Fauchier J P, Cosnay P, Moquet B, Balleh H, Rouesnel P
Cardiologie B et Laboratorie d'Electrophysiologie, Tours, France.
Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):1974-83. doi: 10.1111/j.1540-8159.1988.tb06337.x.
In a series of 83 patients with dilated (DCM) (n = 56) or hypertrophic cardiomyopathies (HCM) (n = 27), were performed 24-hour-Holter monitorings, exercise stress testings, noninvasive recordings of late ventricular potentials (LVP), and programmed ventricular stimulations (PVS) (sinus rhythm and three cycles of stimulation, two extrastimuli, two right ventricle sites) (n = 53), in order to appreciate the frequency of ventricular premature depolarisations (VPDs), to correlate these results with myocardial vulnerability to TV induction, and to compare electrophysiologic and hemodynamic results. Holter monitoring showed that 80% of group A patients had VPDs (75% Lown's grade 3 or over) and 63% in group B (37% greater than or equal to grade 3). LVP were found in 15/56 DCM, and 2/27 HCM; in comparison with a control group of 32 normal subjects, the prevalence of LVP was only significant for DCM group. LVP were more frequent in cases of VPD's greater than or equal to Lown's grade 3 at Holter monitoring in DCM group, (33% versus 7% if VPDs less than or equal to Lown's grade 3) and HCM group (20% versus 0) but the correlation was not significant. Exercise stress testing, conducted only in group B, revealed about 20% of VPDs. PVS provoked ventricular arrhythmia (greater than 5 QRS) in 13 out of 33 cases in group A and in 2 out of 20 cases in group B. There was no significant correlation between the results of these methods of study and those of hemodynamic or echocardiographic explorations except for cardiac index in group A (lower when LVP were present, and VPDs greater than or equal to grade 3 during Holter) and end diastolic diameter (larger when PVS provoked fewer ventricular arrhythmias). In group B, PVS induced monomorphic VT in 2/3 patients with syncopes. Thus: (1) ventricular arrhythmias are frequent in cardiomyopathies but LVP had a significant prevalence only in dilated forms; (2) in DCM monomorphic induced VT reproduce spontaneous crisis, whereas in HCM it is possible to provoke VT in patients with syncopes but without this clinical arrhythmia; (3) in DCM as in HCM, ventricular arrhythmia can be independent from hemodynamic disorders.
在一组83例扩张型心肌病（DCM）（n = 56）或肥厚型心肌病（HCM）（n = 27）患者中，进行了24小时动态心电图监测、运动负荷试验、心室晚电位（LVP）无创记录以及程序性心室刺激（PVS）（窦性心律和三个刺激周期，两个期外刺激，两个右心室部位）（n = 53），以评估室性早搏（VPD）的发生率，将这些结果与心肌对室性心动过速（VT）诱发的易感性相关联，并比较电生理和血流动力学结果。动态心电图监测显示，A组80%的患者有VPD（75%为洛恩分级3级及以上），B组为63%（37%大于或等于3级）。在56例DCM患者中有15例检测到LVP，27例HCM患者中有2例检测到；与32名正常受试者的对照组相比，LVP的发生率仅在DCM组有显著意义。在DCM组和HCM组中，动态心电图监测时VPD大于或等于洛恩分级3级的患者LVP更常见（DCM组中VPD大于或等于洛恩分级3级时为33%，VPD小于或等于洛恩分级3级时为7%；HCM组分别为20%和0），但相关性不显著。仅在B组进行了运动负荷试验，发现约20%的VPD。PVS在A组33例中的13例和B组20例中的2例诱发了室性心律失常（大于5个QRS波）。除A组的心脏指数（存在LVP且动态心电图监测时VPD大于或等于3级时较低）和舒张末期直径（PVS诱发的室性心律失常较少时较大）外，这些研究方法的结果与血流动力学或超声心动图检查结果之间无显著相关性。在B组中，PVS在2/3有晕厥的患者中诱发了单形性VT。因此：（1）心肌病患者室性心律失常常见，但LVP仅在扩张型心肌病中显著常见；（2）在DCM中，诱发的单形性VT重现自发发作，而在HCM中，晕厥患者可诱发VT，但无这种临床心律失常；（3）在DCM和HCM中，室性心律失常可独立于血流动力学紊乱。
