Michel P L, Mandagout O, Vahanian A, Cormier B, Iung B, Luxereau P, Acar J
Cardiology Department, Hôpital Tenon, Paris, France.
Acta Cardiol. 1992;47(2):145-56.
In order to evaluate the effect of aortic valve replacement on the incidence of ventricular arrhythmias in patients with aortic valve disease, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 96 patients without coronary artery disease (aortic stenosis n = 50, combined aortic stenosis and regurgitation n = 19 and aortic regurgitation n = 27). Following aortic valve replacement, repeat recordings were obtained after 13 +/- 4 days and 18 +/- 7 months. Ventricular arrhythmias were in all cases classified according to Lown and were compared with clinical, echocardiographic and hemodynamic data. Preoperatively, ventricular premature beats were observed in 85 patients (89%) and were frequent (greater than 30 ventricular premature beats/hour) in 20 (21%). Multiformity was found in 27 (28%), couplets in 18 (19%) and ventricular tachycardia in 11 (11.5%). The occurrence of ventricular arrhythmias was not related to the type or severity of valve lesions. Patients with severe ventricular arrhythmias (Lown class 3 or 4: 37%) had a greater thickness of their interventricular septum 13.9 +/- 2.5 mm, vs 11.7 +/- 2.6 (p less than 0.05); a higher LV mass 176 +/- 34 g/m2, vs 134 +/- 39 (p less than 0.05) and a lower left ventricular ejection fraction 47 +/- 12%, vs 57 +/- 11, (p less than 0.01). Two weeks postoperatively, the incidence and severity of ventricular arrhythmias had increased: ventricular premature beats were noted in 92% and were severe in 50%. No correlation was found between ventricular arrhythmias and preoperative or operative data. Eighteen months after surgery, ventricular premature beats were still observed in 81% of patients but remained frequent in 7% only. Severe ventricular arrhythmias were noted in 27%. Patients with severe ventricular arrhythmias had at the time of this late recording a lower radionuclide left ventricular ejection fraction 57 +/- 14%, vs 73 +/- 9 (p less than 0.02) and a higher enddiastolic diameter 63 +/- 15 mm, vs 48 +/- 7, (p less than 0.01). This study indicates that ventricular arrhythmias are common in patients with aortic valve disease. The severity of arrhythmias is influenced by the LV consequences of valve lesion both pre- and late postoperatively. The frequency and severity of ventricular arrhythmias increase early after surgery and do not correlate with preoperative or operative data.
为了评估主动脉瓣置换术对主动脉瓣疾病患者室性心律失常发生率的影响，对96例无冠状动脉疾病的患者（主动脉狭窄50例，主动脉狭窄合并反流19例，主动脉反流27例）在手术前进行了24小时动态心电图记录。主动脉瓣置换术后，分别于术后13±4天和18±7个月进行重复记录。所有病例的室性心律失常均根据洛恩标准进行分类，并与临床、超声心动图和血流动力学数据进行比较。术前，85例患者（89%）观察到室性早搏，其中20例（21%）频发（每小时室性早搏超过30次）。发现多形性室性早搏27例（28%），成对室性早搏18例（19%），室性心动过速11例（11.5%）。室性心律失常的发生与瓣膜病变的类型或严重程度无关。严重室性心律失常患者（洛恩3级或4级：37%）的室间隔厚度更大，为13.9±2.5mm，而对照组为11.7±2.6mm（p<0.05）；左心室质量更高，为176±34g/m²，而对照组为134±39g/m²（p<0.05），左心室射血分数更低，为47±12%，而对照组为57±11%（p<0.01）。术后两周，室性心律失常的发生率和严重程度增加：92%的患者出现室性早搏，其中50%为严重室性早搏。未发现室性心律失常与术前或手术数据之间存在相关性。术后18个月，81%的患者仍观察到室性早搏，但仅7%的患者频发。27%的患者出现严重室性心律失常。在此次晚期记录时，严重室性心律失常患者的放射性核素左心室射血分数较低，为57±14%，而对照组为73±9%（p<0.02），舒张末期直径较高，为63±15mm，而对照组为48±7mm（p<0.01）。本研究表明，室性心律失常在主动脉瓣疾病患者中很常见。心律失常的严重程度在术前和术后晚期均受瓣膜病变对左心室影响的影响。室性心律失常的频率和严重程度在术后早期增加，且与术前或手术数据无关。
