JACC：中山大学一院邬素华等Meta分析发现心电图早期复极增加心律失常死亡风险

近期病例对照研究显示心电图早期复极模式（ERP）与心室易颤性有关，但其对总人群的预后意义仍有争议。对此，中山大学附属第一医院邬素华等人进行了一项Meta分析，旨在确定伴有ERP人群心律失常死亡、心脏性死亡及全因死亡的发生率和风险，研究结果于2013年2月12日发表于《美国心脏病学会会刊》。
本次荟萃分析检索并鉴别了MEDLINE和Embase数据库中2012年7月31日前的所有相关研究，纳入研究均按95%置信区间（CIs）估算危险比从而分析相关性。数据萃取和关联性估算均按随机效果模型进行。
分析结果显示，纳入的9项研究中有3项报道心律失常死亡（31,981名受试者在726,741人年随访后，出现1,108例心律失常死亡），6项研究报道心脏死亡（126,583名受试者在2,054,674人年随访后，出现10,010例心脏性死亡），共6项研究报道了全因死亡（112,443名受试者在2,089,535人年随访后，出现22,165例全因死亡）。ERP的相对风险分别为心律失常死亡1.70（95% CI：1.19-2.42；P = 0.003）、心脏性死亡0.78（95% CI：0.27-2.25；P = 0.63）和全因死亡1.06（95% CI：0.87-1.28；P = 0.57）。ERP受试者绝对风险差异为每年每100,000受试者中有70例心律失常死亡。亚组分析发现，下壁导联J点抬高≥0.1 mV和下凹结构会提高心律失常死亡的风险。
总之，ERP与心律失常死亡的风险增加及其低等至中等绝对发生率相关。不过我们还需要进一步研究，以阐明ERP受试者中哪些亚组心律失常死亡风险更高。

与心律失常相关的拓展阅读： 

• Int J Cardiol：Fontan术后房性心律失常引起大块血栓
• 中国心律失常注册研究（C-Rhythm）网络平台完成搭建
• 张澍：2012年中国心律失常介入治疗数据
• MD Linx：复杂室性心律失常专科对室性心动过速的管理
• Circulation：睡眠呼吸障碍增加慢性心衰患者致死性室性心律失常的发生 更多信息请点击：有关心律失常更多资讯

Early repolarization pattern and risk for arrhythmia death: a meta-analysis.
OBJECTIVES
A meta-analysis was performed to determine the risk and incidence rate of arrhythmia death, cardiac death, and all-cause death in the general population with the early repolarization pattern (ERP).
BACKGROUND
The ERP has recently been associated with vulnerability to ventricular fibrillation in case-control studies. However, the prognostic significance of the ERP in the general population is controversial.
METHODS
Relevant studies published through July 31, 2012, were searched and identified in the MEDLINE and Embase databases. Studies that reported risk ratio estimates with 95% confidence intervals (CIs) for the associations of interest were included. Data were extracted, and summary estimates of association were obtained using a random-effects model.
RESULTS
Of the 9 studies included, 3 studies reported on arrhythmia death (31,981 subjects, 1,108 incident cases during 726,741 person-years of follow-up), 6 studies reported on cardiac death (126,583 subjects, 10,010 incident cases during 2,054,674 person-years of follow-up), and 6 studies reported on all-cause death (112,443 subjects, 22,165 incident cases during 2,089,535 person-years of follow-up). The risk ratios of the ERP were 1.70 (95% CI: 1.19 to 2.42; p = 0.003) for arrhythmia death, 0.78 (95% CI: 0.27 to 2.25; p = 0.63) for cardiac death, and 1.06 (95% CI: 0.87 to 1.28; p = 0.57) for all-cause death. The estimated absolute risk differences of subjects with the ERP were 70 cases of arrhythmia death per 100,000 subjects per year. J-point elevation ≥ 0.1 mV in the inferior leads and notching configuration had an increased risk for arrhythmia death in subgroup studies.
CONCLUSIONS
The ERP was associated with increased risk and a low to intermediate absolute incidence rate of arrhythmia death. Further study is needed to clarify which subgroups of subjects with the ERP are at higher risk for arrhythmia death.