Ventricular tachyarrhythmia associated with cardiac sarcoidosis: Its mechanisms and outcome
Ventricular tachyarrhythmia associated with cardiac sarcoidosis: Its mechanisms and outcome
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DOI：
10.1002/clc.4960270409
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发表时间：
2004-04-01
影响因子：
2.7
通讯作者：
Aizawa, Y
中科院分区：
文献类型：
--
作者：
Furushima, H;Chinushi, M;Aizawa, Y
背景：心脏结节病越来越受到人们的重视，并且与不良预后相关。与心脏结节病相关的室性心动过速（VT）是大多数患者猝死的最可能原因，但其机制尚未明确。 假设：本研究调查与心脏结节病相关的 VT 的机制和结局。 方法：该研究连续纳入我院连续 8 名患有与心脏结节病相关的持续单形性 VT 的患者（5 名男性，3 名女性，年龄 54-19 岁）。 结果：平均射血分数为43 +/- 11%。在这些患者中观察到 22 次 VT，VT 期间的平均心率为 192 +/- 29 次/分钟（范围 144-259）。通过心室起搏记录了 22 例 VT 中的 10 例 (45%) 记录了短暂夹带现象（其中 8 例处于活动期）。另外五个 (23%) 室速无法被夹带，但可以通过程序刺激启动并通过快速起搏重复终止。 22例（14%）室速中，有3例（14%）因速度快而需紧急复律，其余4例（18%）可在电生理研究中诱导。结论：本研究中，15例（68%）室速的机制很可能是折返。折返基质的形成不仅与心脏结节病非活动期心脏肉芽肿的愈合有关，而且与活动期心脏肉芽肿的愈合有关。在电生理学研究中，伴有心脏结节病的室性心动过速，即使这种机制是折返性的，在活动期和非活动期之间也具有不同的诱导性。这使得心脏结节病的治疗（例如线圈类固醇、抗心律失常药和导管消融）变得困难。植入式心律转复除颤器是治疗伴有心脏结节病的室性快速心律失常的有效方法。
Background: Cardiac sarcoidosis is increasingly recognized and is associated with poor prognosis. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most likely cause of sudden death in most patients, but the mechanism has not been well established.Hypothesis: This study investigated the mechanisms and outcome of VT associated with cardiac sarcoidosis.Methods: The study included eight consecutive patients (five men, three women, aged 54 19 years) who had sustained monomorphic VT associated with cardiac sarcoidosis in our hospital.Results: The average ejection fraction was 43 +/- 11%. Twenty-two VTs were observed in these patients, and mean heart rate during VT was 192 +/- 29 beats/min (range 144-259). The phenomenon of transient entrainment was documented in 10 of 22 (45%) VTs by ventricular pacing (eight in the active phase). Another five (23%) VTs could not be entrained, but could be initiated by programmed stimulation and terminated by rapid pacing, reproducibly. In 3 of the 22 (14%) VTs, cardioversion was required urgently because of the fast rate, while the remaining 4 (18%) could be induced during electrophysiologic study.Conclusions: In this study, there was a high possibility that the mechanism of 15 (68%) VTs was reentry. Reentrant substrate is formed not only in association with the healing of cardiac granulomas in the inactive phase of cardiac sarcoidosis but also in the active phase. Ventricular tachycardia with cardiac sarcoidosis, even if this mechanism is reentry, has different inducibility between the active and inactive phases in an electrophysiologic study. This makes the therapy for cardiac sarcoidosis (e.g., coil icosteroids, antiarrhythinic agents, and catheter ablation) difficult. The implantable cardioverter-defibrillator is an effective treatment for ventricular tachyarrythmia with cardiac sarcoidosis.