Electrophysiological characteristics of ventricular tachyarrhythmias in cardiac sarcoidosis versus arrhythmogenic right ventricular cardiomyopathy
Electrophysiological characteristics of ventricular tachyarrhythmias in cardiac sarcoidosis versus arrhythmogenic right ventricular cardiomyopathy
复制标题
DOI：
10.1016/j.hrthm.2012.10.019
复制
发表时间：
2013-02-01
期刊：
影响因子：
5.5
通讯作者：
Eckardt, Lars
中科院分区：
文献类型：
--
作者：
Dechering, Dirk G.;Kochhaeuser, Simon;Eckardt, Lars
背景最近的证据表明，心脏结节病（CS）和致心律失常性右室心肌病（ARVC）的表现非常相似。 目的 调查 CS 和 ARVC 患者之间是否存在显着的人口统计学和电生理差异。 方法 我们前瞻性地比较了经 3 维电解剖标测接受射频导管消融治疗室性心动过速的经证实患有 CS 或 ARVC 的患者。此外，我们还评估了 ARVC 的诊断标准是否排除了 CS 患者的 ARVC。 结果 纳入了 18 名患者（13 名男性；平均年龄 44.9 岁）。所有 18 名患者的右心室射血分数均轻度至中度降低。心脏结节病患者 (n = 8) 的平均左心室射血分数显着较低（35.6 +/- 19.3 vs 60.6 +/- 9.4；P = .002）。 CS 患者的 QRS 明显更宽（0.146 vs 0.110s；P = .004）。 8 名 CS 患者中有 5 名 (63%) 符合诊断 ARVC 标准。除一名患者（患有 CS）外，所有患者均记录到伴有左束支传导阻滞模式的室性心动过速 (VT)。程序性心室刺激在 CS 患者中平均诱发 3.7 种不同的单形性室速，而在 ARVC 患者中诱发 1.8 种 (P = .01)。在 CS 与 ARVC 中，VT 显着性更常见于右心室心尖区 (P = .001)，没有其他好发部位。消融成功率和其他电生理参数没有差异。 结论 目前的 ARVC 诊断指南不能可靠地排除 CS 患者。我们患者的 CS 特征性临床和电生理参数包括左心室射血分数降低、QRS 波明显变宽、右侧心尖 VT 以及更多可诱导形式的单形 VT。
BACKGROUND Recent evidence suggests that cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) can manifest very similarly.OBJECTIVE To investigate whether there are significant demographic and electrophysiological differences between patients with CS and ARVC.METHODS We prospectively compared patients with proven CS or ARVC who underwent radiofrequency catheter ablation of ventricular tachycardias by using 3-dimensional electroanatomical mapping. Furthermore, we evaluated whether the diagnostic criteria for ARVC would have excluded ARVC in patients with CS.RESULTS Eighteen patients (13 men; mean age 44.9 years) were included. All 18 patients had mild to moderately reduced right ventricular ejection fraction. Patients with cardiac sarcoidosis (n = 8) had a significandy lower mean left ventricular ejection fraction (35.6 +/- 19.3 vs 60.6 +/- 9.4; P = .002). Patients with CS had a significandy wider QRS (0.146 vs 0.110s; P = .004). Five of 8 (63%) patients with CS fulfilled the diagnostic ARVC criteria. Ventricular tachycardias (VTs) with a left bundle branch block pattern were documented in all but one patient (with CS). Programmed ventricular stimulation induced an average of 3.7 different monomorphic VTs in patients with CS vs 1.8 in patients with ARVC (P = .01). VT significandy more often originated in the apical region of the right ventricle in CS vs ARVC (P = .001), with no other predilection sites. Ablation success and other electrophysiological parameters were not different.CONCLUSIONS The current diagnostic ARVC guidelines do not reliably exclude patients with CS. Clinical and electrophysiological parameters that were characteristic of CS in our patients include reduced left ventricular ejection fraction, a significandy wider QRS, right-sided apical VT, and more inducible forms of monomorphic VT.