The Predictive Value Of J Wave, JTc,Tp-ec On Triggered Treatment In Patients With Cardiac Resynchronization Therapy Defibrillator

Objective J wave, JTc interval, Tp-ec interval represent early repolarization of ventricle, time of repolarization and transmural dispersion of repolarization. The related basic and clinical studies suggest abnormal ventricular repolarization may play an important role in occurrence and development of malignant ventricular arrhythmia. This study was designed to explore the predictive value of J Wave, JTc, Tp-ec from preoperative 12-lead electrocardiogram(ECG) on triggered treatment in patients with synchronous cardioerter triggered by ventricular fibrillation or ventricular tachycar dia(the triggered treatment of CRT-D) from intra-electrocardiogram, and divided into two groups:triggered treatment group and non-triggered treatment group. Compare two groups of baseline general conditions, analysis the correlation between J wave, JTc, Tp-ec and trigger events, and then assess the effect of CRT-D. Monitoring of JTc’s and Tp-ec’s change was made during 1-year follow up. All patients with CRT-D were received standardized drug therapy in duration of hospital and post-discharge.Results The baseline data showed that there were no significant difference in age, NYHA classification, hypertension, diabetes, atrial fibrillation, basic heart rate and QRS duration among the two groups. The J wave positive(P<0.05), JTc(P<0.05), Tp-ec (P<0.001) in triggered group significantly higher than in non-triggered group.In addition, the two groups in gender, left ventricular end-diastolic diameter(LVEDD), the rate of oral amiodarone had differences(P<0.05); left ventricular ejection fraction(LVEF), arrhythmia history also had differences between two groups(P<0.001). After adjustment these factors with Logistic model, the result showed that patients received triggered treatment had increased TJc, Tp-ec than did not receive triggered treatment, especially when TJc≥358.50 ms, Tp-ec≥116.47 ms. They were associated with malignant arrhythmia and prognosis(OR=3.233,95%CI 1.411～7.406, P<0.05; OR=4.868,95%CI 2.174～11.042, P<0.001). Immediate postoperative stage between the JTc, Tp-ec has increased obviously(P<0.05), but 1 year follow-up results suggest both significantly decreases, and they changed in gradually decline trend after peak. At the same time, LVEF significantly increased from the third month(P<0.05) and LVEDD significantly decreased from sixth month. This appearance might indicate CRT-D could improve ventricular remodeling and had a certain anti-arrhythmic effects at the same time. But J wave positive was no significant difference between two groups(P=0.065).Conclusion In the indicators from preoperative ECG representatived ventricular repolarization, JTc, Tp-ec were positively related to malignant arrhythmia. Especially when TJc≥358.50 ms, Tp-ec≥116.47 ms, patients with CRT-D had higher risk for malignant arrhythmia and these two indicators could be used to predict triggered treatment. CRT-D could improve ventricular remodeling and had a certain anti-arrhythmic effects at the same time.