Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy.
Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy.
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特发性扩张型心肌病持续性室性心律失常的电生理学评估。
DOI：
10.1111/j.1540-8159.1988.tb04551.x
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Lerman,BB
中科院分区：
文献类型：
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作者：
Milner,PG;Dimarco,JP;Lerman,BB
持续性室性快速性心律失常和猝死在特发性扩张型心肌病（IDC）患者中尤为常见。与缺血性心脏病患者相比，IDC患者的0/电生理刺激（EPSJ）值尚未确定。为了阐明EPS在这些患者中的作用，我们研究了19例（58 ± 11岁）IDC患者，他们有症状性室性心动过速（VT）或心室颤动（VF）。平均左心室射血分数为26 ± 9%。10名患者在院外心脏骤停后存活，8名患者记录了持续性单形性VT，1名患者发生了与晕厥相关的非持续性VT。19例患者中有13例（68%）在EPS处诱发了临床室性快速心律失常（12例VT，1例VF）。在13例患者中的9例（69%）中，心律失常随后在系列电生理药物试验中得到抑制。在17 ± 11个月的随访期间，10/19例（53%）患者发生心律失常复发，9/19例（47%）患者死亡; 6例突然死亡，3例继发于心力衰竭。在初始研究中，有和没有诱导性室性快速性心律失常的患者之间的心律失常复发率没有差异。此外，在系列测试中抑制心律失常并不能预测结果;在9例心律失常受到抑制的患者中，观察到复发。这些数据表明，在IDC和症状性室性快速性心律失常患者中，程控心室刺激的灵敏度约为70%，并且在控制EPS期间的非诱导或使用抗心律失常治疗预防心律失常诱导并不能提供针对复发性心律失常的长期保护。
Sustained ventricular tachyarrhythmias and sudden death are particularly prevalent in patients with idiopathic dilated cardiomyopathy (IDC). In contrast to patients with ischemic heart disease, the value 0/electrophysiological stimulation (EPSJ in patients with IDC has not yet been established. To clarify the role of EPS in these patients, we studied 19 patients (58 ± 11 years) with IDC who had symptomatic ventricular tachycardia (VT) or ventricular fibrillation (VF). The mean left ventricular ejection fraction was 26 ± 9%. Ten patients had survived out‐of‐hospital cardiac arrest, eight had documented sustained monomorphic VT and one patient had non‐sustained VT associated with syncope. Thirteen of the 19 patients (68%) had their clinical ventricular tachyarrhythmias induced at EPS (12 VT, 1 VF). In nine of 13 patients (69%), the arrhythmias were subsequently suppressed during serial electrophysiological drug testing. During 17 ± 11 months of follow‐up, 10/19 (53%) patients experienced recurrence of their arrhythmias and nine out of 19 (47%) patients died; six died suddenly and three secondary to heart failure. There was no difference in arrhythmia recurrence between patients with and without inducible ventricular tachyarrhythmias at initial study. Furthermore, suppression of arrhythmia during serial testing did not predict outcome; recurrences were observed in jive out of nine patients whose arrhythmias were suppressed. These data indicate that the sensitivity of programmed ventricular stimulation in patients with IDC and symptomatic ventricular tachyarrhythmias is approximately 70%, and that non‐inducibility during control EPS or prevention of arrhythmia induction with antiarrhythmic therapy does not confer long‐term protection against recurrent arrhythmias.