Cruz F E, Cheriex E C, Smeets J L, Atié J, Peres A K, Penn O C, Brugada P, Wellens H J
Department of Cardiology, Academic Hospital, University of Limburg, Maastricht, The Netherlands.
J Am Coll Cardiol. 1990 Sep;16(3):739-44. doi: 10.1016/0735-1097(90)90368-y.
Seven of 17 patients with incessant supraventricular tachycardia caused by an accessory pathway with a long retrograde conduction time were seen with symptoms or echocardiographic signs of a tachycardia-induced cardiomyopathy. Three patients were in New York Heart Association functional class II with dyspnea and four were in class III. Eight patients (six with tachycardia-induced cardiomyopathy) underwent surgery because of failure of medical treatment (including one patient in functional class I) and one underwent direct current catheter ablation of the atrioventricular (AV) node. In six patients echocardiograms recorded before and after the procedure were available. Before surgery or direct current ablation the mean left ventricular ejection fraction was 36.3 +/- 8.7%, the left ventricular end-diastolic diameter 55.7 +/- 7.6 mm and the left ventricular end-systolic diameter 44.3 +/- 7.8 mm. A mean of 21.6 +/- 6.8 months after the procedure the mean left ventricular ejection fraction increased to 58.6 +/- 8.0%, the left ventricular end-diastolic diameter decreased to 49.0 +/- 3.6 mm and the left ventricular end-systolic diameter decreased to 32.2 +/- 2.7 mm; all six patients were in functional class I. These results confirm that control of incessant tachycardia leads to a regression of symptoms and signs of cardiomyopathy and progressive normalization of the dimensions of the heart. Because of these findings, surgery should be considered early in patients with an accessory AV pathway and incessant tachycardia. The presence of a tachycardia-induced cardiomyopathy should therefore be an indication for surgery rather than a contraindication.
17例因旁路导致持续性室上性心动过速且逆行传导时间长的患者中，7例出现了心动过速性心肌病的症状或超声心动图表现。3例纽约心脏协会心功能分级为II级，有呼吸困难症状，4例为III级。8例患者（6例有心动过速性心肌病）因药物治疗无效接受了手术（包括1例心功能I级的患者），1例接受了房室结直流电导管消融术。6例患者有术前和术后的超声心动图记录。手术或直流电消融术前，平均左心室射血分数为36.3±8.7%，左心室舒张末期直径为55.7±7.6mm，左心室收缩末期直径为44.3±7.8mm。术后平均21.6±6.8个月，平均左心室射血分数增至58.6±8.0%，左心室舒张末期直径降至49.0±3.6mm，左心室收缩末期直径降至32.2±2.7mm；所有6例患者心功能均为I级。这些结果证实，控制持续性心动过速可使心肌病的症状和体征消退，心脏大小逐渐恢复正常。基于这些发现，对于有房室旁路和持续性心动过速的患者，应尽早考虑手术。因此，心动过速性心肌病的存在应是手术指征而非禁忌证。
