The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan.
J Cardiovasc Electrophysiol. 2010 Sep;21(9):991-9. doi: 10.1111/j.1540-8167.2010.01769.x.
To assess the incidence, characteristics, and prognosis of ventricular tachyarrhythmia in hypertrophic cardiomyopathy (HCM).
The study consisted of 66 consecutive patients with HCM who were admitted to Niigata University Hospital between 1992 and 2005. Their clinical characteristics and ECG morphology were investigated according to the type of HCM.
The type of HCM was asymmetric hypertrophy (ASH) in 34 patients (51%), obstructive HCM (HOCM) in 9 (14%), apical HCM (ApHCM) in 14 (21%), and midventricular obstruction (MVO) in 9 (14%). The cause of admission was ventricular tachyarrhythmia in 25 patients (38%), unexplained syncope in 11 (17%), and heart failure in 30 (45%). Sustained monomorphic ventricular tachycardia (SMVT) occurred in 19 patients and ventricular fibrillation in 6. In the 19 patients with SMVT, 12 had MVO and 3 of these had previous apHCM. Six of the 19 patients with SMVT had ASH, and 3 had abnormal apical wall motion. In 14 patients, the SMVT appeared to originate from the apical aneurysm based on the morphology of the tachycardia. Ventricular tachyarrhythmia recurred in 14 of the 25 patients (56%), and 4 of the 18 patients with an ICD had electrical storm. ASH with abnormal wall motion of the LV apex or MVO was recognized in the 4 patients with electrical storm; they commonly had abnormal Q waves and ST elevation in leads V4-V6.
Ventricular tachyarrhythmia was responsible for 38% of hospitalizations in HCM, and SMVT occurred in patients with MVO and/or with abnormal wall motion of the LV apex. Electrical storm was more common in patients with ST elevation in precordial leads V4-V6.
评估肥厚型心肌病（HCM）中室性心动过速的发生率、特征和预后。
本研究纳入了 1992 年至 2005 年期间在新泻大学医院就诊的 66 例连续 HCM 患者。根据 HCM 类型调查了患者的临床特征和心电图形态。
34 例（51%）患者为不对称性肥厚（ASH），9 例（14%）为梗阻性 HCM（HOCM），14 例（21%）为心尖肥厚型心肌病（ApHCM），9 例（14%）为中隔心肌梗阻（MVO）。25 例（38%）患者因室性心动过速入院，11 例（17%）因不明原因晕厥入院，30 例（45%）因心力衰竭入院。19 例患者发生持续性单形性室性心动过速（SMVT），6 例患者发生心室颤动。19 例 SMVT 患者中，12 例存在 MVO，其中 3 例之前存在 ApHCM。19 例 SMVT 患者中，6 例为 ASH，3 例存在心尖部异常壁运动。14 例患者的 SMVT 起源于心动过速的形态，根据起源于心尖部的室性心动过速。25 例患者中有 14 例（56%）复发室性心动过速，18 例植入 ICD 的患者中有 4 例发生电风暴。电风暴的 4 例患者中，ASHD 和 LV 心尖部异常壁运动或 MVO 得到识别，他们通常存在 V4-V6 导联异常 Q 波和 ST 段抬高。
在 HCM 患者中，38%的住院患者因室性心动过速引起，SMVT 发生于存在 MVO 和/或 LV 心尖部异常壁运动的患者中。电风暴在 V4-V6 导联存在 ST 段抬高的患者中更常见。
