Jansson K, Dahlström U, Karlsson E, Nylander E, Walfridsson H, Sonnhag C
Department of Medicine, Linköping University, Sweden.
Pacing Clin Electrophysiol. 1990 Oct;13(10):1261-7. doi: 10.1111/j.1540-8159.1990.tb02025.x.
To determine the best way to detect serious ventricular arrhythmia in patients with hypertrophic cardiomyopathy (HCM), 15 patients with HCM performed an exercise test, had Holter monitoring during 24 hours, and programmed electrical stimulation (PES) in a randomized order, and the presence and type of ventricular arrhythmia was noted. During exercise testing, only one patient demonstrated ventricular tachycardia (VT) just prior to the test. By Holter monitoring, four patients had short episodes of asymptomatic VT. PES, using up to three extrastimuli induced VT or ventricular fibrillation (VF) in ten patients including those with VT during exercise testing and Holter monitoring. There were no differences between patients with and without ventricular arrhythmia during PES regarding age, left ventricular outflow obstruction, thickness of interventricular septum, interventricular septum/posterior wall thickness ratio, corrected QT interval, or the amplitude of the R wave in lead aVR in electrocardiography. Our results indicate that inducible VT/VF during PES is a common finding in patients with HCM. Twenty-four hour Holter monitoring was superior to exercise testing in revealing serious ventricular arrhythmia in those patients.
为确定检测肥厚型心肌病（HCM）患者严重室性心律失常的最佳方法，15例HCM患者按随机顺序进行运动试验、24小时动态心电图监测及程控电刺激（PES），并记录室性心律失常的存在情况及类型。运动试验期间，仅1例患者在试验即将结束时出现室性心动过速（VT）。通过动态心电图监测，4例患者有短暂的无症状VT发作。PES时，使用多达3个额外刺激，在包括运动试验和动态心电图监测期间出现VT的患者在内的10例患者中诱发了VT或心室颤动（VF）。在PES期间，有和没有室性心律失常的患者在年龄、左心室流出道梗阻、室间隔厚度、室间隔/后壁厚度比值、校正QT间期或心电图aVR导联R波振幅方面无差异。我们的结果表明，PES期间可诱发的VT/VF在HCM患者中是常见发现。24小时动态心电图监测在发现这些患者的严重室性心律失常方面优于运动试验。
