Rabinovich Rafael F, Muratore Claudio A, Baranchuk Adrián
Departamento Cardiovascular, Sanatorio Trinidad Mitre, Buenos Aires, Argentina.
Arch Cardiol Mex. 2008 Jul-Sep;78(3):279-84.
The purpose of this study was to investigate the modes of initiation of malignant ventricular tachyarrhythmias in patients with Chagas' cardiomyopathy (ChC) with an implantable cardioverter-defibrillator (ICD) through the analysis of stored intracardiac electrograms. Specifically, we analyzed the incidence of ventricular arrhythmias preceded by the short-long-short-pattern (sls).
We analyzed 179 spontaneous malignant ventricular tachyarrhythmias episodes in 15 patients with Chagas' cardiomyopathy with an ICD. The mean cycle length in normal sinus rhythm before initiation of the malignant ventricular tachyarrhythmias, the ventricular tachycardia (VT) cycle length, the prematurity ratio and the number of ventricular premature contractions (VPCs) (single, pairs or multiple) that triggered malignant ventricular tachyarrhythmias were compared between the two different initiation modes.
Mean age: 60.4 +/- 5.7 -years-old, mean EF, 33.2 +/- 8.5%, 9 men and 6 women. A sls-pattern was found in 43.5% of the malignant ventricular tachyarrhythmias. Baseline cycle length (795 +/- 16 vs 788 +/- 14 ms), VT cycle length (320 +/- 7.7 ms vs 329 +/- 5.7 ms) and prematurity ratio (0.57 +/- 11 vs 0.60 +/- 12) were similar between sls and non-sls-sequences. Multiple VPCs as a trigger of malignant ventricular tachyarrhythmias was significantly less often in sls-events than in non-sls events (14% vs 40%; P < 0.0001).
In this select population of patients with ChC, we observed a high prevalence of sls-pattern just before initiation of malignant ventricular tachyarrhythmias. Multiple VPCs were often associated with a non-sls trigger mode.
本研究旨在通过分析植入式心脏复律除颤器（ICD）存储的心内心电图，探讨恰加斯心肌病（ChC）患者恶性室性心律失常的起始模式。具体而言，我们分析了短-长-短模式（sls）之前发生的室性心律失常的发生率。
我们分析了15例植入ICD的恰加斯心肌病患者的179次自发性恶性室性心律失常发作。比较了两种不同起始模式下恶性室性心律失常发作前正常窦性心律的平均周期长度、室性心动过速（VT）周期长度、早搏率以及触发恶性室性心律失常的室性早搏（VPC）数量（单发、成对或多发）。
平均年龄：60.4±5.7岁，平均射血分数33.2±8.5%，9名男性和6名女性。43.5%的恶性室性心律失常中发现有sls模式。sls序列和非sls序列之间的基线周期长度（795±16 vs 788±14毫秒）、VT周期长度（320±7.7毫秒 vs 329±5.7毫秒）和早搏率（0.57±11 vs 0.60±12）相似。与非sls事件相比，sls事件中作为恶性室性心律失常触发因素的多发VPC明显较少（14%对40%；P<0.0001）。
在这一特定的ChC患者群体中，我们观察到在恶性室性心律失常发作前sls模式的高发生率。多发VPC通常与非sls触发模式相关。
