Fuchs Therese, Torjman Amram
Arrhythmia Service, Assaf Harofeh Medical Center, Zerifin, Israel.
Isr Med Assoc J. 2009 Oct;11(10):606-10.
Patients with hypertrophic cardiomyopathy are prone to ventricular arrhythmias and sudden death. Identifying patients at risk of sudden death is difficult.
To determine whether microvolt T-wave alternans detected during exercise or rapid atrial pacing can identify patients with HCM who are at risk of ventricular arrhythmias and sudden death.
This prospective observational study included 21 patients with HCM: the disease was abstructive in 11, nonobstructive in 9 and apical in 1. TWA was measured while the patients were on anti-arrhythmic medication.
TWA was positive in 9 patients (43%) and negative in 12 (57%). Three patients were resuscitated after sudden death before their enrollment in the study and two patients developed ventricular tachycardia and fibrillation respectively during the study period. After combining the endpoint of sudden death from a ventricular arrhythmia and the presence of ventricular arrhythmias on a Holter monitor, there was no significant correlation between the presence of a positive TWA and the presence of ventricular arrhythmias on the Holter monitor or a history of sudden death.
TWA cannot be used as a non-invasive test for detecting patients with HCM and electrical instability. TWA is not useful for predicting sudden death in patients with HCM.
肥厚型心肌病患者易发生室性心律失常和猝死。识别有猝死风险的患者很困难。
确定运动或快速心房起搏期间检测到的微伏级T波电交替能否识别有室性心律失常和猝死风险的肥厚型心肌病患者。
这项前瞻性观察性研究纳入了21例肥厚型心肌病患者：其中梗阻性11例，非梗阻性9例，心尖部1例。在患者服用抗心律失常药物时测量T波电交替。
9例患者（43%）T波电交替呈阳性，12例（57%）呈阴性。3例患者在入组本研究前发生猝死经复苏成功，2例患者在研究期间分别发生室性心动过速和心室颤动。将室性心律失常导致的猝死终点与动态心电图监测上的室性心律失常情况相结合后，T波电交替阳性与动态心电图监测上的室性心律失常或猝死史之间无显著相关性。
T波电交替不能作为检测肥厚型心肌病和电不稳定患者的无创检查。T波电交替对预测肥厚型心肌病患者的猝死无用。
