Gonska B D, Bethge K P, Kreuzer H
Medizinische Universitätsklinik Göttingen, Abteilung Kardiologie und Pulmonologie.
Z Kardiol. 1987 Sep;76(9):546-53.
To assess the incidence and significance of spontaneous and induced ventricular arrhythmias in idiopathic dilated cardiomyopathy, 24 h ambulatory electrocardiographic monitoring and programmed ventricular stimulation were performed in 52 patients. The mean left ventricular ejection fraction was 38 +/- 13%. Ventricular arrhythmias were present in 94%: 56% had non-sustained ventricular tachycardia with 3-20 consecutive VPCs and 17% ventricular pairs. In 56% of patients, more than 10(3) single VPCs/24 h were seen. Repetitive ventricular response was induced by programmed stimulation in 28 patients (54%): in 39%, 2-4 VPCs and in 15%, greater than or equal to 5 VPCs. In three patients (6%), sustained ventricular tachycardia (greater than or equal to 30 s) was initiated, which was of a monomorphic configuration in two of them. The incidence of induced ventricular arrhythmias could neither be correlated with the Lown grade of spontaneous arrhythmias nor with the total number of single VPCs/24 h. The inducibility of sustained ventricular tachycardia, however, was only seen in patients with arrhythmias of Lown grade IVb. No clear correlation could be determined between the impairment of left ventricular function and spontaneous or induced arrhythmias. During the 9-48 (median 34) months' follow-up, nine patients (17%) died, three of them died suddenly and five in congestive heart failure. All sudden cardiac death victims and three out of the five who died of congestive heart failure had non-sustained ventricular tachycardia during 24 h ambulatory electrocardiographic monitoring, but no higher incidence of single VPCs than the survivors. All patients who died had a significantly reduced left ventricular ejection fraction as compared to those who survived. In none of the patients who died were there more than three consecutive VPCs induced by programmed ventricular stimulation.
为评估特发性扩张型心肌病患者自发性和诱发性室性心律失常的发生率及意义，对52例患者进行了24小时动态心电图监测及程控心室刺激。左心室平均射血分数为38±13%。94%的患者存在室性心律失常：56%有非持续性室性心动过速，伴有3 - 20个连续的室性早搏，17%有室性成对搏动。56%的患者24小时内可见超过10（3）个单发室性早搏。28例患者（54%）经程控刺激诱发了重复性心室反应：39%诱发了2 - 4个室性早搏，15%诱发了≥5个室性早搏。3例患者（6%）诱发了持续性室性心动过速（≥30秒），其中2例为单形性。诱发性室性心律失常的发生率既与自发性心律失常的Lown分级无关，也与24小时内单发室性早搏的总数无关。然而，持续性室性心动过速的可诱发性仅见于Lown分级为IVb级的心律失常患者。左心室功能损害与自发性或诱发性心律失常之间未发现明确的相关性。在9 - 48（中位值34）个月的随访期间，9例患者（17%）死亡，其中3例猝死，5例死于充血性心力衰竭。所有心源性猝死患者以及5例死于充血性心力衰竭患者中的3例在24小时动态心电图监测期间有非持续性室性心动过速，但单发室性早搏的发生率并不高于存活者。所有死亡患者的左心室射血分数均明显低于存活者。在死亡患者中，经程控心室刺激诱发的连续室性早搏均未超过3个。
