Bogun Frank, Crawford Thomas, Reich Stephen, Koelling Todd M, Armstrong William, Good Eric, Jongnarangsin Krit, Marine Joseph E, Chugh Aman, Pelosi Frank, Oral Hakan, Morady Fred
University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
Heart Rhythm. 2007 Jul;4(7):863-7. doi: 10.1016/j.hrthm.2007.03.003. Epub 2007 Mar 12.
Idiopathic premature ventricular complexes (PVCs) usually are considered benign, even when frequent. However, case reports have demonstrated a possible link between frequent PVCs and left ventricular (LV) dysfunction. In addition, frequent PVCs recently were demonstrated to be associated with increased LV dimensions and cardiomyopathy.
Among 60 consecutive patients with idiopathic, frequent PVCs (>10/hour), a reduced LV ejection fraction (EF; mean 34% +/- 13%) was present in 22 (37%) patients. Patients with decreased LV function had a greater PVC burden on a 24-hour Holter monitor than patients with normal EF (37% +/- 13% vs. 11% +/- 10% of all QRS complexes; P <.0001). There was a significant inverse correlation between the PVC burden and the EF before ablation (r = 0.73, P <.0001).
The PVCs originated in the right ventricular outflow tract in 31 (52%) of 60 patients, the LV outflow tract in 9 (15%) of 60 patients, and in other sites in 13 (22%) of 60 patients. The site of PVC origin could not be determined in seven patients. Ablation was completely successful in 48 (80%) patients. In patients with an abnormal EF before ablation, LV function normalized in 18 (82%) of 22 patients from a baseline of 34% to 59% +/- 7% (P <.0001) within 6 months. In the four patients in whom ablation was ineffective, the EF further declined from 34% +/- 10% to 25% +/- 7% (P = .06) during follow-up. In a control group of 11 patients with a similar PVC burden (30% +/- 8%) and a reduced EF (28% +/- 13%) who did not undergo ablation, the EF remained unchanged in 10/11 patients over 19 +/- 17 months of follow-up and one patient underwent heart transplantation.
LV dysfunction in the setting of frequent, idiopathic PVCs may represent a form of cardiomyopathy that can be reversed by catheter ablation of the PVCs.
特发性室性早搏（PVC）通常被认为是良性的，即使频发时也是如此。然而，病例报告显示频发PVC与左心室（LV）功能障碍之间可能存在联系。此外，最近有研究表明频发PVC与左心室尺寸增加和心肌病有关。
在连续60例特发性频发PVC（>10次/小时）患者中，22例（37%）患者左心室射血分数（EF）降低（平均34%±13%）。左心室功能降低的患者在24小时动态心电图监测中的PVC负荷高于EF正常的患者（分别占所有QRS波群的37%±13%和11%±10%；P<.0001）。消融前PVC负荷与EF之间存在显著负相关（r=0.73，P<.0001）。
60例患者中，31例（52%）的PVC起源于右心室流出道，9例（15%）起源于左心室流出道，13例（22%）起源于其他部位。7例患者的PVC起源部位无法确定。48例（80%）患者消融完全成功。消融前EF异常的患者中，22例中有18例（82%）的左心室功能在6个月内从基线的34%恢复正常至59%±7%（P<.0001）。在4例消融无效的患者中，随访期间EF从34%±10%进一步降至25%±7%（P=.06）。在11例PVC负荷相似（30%±8%）且EF降低（28%±13%）但未接受消融的对照组患者中，10/11例患者在19±17个月的随访期间EF保持不变，1例患者接受了心脏移植。
频发特发性PVC情况下的左心室功能障碍可能代表一种心肌病形式，可通过导管消融PVC来逆转。
