Current Concepts of Premature Ventricular Contractions
Current Concepts of Premature Ventricular Contractions
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发表时间：
2013-03
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通讯作者：
Min-Soo Ahn
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作者：
Min-Soo Ahn
室性早搏是起源于脑室的心肌早期去极化。静脉曲张很常见，通过24至48小时的Holter监测，估计其在普通人群中的患病率为40%至75%。传统上，在没有结构性心脏病的情况下，它们被认为是相对良性的，但它们代表着结构性心脏病中猝死的风险增加。尤其是在缺血性心脏病中，室上性早搏的频率和复杂性与死亡率有关。植入型心律转复除颤器适用于既往有心肌梗死史的非持续性室性心动过速(NsVT)、左心室射血分数小于或等于40%、电生理检查可诱发室颤或持续性室性心动过速的患者。在充血性心力衰竭中，除了现成的临床变量外，静脉曲张并没有提供显著的增量预后信息。因此，nsVT不应指导治疗干预。最近，当药物抑制特发性扩张型心肌病患者的PVCs后表现为改善左心室收缩功能障碍时，提出了聚氯乙烯诱导的心肌病的概念。对于静脉曲张的治疗，重要的是要考虑潜在的心脏病、静脉曲张的频率以及症状的频率和严重程度。
Premature ventricular contractions (PVCs) are early depolarizations of the myocardium originating in the ventricle. PVCs are common with an estimated prevalence of 40% to 75% in the general population on 24- to 48-hour Holter monitoring. Traditionally, they have been thought to be relatively benign in the absence of structural heart disease but they represent increased risk of sudden death in structural heart disease. Especially in ischemic heart disease, the frequency and complexity of PVCs is associated with mortality. Implantable cardioverter defibrillator therapy is indicated in patients with nonsustained ventricular tachycardia (NSVT) due to prior myocardial infarction, left ventricular ejection fraction less than or equal to 40%, and inducible ventricular fibrillation or sustained ventricular tachycardia at electrophysiological study. In congestive heart failure, PVCs did not provide significant incremental prognostic information beyond readily available clinical variables. Consequently, NSVT should not guide therapeutic interventions. Recently, the concept of PVC-induced cardiomyopathy was proposed when pharmacological suppression of PVCs in patients with presumed idiopathic dilated cardiomyopathy subsequently showed improved left ventricular systolic dysfunction. For the treatment PVCs, it is important to consider underlying heart disease, the frequency of the PVCs and the frequency and severity of symptoms.