Cardiac Arrhythmia Center, Tufts Medical Center, 800 Washington Street, Box #197, Boston, MA 02111, USA.
Curr Cardiol Rep. 2012 Oct;14(5):552-62. doi: 10.1007/s11886-012-0297-3.
Patients with hypertrophic cardiomyopathy are at risk of atrial and ventricular arrhythmias, yet treatment options for these patients are made almost solely by extrapolation from patients with other diseases. Heart block may be seen spontaneously but is especially prevalent following septal reduction strategies. Atrial fibrillation is the most common arrhythmia in patients with hypertrophic cardiomyopathy. The onset of atrial fibrillation often represents a turning point clinically for patients, marked by substantial functional deterioration and morbidity. Sudden cardiac death is the most common cause of death in the young patient, but still contributes to mortality in older patients. Major risk factors for sudden cardiac death include resuscitated sudden cardiac death, marked hypertrophy, syncope, and family history of sudden cardiac death due to hypertrophic cardiomyopathy. Minor risk factors for sudden cardiac death include nonsustained ventricular tachycardia, and hypotensive response to exercise. Emerging possible risk factors include atrial fibrillation, myocardial ischemia, left ventricular outflow tract obstruction, genetic mutations, left ventricular apical aneurysms, myocardial fibrosis, and end stage disease.
肥厚型心肌病患者存在心房和心室心律失常风险，但这些患者的治疗方案几乎完全是从其他疾病患者中推断得出的。心脏传导阻滞可能是自发发生的，但在室间隔减容策略后尤为常见。心房颤动是肥厚型心肌病患者中最常见的心律失常。心房颤动的发作通常代表患者临床转归的一个转折点，标志着显著的功能恶化和发病率。心脏性猝死是年轻患者最常见的死亡原因，但在老年患者中仍导致死亡。心脏性猝死的主要危险因素包括复苏性心脏性猝死、明显的心肌肥厚、晕厥和因肥厚型心肌病导致的心脏性猝死家族史。心脏性猝死的次要危险因素包括非持续性室性心动过速和运动时低血压反应。新出现的可能风险因素包括心房颤动、心肌缺血、左心室流出道梗阻、基因突变、左心室心尖部瘤、心肌纤维化和终末期疾病。
