Ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy: clinical presentation, risk stratification and results of long-term follow-up.
Ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy: clinical presentation, risk stratification and results of long-term follow-up.
复制标题
致心律失常性右心室发育不良/心肌病中的室性心动过速：临床表现、风险分层和长期随访结果。
DOI：
10.1016/j.ijcard.2005.03.049
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发表时间：
2006
影响因子：
3.5
通讯作者：
H. Schmidinger
中科院分区：
文献类型：
--
作者：
T. Pezawas;G. Stix;J. Kastner;B. Schneider;M. Wolzt;H. Schmidinger
并非所有的致心脏病性右心室发育不良/心肌病（ARVD/C）患者都有心脏性猝死的风险。本研究的目的是评估ARVD/C患者的危险分层。方法和步骤对34例ARVD/C患者进行程序心室刺激（PVS）。分别有22例、7例和4例患者记录到持续性单形性室性心动过速（smVT）、非smVT和室颤。1例患者仅发生晕厥。植入式心律转复除颤器（ICD）植入11例smVT诱导患者的血液动力学损害，4例记录室颤和1例非smVT（194 ms心动过速周期长度）（ICD组，n=16）。10例患者未接受任何抗心律失常治疗，5例患者接受了抗心律失常药物治疗，3例患者成功进行了VT消融（非ICD组，n=18）。13例心电图平均信号异常。在6.5±2.4年期间，69%的ICD患者接受了适当的出院，1例非ICD患者发生了血流动力学耐受的smVT复发（两组均无心源性猝死）。临床室性心动过速、诱发室性心动过速和随访室性心动过速的周期长度之间的比较显示出很强的相关性（R=0.62-0.88）。在多变量分析异常信号平均心电图和左心室射血分数下降是统计学显着预测VT recurrent.CONCLUSIONSIn ARVD/C的心动过速周期长度的临床VT，PVS诱导的VT和后续VT相关以及暗示PVS引导的方法不提供额外的信息。自发性心律失常与临床表现相结合，可以识别需要ICD的患者。
BACKGROUNDNot all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are at risk for sudden cardiac death. The aim of the study was to evaluate the risk stratification in patients with ARVD/C.METHODS AND RESULTSProgrammed ventricular stimulation (PVS) was performed in 34 ARVD/C patients. Twenty-two, 7 and 4 patients had documented sustained monomorphic ventricular tachycardia (smVT), non-smVT and ventricular fibrillation, respectively. One patient experienced syncope only. An implantable cardioverter defibrillator (ICD) was implanted in 11 patients inducible in smVT with hemodynamic compromise, in 4 patients with documented ventricular fibrillation and in one patient with non-smVT (194 ms tachycardia cycle length) (ICD group, n=16). Ten patients were left without any antiarrhythmic therapy, 5 patients received antiarrhythmic drugs and 3 patients underwent successful VT ablation (non-ICD group, n=18). Thirteen patients had an abnormal signal averaged ECG. During 6.5±2.4 years 69% of ICD patients received appropriate discharges and one non-ICD patient had a hemodynamically tolerated smVT recurrence (no sudden cardiac death in both groups). Comparison between the cycle lengths of clinical VT, induced VT and follow-up VT revealed a strong relationship (R=0.62–0.88). On multivariate analysis abnormal signal averaged ECG and decreased left ventricular ejection fraction were statistically significant predictors for VT recurrence.CONCLUSIONSIn ARVD/C the tachycardia cycle length of clinical VT, PVS-induced VT and follow-up VT correlate well implicating that a PVS-guided approach does not provide additional information. Spontaneous arrhythmia in combination with clinical presentation allows identification of patients in need for an ICD.