Panda Subhanarayan, Kaur Daljeet, Lalukota Krishnamohan, Sundar Gomathi, Pavri Behzad B, Narasimhan Calambur
CARE Hospital, Division of Cardiac Electrophysiology, Hyderabad, India.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Pacing Clin Electrophysiol. 2015 Jun;38(6):694-9. doi: 10.1111/pace.12626. Epub 2015 Apr 14.
Ventricular tachycardia (VT), a common manifestation of cardiac sarcoidosis (CS), is associated with high morbidity and mortality. It could be mistaken for idiopathic VT (IVT) in the absence of systemic manifestations and overt cardiac structural abnormality. We studied the electrocardiogram (ECG) characteristics of VT in CS that may distinguish from IVT and also explored the relationship of the ECG characteristics with imaging findings in patients with CS.
Twelve-lead ECG characteristics of VT in CS patients (Group I = 37) were compared with IVT (Group II = 49). QRS duration, axis, morphology, VT cycle length, and cycle length variation (CLV) were analyzed. In Group I, 18 (49%) had pleomorphic VT (PLVT) and none in Group II. CLV was seen only in Group I (24%). Mean QRS duration (milliseconds) and cycle length (milliseconds) were greater in Group I (QRSd 152.49 [39.3] vs 140.9 [19.2]) and (332.2 [136.5] vs 312.9 [56.2]), the differences not statistically significant. In Group I, myocardial scar was present in 22 of 25 patients and myocardial inflammation in 28 of 29 patients as assessed by cardiac magnetic resonance imaging (delayed enhancement) and 18-fluorodeoxyglucose positron emission computed tomography, respectively. PLVT was seen more commonly in patients with involvement of >1 myocardial region than focal involvement (58% and 30%, respectively, with myocardial scar and 50% and 40%, respectively, with myocardial inflammation).
Pleomorphism and CLV during VT may be distinguishing features between IVT and VTs of CS origin.
室性心动过速（VT）是心脏结节病（CS）的常见表现，与高发病率和死亡率相关。在没有全身表现和明显心脏结构异常的情况下，它可能被误诊为特发性室性心动过速（IVT）。我们研究了CS中VT的心电图（ECG）特征，这些特征可能有助于将其与IVT区分开来，并探讨了这些ECG特征与CS患者影像学表现之间的关系。
将CS患者（I组 = 37例）VT的12导联心电图特征与IVT患者（II组 = 49例）进行比较。分析了QRS波时限、电轴、形态、VT周期长度和周期长度变化（CLV）。在I组中，18例（49%）有形态多形性室性心动过速（PLVT），II组中无。CLV仅在I组中出现（24%）。I组的平均QRS波时限（毫秒）和周期长度（毫秒）更大（QRSd 152.49 [39.3] 对比140.9 [19.2]）以及（332.2 [136.5] 对比312.9 [56.2]），差异无统计学意义。在I组中，通过心脏磁共振成像（延迟强化）和18氟脱氧葡萄糖正电子发射计算机断层扫描分别评估，25例患者中有22例存在心肌瘢痕，29例患者中有28例存在心肌炎症。与局限性受累相比，PLVT在累及>1个心肌区域的患者中更常见（心肌瘢痕分别为58%和30%，心肌炎症分别为50%和40%）。
VT期间的多形性和CLV可能是IVT与CS起源的VT之间的鉴别特征。
