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POSTEXTRASYSTOLIC REPOLARIZATION ABNORMALITIES IN ST-U SEGMENT IN PATIENTS WITH MALIGNANT VENTRICULAR ARRHYTHMIAS.
P.Kukla, I.Wozniak-Skowerska, A.Filipecki, E.Peszek, K.Szydlo, E.Wojcik, M.Trusz-Gluza.
Ist Department of Cardiology, Silesian Medical Academy, Katowice.

The purpose of the study was to find correlation between postextrasystolic ST-U segment changes and history of sustained ventricular tachycardia or ventricular fibrillation (VT/VF). Changes in U wave amplitude after premature ventricular beats (PVC) are prognostic markers in the Long QT Syndrome- depended on bradycardia.
Two groups of pts were evaluated: I-32 pts with VT/VF history and II- 36pts with potentially malignam arrhythmia (structural heart disease and frequent PVC). From 24-hour ambulatory ECG the ST-U configuration of postextrasystolic beats was compared with the ST-U amplitude and morphology during sinus rhythm.
We found T wave changes in 8 pts (25%) from group I and in 12 pts (33,3%) from group II (p=NS) and U wave changes in 13 pts (40,7%) and 3 pts (8,3%) respectively (p<0.05). Other ECG indexes related to PVC's were also considered: RR interval, coupling interval (CI), prematurity index (PI) and postextrasystolic pause (PP).


* p7<0.05   ** p<0.01   *** p<0.001

 
RR (ms)
CI (ms)
PI
PP (ms)

no changes
918±200
584±117
0.65±0.16
1130±247

T wave changes
896±115
505±94**
0.57±0.14*
1261±227*

U wave changes
1025±211*
556±108
0. 54±0.12**
1383±223***




During follow-up (mean 12 months, 4-25) the recurrence of malignant ventricular arrhythmias was recorded in 4 of 8 pts (50%) with T-wave changes and in 9 from 13 pts (69%) with U-wave changes from group I. Such a relationship was not observed in group II.

Conclusions: Postextrasystolic changes in ST-U configuration are depended on bradycardia, low prematurity index and lengthening of postextrasystolic pause. ST-U changes frequently appears in patients with malignant arrhythmias and might be predictive for the recurrence of arrhythmia episodes.




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