Blagova O V, Nedostup A V, Kogan E A, Sulimov V A, Abugov S A, Kupriyanova A G, Zaydenov V A, Donnikov A E, Zaklyazminskaya E V, Okisheva E A
Sechenov First Moscow State Medical University 119992, Moscow, B.Pirogovskaya str., 6.
Petrovsky Russian Scientific Center of Surgery. RAMS.
J Atr Fibrillation. 2016 Jun 30;9(1):1414. doi: 10.4022/jafib.1414. eCollection 2016 Jun-Jul.
The nosological nature of "idiopathic" arrhythmias and the effect of etiotropic and pathogenetic treatment are often unknown.
19 patients (42.6±11.3 years, 9 women) with atrial fibrillation (n = 16), supraventricular (n = 10) and ventricular (n = 4) premature beats, supraventricular (n = 2) and ventricular tachycardia (n = 1), left bundle branch block (n= 2), AV block (n = 2) without structural heart changes. Viruses were identified (polymerase chain reaction, PCR) along with measurement of anti-heart antibodies (AHA) and endomyocardial biopsy (EMB). EMB allowed to establish diagnosis in all patients: infectious-immune myocarditis (n = 11, parvovirus-positive in 1),parvovirus-positive endomyocarditis (n = 1),systemic (n = 2) and myocardial (n = 1) vasculitis,Fabry's disease (n = 1), arrhythmogenic right ventricular dysplasia (n = 1),unspecified genetic cardiomyopathy (n = 2, herpes virus 6 one positive). Level of AHA had the greatest significance for myocarditis diagnostics. All patients with myocarditis/vasculitis had background therapy: acyclovir (n = 10), IV immunoglobulin (n = 2), meloxicam (n = 12), hydroxychloroquine (n = 15), steroids (n = 14, 31.1±12.5 mg/day), azathioprine 150 mg/day (n = 2). Median follow-up was 4 years. Treatment significantly reduced the rate of arrhythmias (8 [5;8] to 3 [1.25;7.75] points); disappearance of bundle branch block was noted.
EMB allowed to diagnose immune-mediated inflammatory diseases in 78.9% patients with 'idiopathic' arrhythmias and genetic diseases in 21.1%. Background therapy of myocarditis improved the antiarrhythmic efficiency, and allowed the best premed for interventional treatment.
“特发性”心律失常的疾病本质以及病因导向和发病机制治疗的效果通常尚不清楚。
19例患者（年龄42.6±11.3岁，女性9例），患有心房颤动（n = 16）、室上性（n = 10）和室性（n = 4）早搏、室上性（n = 2）和室性心动过速（n = 1）、左束支传导阻滞（n = 2）、房室传导阻滞（n = 2），无结构性心脏改变。通过病毒鉴定（聚合酶链反应，PCR）以及抗心脏抗体（AHA）检测和心内膜心肌活检（EMB）进行评估。EMB使所有患者得以确诊：感染性免疫性心肌炎（n = 11，其中1例细小病毒阳性）、细小病毒阳性心内膜炎（n = 1）、系统性（n = 2）和心肌性（n = 1）血管炎、法布里病（n = 1）、致心律失常性右心室发育不良（n = 1）、未明确的遗传性心肌病（n = 2，其中1例疱疹病毒6阳性）。AHA水平对心肌炎诊断具有最大意义。所有心肌炎/血管炎患者均接受了基础治疗：阿昔洛韦（n = 10）、静脉注射免疫球蛋白（n = 2）、美洛昔康（n = 12）、羟氯喹（n = 15）、类固醇（n = 1）。
EMB使78.9%的“特发性”心律失常患者被诊断为免疫介导的炎性疾病，21.1%被诊断为遗传性疾病。心肌炎的基础治疗提高了抗心律失常疗效，并为介入治疗提供了最佳前提条件。
