Haissaguerre M, Montserrat P, Le Métayer P, Barrat J L, Warin J F
Service de cardiologie, hôpital Saint-André, Bordeaux.
Arch Mal Coeur Vaiss. 1989 Nov;82(11):1845-53.
The sympathetic nervous system seems to play a major role in the genesis of ventricular arrhythmias. The authors studied this adrenergic factor prospectively by exercise stress testing and intravenous isoprenaline in 107 patients referred for evaluation of arrhythmias or symptoms thought to be due to arrhythmias: 30 patients had morphologically normal hearts (15 ventricular extrasystoles, 15 bursts of ventricular tachycardia); 55 patients had dilated cardiomyopathy and 22 had probable or proven arrhythmogenic right ventricular dysplasia. Exercise testing was carried out with 30 watt increments every 3 minutes. Ventricular tachycardia was induced in 6 patients with apparently normal hearts (17%), 13 patients with dilated cardiomyopathy (31%) and 7 patients with arrhythmogenic right ventricular dysplasia (40%). Isoprenaline was infused for 3 minutes at a dose of 8-12 g/min: ventricular tachycardia was induced in 7 patients with apparently normal hearts (24%) and 23 patients with dilated cardiomyopathy. In some patients presenting with syncope, an arrhythmogenic response to isoprenaline was the only abnormality detected by the study protocol. An arrhythmia was induced by isoprenaline in 17 of the 18 patients with confirmed right ventricular dysplasia (94%), 12 of whom had sustained mono or polymorphic ventricular tachycardia. Two of these patients did not have significant right ventricular wall motion abnormalities. Four asymptomatic subjects related to patients with right ventricular dysplasia underwent the isoprenaline test; bursts of ventricular tachycardia were recorded in 3 of them. Polymorphic ventricular tachycardia was specifically associated with cardiac disease. The maximum heart rate attained by exercise testing (148 +/- 19/min) was higher than that attained with isoprenaline (148 +/- 22/min).(ABSTRACT TRUNCATED AT 250 WORDS)
交感神经系统似乎在室性心律失常的发生中起主要作用。作者通过运动负荷试验和静脉注射异丙肾上腺素，对107例因心律失常或疑似心律失常症状而转诊进行评估的患者进行了前瞻性的肾上腺素能因素研究：30例患者心脏形态正常（15例室性早搏，15例室性心动过速发作）；55例患者患有扩张型心肌病，22例可能患有或已证实患有致心律失常性右室发育不良。运动试验每3分钟以30瓦的增量进行。6例心脏明显正常的患者（17%）、13例扩张型心肌病患者（31%）和7例致心律失常性右室发育不良患者（40%）诱发了室性心动过速。以8 - 12微克/分钟的剂量静脉注射异丙肾上腺素3分钟：7例心脏明显正常的患者（24%）和23例扩张型心肌病患者诱发了室性心动过速。在一些出现晕厥的患者中，对异丙肾上腺素的致心律失常反应是研究方案检测到的唯一异常。18例确诊为右室发育不良的患者中有17例（94%）被异丙肾上腺素诱发心律失常，其中12例发生持续性单形性或多形性室性心动过速。这些患者中有2例没有明显的右室壁运动异常。4名与右室发育不良患者相关的无症状受试者接受了异丙肾上腺素试验；其中3例记录到室性心动过速发作。多形性室性心动过速与心脏病有特定关联。运动试验达到的最大心率（148±19次/分钟）高于异丙肾上腺素试验达到的最大心率（148±22次/分钟）。（摘要截选至250字）
