JCE：低体温可诱导早复极综合征患者发生室颤

Osborne波又称为J波，表现为紧随QRS波群后的，与R波方向相同的锯齿状波。J波首先由Osborne等在猪低体温模型中被发现，后来逐渐认识到J波与早复极综合征（early repolarization syndrome，ERS）及Brugada综合征相关。颅内出血可导致下丘脑损伤，导致体温调节中枢障碍，并引起自发性低体温。

近来的临床研究表明，环境因素与ERS及Brugada综合征相关的事件发作呈明显相关，低体温在其中起重要作用。近来，Rederman NJ等报道了一例早复极综合征患者由低体温诱发的室颤。该患者为一例34岁男性患者，主要表现为在家里休息的情况下出现的室颤发作；患者于9月前因前交通动脉动脉瘤破裂而出现蛛网膜下腔出血，并损伤了下丘脑。患者在颅内出血以前并无心律失常或晕厥病史。患者入院时心电监护记录为室颤，经过1次电复律后转复为窦律，患者当时的体温为32℃。

患者的窦律下心电图提示下壁及侧壁的J波形成，QTc间期为370ms，使用普鲁卡因酰胺后QTc间期延长至420ms，患者心电图运动试验、经胸超声心电图、心肌磁共振检查未见明显异常，长QT综合征相关基因监测为阴性，据此该患者诊断为早复极综合征诱发的室颤。

该患者接受了ICD植入，手术3月后患者再次出现体温降至35℃，并出现3次室颤发作，均成功放电，随后加用了胺碘酮口服，经长期随访后无室性心律失常发作。

该病例得出的结论如下：低体温是早复极综合征患者室颤发作的重要诱因，在临床工作用因予以高度重视。

DOI: 10.1111/jce.12030
PMC:
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Ventricular Fibrillation Induced by Spontaneous Hypothermia in a Patient with Early Repolarization Syndrome

NICHOLAS J. FEDERMAN B.M.Sc.1, ALEXIS MECHULAN M.D.1, GEORGE J. KLEIN M.D.1, ANDREW D. KRAHN M.D.2

We present the case of a 34-year-old male with cardiac arrest in the context of spontaneous hypothalamic mediated thermal dysregulation after intracranial hemorrhage. Ventricular fibrillation with a marked ER pattern recurred with therapeutic hypothermia. Spontaneous hypothermia due to hypothalamic dysregulation was observed to enhance the amplitude of the ER pattern and was contemporaneous with recurrent ventricular fibrillation during follow-up. Conclusions: Hypothermia is an important trigger of VF in the setting of early repolarization syndrome, and warrants assessment as an environmental trigger of spontaneous events.