 males and 11 females, mean age 37.4 ± 11.2 years) from January 1998 to October 2003 were diagnosed as HOCM by echocardiography. PTSMA was performed in our hospital 3 days before surgery, Three days after surgery and 12 years after operation, 12-lead electrocardiogram (ECG) and 24-hour Holter monitoring were performed respectively. The changes of PR interval, conduction block, QRS duration, QT, QTd and QT dispersion (QTcd), JT interval, JTd, JTcd and heart rate variability (HRV) related indicators: RR interval standard deviation (SDNN), RR interval standard deviation (SDANN ), Mean square root of adjacent RR interval (rMSSD), percentage of heart rate with RR interval difference of more than 50 ms in RR interval (PNN_ (50)), low frequency power (LF ), High frequency power (HF), LF / HF ratio. Results All patients were successfully treated with PTSMA. One patient developed third degree atrioventricular block and implanted permanent pacemaker. The PR interval was significantly prolonged 3 days after operation and returned to normal after 3 years. After 3 days Right bundle branch block was found in all patients. Right bundle branch block was still found in 24 cases 3 years after operation. QRS duration and QT interval were significantly longer in 3 days and 3 years respectively. QTd and QTcd postoperatively 3 days postoperatively, and returned to the preoperative level 3 years postoperatively. There was no significant change in the 3 days after JT, JTd and JTcd. The levels of LF, HF, rMSSD and PNN_ (50) Compared with the preoperative, the mean increase of LF / HF ratio, SDNN, SDANN after 3 days and no significant change after 3 years. Conclusions PTSMA is a safe and effective way to treat HOCM. Postoperative ECG changes mainly to right bundle branch block. Postoperative short-term QTd and QTcd prolongation, and has no obvious effect on ECG parameters in the mid to long term. Vagal tone improves autonomic function in HOCM patients.