Kobayashi Y, Yazawa T, Baba T, Mukai H, Inoue S, Takeyama Y, Niitani H
Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
Pacing Clin Electrophysiol. 1988 Aug;11(8):1154-67. doi: 10.1111/j.1540-8159.1988.tb03967.x.
Fifty patients with supraventricular tachycardia (SVT) underwent clinical electrophysiological studies (EPS), endomyocardial biopsies and cardiac catheterizations. EPS revealed AV nodal reentrant tachycardia (AVNRT) in seven patients, AV reentrant tachycardia utilizing concealed AV bypass tracts (AVR-CBT) in nine patients, AV reentrant tachycardia utilizing AV bypass tracts with ventricular preexcitation (manifest WPW) in 13 patients, sinus nodal or intra-atrial reentrant tachycardia (SNRT or IART) in three patients, atrial flutter (AF) in nine patients, automatic atrial tachycardia (AAT) in five patients, and multifocal atrial tachycardia (MAT) in four patients. According to the clinical observations, three patients with AVNRT (43%), six with AVR-CBT (67%), six with manifest WPW (46%), two with SNRT or IART (67%), eight with AF (89%), two with AAT (40%), and two with MAT (50%) showed other accompanying clinical abnormalities. In all patients who were studied histologically, changes in the myocardium were seen; myocarditic changes, postmyocarditic changes and nonspecific abnormalities were present in six (12%), 15 (30%), and nine (18%) respectively. Myocardial changes were observed in four out of seven cases with AVNRT (57%), in six out of nine with AVR-CBT (67%), in five out of 13 with manifest WPW (38%), in two out of three with SNRT or IART (67%), in six out of nine with AF (67%), in all five cases of AAT (100%), and in two out of four with MAT (50%). Nineteen out of 32 without clinical abnormalities except for arrhythmias (59%) had myocardial changes (six had myocarditic changes, ten had postmyocarditic changes, and three had nonspecific abnormalities). On the other hand, nine out of 21 with myocarditic or postmyocarditic changes were accompanied with various arrhythmias other than SVT (two had SSS, five had AV block or rBBB, and two had VT). Elevated LVEDP was present in 36% of the group with normal myocardium and in 53% of the group with myocardial changes. However, the low EF was shown in no patients with normal myocardium but in 21% of the group with myocardial changes. The low CI was also shown in only 9% of the group with normal myocardium but in 28% of the group with myocardial changes. These results suggest that patients with SVT may exhibit several histopathological changes in the myocardium, even in the absence of any clinical organic heart disease.
50例室上性心动过速（SVT）患者接受了临床电生理研究（EPS）、心内膜活检和心脏导管检查。EPS显示，7例为房室结折返性心动过速（AVNRT），9例为利用隐匿性房室旁路通道的房室折返性心动过速（AVR - CBT），13例为利用伴有心室预激的房室旁路通道的房室折返性心动过速（显性WPW），3例为窦房结或房内折返性心动过速（SNRT或IART），9例为心房扑动（AF），5例为自律性房性心动过速（AAT），4例为多源性房性心动过速（MAT）。根据临床观察，3例AVNRT患者（43%）、6例AVR - CBT患者（67%）、6例显性WPW患者（46%）、2例SNRT或IART患者（67%）、8例AF患者（89%）、2例AAT患者（40%）和2例MAT患者（50%）伴有其他临床异常。在所有接受组织学研究的患者中，均可见心肌改变；分别有6例（12%）出现心肌炎性改变、15例（30%）出现心肌炎性后改变和9例（18%）出现非特异性异常。7例AVNRT患者中有4例（57%）观察到心肌改变，9例AVR - CBT患者中有6例（67%），13例显性WPW患者中有5例（38%），3例SNRT或IART患者中有2例（67%），9例AF患者中有6例（67%），5例AAT患者全部（100%），4例MAT患者中有2例（50%）。32例除心律失常外无临床异常的患者中有19例（59%）有心肌改变（6例有心肌炎性改变，10例有心肌炎性后改变，3例有非特异性异常）。另一方面，21例有心肌炎性或心肌炎性后改变的患者中有9例伴有SVT以外的各种心律失常（2例有窦性停搏，5例有房室传导阻滞或右束支传导阻滞，2例有室性心动过速）。心肌正常组中36%的患者左室舒张末期压力（LVEDP）升高，心肌改变组中53%的患者升高。然而，心肌正常的患者中无EF降低者，但心肌改变组中有21%的患者EF降低。心肌正常组中仅有9%的患者心脏指数（CI）降低，而心肌改变组中有28%的患者CI降低。这些结果表明，即使没有任何临床器质性心脏病，SVT患者的心肌也可能出现几种组织病理学改变。
