Link Mark S, Bockstall Katy, Weinstock Jonathan, Alsheikh-Ali Alawi A, Semsarian Christopher, Estes N A Mark, Spirito Paolo, Haas Tammy S, Rowin Ethan J, Maron Martin S, Maron Barry J
UT Southwestern Medical Center, Dallas, Texas, USA.
Mount Sinai Medical Center, New York, New York, USA.
J Cardiovasc Electrophysiol. 2017 May;28(5):531-537. doi: 10.1111/jce.13194. Epub 2017 Mar 31.
Triggers and ICD interventions of ventricular arrhythmias in patients with hypertrophic cardiomyopathy (HCM) offer insight into mechanisms and treatment.
Intracardiac ICD electrograms from 71 HCM patients in the HCM I and II studies were analyzed by three individuals. Rhythms were defined as VF (polymorphic ventricular arrhythmia), VT (monomorphic ventricular tachycardia), and ventricular flutter (VFL; VT ≥ 240 bpm). Physical activity and rhythm preceding the arrhythmia were ascertained. Of 149 arrhythmias, VF was present in 74, VT in 57, and VFL in 18. In those whose activity was known, moderate or intense physical activity was associated with over 50% of the tachycardias (57 of 111). Rhythms preceding ventricular arrhythmias were often sinus tachycardia (49 of 149; 33%) or rapid atrial fibrillation (7 of 149; 5%). VF and VFL were more likely preceded by supraventricular rhythms >100 bpm (30 of 68 with VF; 44%; 12 of 16 with VFL 75%, vs. 14 of 50 with VT 28%; P = 0.001). Antitachycardia pacing (ATP) was successful in 39 of 53 (74%). Multiple shocks were more often required to terminate VFL (10 of 18; 56%) compared to VF (10 of 72; 14%) and VT (2 of 25; 8%; P < 0.0001). Of arrhythmias requiring more than one shock to terminate, 16 of 22 were preceded by sinus tachycardia and/or moderate or extreme physical activity.
Rapid supraventricular rhythms, and at least moderate activity, frequently precede VT and VF, and when they occur in these situations often require multiple ICD shocks to restore sinus rhythm. ATP is successful in terminating VT and VFL, and should be a programmed in all HCM patients with ICDs.
肥厚型心肌病（HCM）患者室性心律失常的触发因素及植入式心律转复除颤器（ICD）干预措施有助于深入了解其机制和治疗方法。
对HCM I和II研究中71例HCM患者的心内ICD电图由三人进行分析。心律失常类型定义为心室颤动（VF，多形性室性心律失常）、室性心动过速（VT，单形性室性心动过速）和心室扑动（VFL，VT≥240次/分钟）。确定心律失常发作前的体力活动及心律情况。在149次心律失常中，VF有74次，VT有57次，VFL有18次。在活动情况已知的患者中，超过50%的心动过速（111次中的57次）与中度或剧烈体力活动有关。室性心律失常发作前的心律常为窦性心动过速（149次中的49次，33%）或快速心房颤动（149次中的7次，5%）。VF和VFL更可能在室上性心律>100次/分钟之前出现（VF的68次中有30次，44%；VFL的16次中有12次，75%，而VT的50次中有14次，28%；P=0.001）。抗心动过速起搏（ATP）在53次中有39次成功（74%）。与VF（72次中的10次，14%）和VT（25次中的2次，8%）相比，终止VFL通常需要更多次电击（18次中的10次，56%；P<0.0001）。在需要多次电击才能终止的心律失常中，22次中有16次发作前有窦性心动过速和/或中度或剧烈体力活动。
快速室上性心律以及至少中度活动常先于VT和VF出现，且在这些情况下发生时，往往需要多次ICD电击才能恢复窦性心律。ATP能成功终止VT和VFL，应纳入所有植入ICD的HCM患者的程控中。
