Viskin S, Belhassen B
Department of Medicine, Tel-Aviv Medical Center, Ichilov Hospital, Israel.
Am Heart J. 1990 Sep;120(3):661-71. doi: 10.1016/0002-8703(90)90025-s.
A review of the literature dealing with sudden death revealed 19 articles in which ostensibly healthy patients with documented VF unrelated to any known cardiac or noncardiac etiology are reported. Fifty-four patients fulfilling the criteria for idiopathic VF, including 14 patients investigated at our institution, are described. The mean age of patients for studies that reported age data was 36 years, with a male-to-female ratio of 2.5 to 1. Over 90% of the patients required resuscitation, while syncope due to nonsustained VF occurred in the rest. Diagnosis of VF was preceded by syncope in one fourth of the patients. Holter monitoring and exercise stress tests were often unrewarding. Available electrophysiologic data revealed a 69% inducibility rate of sustained ventricular tachyarrhythmias using nonaggressive protocols of ventricular stimulation in most cases. Induced tachyarrhythmias were poorly tolerated, and were mostly of polymorphic configuration. Class IA antiarrhythmic agents were highly effective in preventing reinduction of these arrhythmias. Available figures suggest an 11% rate of sudden death within 1 year of diagnosis. Appropriate antiarrhythmic therapy appears to improve prognosis. Reviewed data suggest that idiopathic VF represents an underestimated cause of sudden cardiac death in ostensibly healthy patients. An international registry of patients with idiopathic VF is warranted.
一项关于猝死的文献综述发现了19篇文章，这些文章报道了表面健康但记录有室颤且与任何已知心脏或非心脏病因无关的患者。文中描述了54例符合特发性室颤标准的患者，其中包括在我们机构接受调查的14例患者。报告了年龄数据的研究中，患者的平均年龄为36岁，男女比例为2.5比1。超过90%的患者需要进行复苏，其余患者则因非持续性室颤而出现晕厥。四分之一的患者在室颤发作前出现过晕厥。动态心电图监测和运动负荷试验常常没有结果。现有的电生理数据显示，在大多数情况下，采用非侵入性心室刺激方案时，持续性室性快速心律失常的诱发率为69%。诱发的快速心律失常耐受性差，大多为多形性。IA类抗心律失常药物在预防这些心律失常的再次诱发方面非常有效。现有数据表明，诊断后1年内猝死率为11%。适当的抗心律失常治疗似乎可以改善预后。综述数据表明，特发性室颤是表面健康患者心脏性猝死的一个被低估的原因。有必要建立一个特发性室颤患者的国际登记处。
