Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas 78705, USA.
Heart Rhythm. 2012 Aug;9(8):1200-6. doi: 10.1016/j.hrthm.2012.03.057. Epub 2012 Mar 30.
Islets of myocytes within fibrofatty scars represent the substrate for reentrant ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). Electroanatomic mapping can reliably identify such areas.
To prospectively test the association between late and fragmented electrograms within scar and arrhythmic events in patients with ARVC.
High-density right ventricle electroanatomic mapping was performed in 32 patients with ARVC without history of cardiac arrest or sustained ventricular arrhythmias. Standard definitions of electroanatomic scars and fragmented, isolated, and very late potentials were used. All patients received an implantable cardioverter-defibrillator for the primary prevention of sudden death.
After a mean follow-up of 25 ± 7 months, 12 (38%) patients received appropriate implantable cardioverter-defibrillator shock for sustained ventricular arrhythmias. With the exception of a higher rate of previous syncope (P = .053), patients with arrhythmic events at follow-up did not differ from those who remained free from arrhythmic events in terms of other clinical variables, including cardiac magnetic resonance findings. Electroanatomic scars were present in all patients. The distribution and extent of electroanatomic scars were similar in the 2 groups (38 ± 25 cm(2) vs 33 ± 20 cm(2); P = .51). However, patients with implantable cardioverter-defibrillator shock had a higher prevalence of fragmented electrograms (92% vs 20%; P <.001), of isolated late potentials (75% vs 20%; P = .004), and of very late potentials (67% vs 25%; P = .030). Fragmented electrograms were the only variable independently associated with arrhythmic events at follow-up (hazard ratio 21; P = .015).
The presence of fragmented and delayed electrograms within the scar predicts arrhythmic events in ARVC.
纤维脂肪性瘢痕中的心肌细胞岛是致心律失常性右室心肌病（ARVC）中折返性室性心律失常的基质。电解剖标测可以可靠地识别这些区域。
前瞻性检测 ARVC 患者瘢痕内晚期和碎裂电图与心律失常事件之间的关联。
对 32 例无心脏骤停或持续性室性心律失常史的 ARVC 患者进行高密度右心室电解剖标测。使用电解剖瘢痕和碎裂、孤立和很晚的电位的标准定义。所有患者均因预防猝死而植入了植入式心律转复除颤器。
平均随访 25 ± 7 个月后，12 例（38%）患者因持续性室性心律失常而接受了适当的植入式心律转复除颤器电击。除了先前晕厥的发生率较高（P =.053）外，在随访期间发生心律失常事件的患者与未发生心律失常事件的患者在其他临床变量方面没有差异，包括心脏磁共振检查结果。所有患者均存在电解剖瘢痕。2 组患者的电解剖瘢痕分布和范围相似（38 ± 25 cm² vs 33 ± 20 cm²；P =.51）。然而，植入式心律转复除颤器电击的患者存在碎裂电图的比例更高（92% vs 20%；P <.001）、孤立的晚期电位比例更高（75% vs 20%；P =.004）和很晚的电位比例更高（67% vs 25%；P =.030）。碎裂电图是唯一与随访时心律失常事件独立相关的变量（危险比 21；P =.015）。
瘢痕内存在碎裂和延迟电图预测 ARVC 中的心律失常事件。
