Wang Weijia, Lian Zhesi, Rowin Ethan J, Maron Barry J, Maron Martin S, Link Mark S
From the Hypertrophic Cardiomyopathy Institute, Department of Medicine, Tufts Medical Center and School of Medicine, Boston, MA (W.W., E.J.R., B.J.M., M.S.M.); Department of Public Health, Tufts University School of Medicine, Boston, MA (Z.L.); and Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas TX (M.S.L.).
Circ Arrhythm Electrophysiol. 2017 Mar;10(3). doi: 10.1161/CIRCEP.116.004604.
The prognostic significance of nonsustained ventricular tachycardia (NSVT) in patients with hypertrophic cardiomyopathy is incompletely resolved.
The study group comprised 160 patients with implantable cardioverter defibrillators (ICDs), of whom 94 patients had 24- to 48-hour ambulatory monitoring preimplant. ICDs were interrogated and ambulatory ECGs monitored for NSVT episodes, with associations between NSVT- and ICD-treated ventricular arrhythmias examined. Eighty-six (54%) patients had runs of NSVT, including 17 before implant on ambulatory monitoring, 44 after ICD implantation, and 22 on both. Agreement between preimplant ambulatory monitoring and ICD interrogation for detecting NSVT was poor (κ=0.18). Eighteen of 86 patients (21%) with NSVT and 6 of 74 patients (8%) without NSVT experienced ICD-treated ventricular tachycardia (VT)/ventricular fibrillation (VF). NSVT was significantly associated with ICD-treated VT/VF (adjusted hazard ratio, 3.98; 95% confidence interval, 1.41-11.29; =0.0093). ICD-treated VT/VF was associated with NSVT runs at a rate >200 beats per minute (adjusted hazard ratio, 15.63; 95% confidence interval, 4.01-60.89; <0.0001) and >7 beats (adjusted hazard ratio, 6.26; 95% confidence interval, 2.02-19.41; =0.0015). Repetitive runs of NSVT were also associated with ICD-treated VT/VF (adjusted hazard ratio, 9.22; 95% confidence interval, 2.53-33.60; =0.0008). Slower (≤200 beats per minute), shorter (≤7), or a single run of NSVT were not associated with ICD-treated ventricular arrhythmias.
On extended monitoring, NSVT was independently associated with ICD-treated ventricular arrhythmias, supporting the importance of NSVT in hypertrophic cardiomyopathy risk stratification. Faster rate (>200 beats per minutes), longer (>7 beats), and repetitive runs of NSVT were more highly predictive of ICD-treated VT/VF.
肥厚型心肌病患者非持续性室性心动过速（NSVT）的预后意义尚未完全明确。
研究组包括160例植入式心脏复律除颤器（ICD）患者，其中94例在植入前进行了24至48小时动态监测。对ICD进行询问，并监测动态心电图以观察NSVT发作情况，同时研究NSVT与ICD治疗的室性心律失常之间的关联。86例（54%）患者出现NSVT发作，其中17例在植入前动态监测时出现，44例在ICD植入后出现，22例在两者监测中均出现。植入前动态监测与ICD询问在检测NSVT方面的一致性较差（κ=0.18）。86例有NSVT的患者中有18例（21%）以及74例无NSVT的患者中有6例（8%）经历了ICD治疗的室性心动过速（VT）/心室颤动（VF）。NSVT与ICD治疗的VT/VF显著相关（调整后风险比为3.98；95%置信区间为1.41 - 11.29；P=0.0093）。ICD治疗的VT/VF与NSVT发作频率>200次/分钟相关（调整后风险比为15.63；95%置信区间为4.01 - 60.89；P<0.0001）以及与发作>7次相关（调整后风险比为6.26；95%置信区间为2.02 - 19.41；P=0.0015）。NSVT的重复发作也与ICD治疗的VT/VF相关（调整后风险比为9.22；95%置信区间为2.53 - 33.60；P=0.0008）。较慢（≤200次/分钟）、较短（≤7次）或单次发作的NSVT与ICD治疗的室性心律失常无关。
在长期监测中，NSVT与ICD治疗的室性心律失常独立相关，支持NSVT在肥厚型心肌病风险分层中的重要性。更快的频率（>200次/分钟）、更长的发作时间（>7次）以及NSVT的重复发作对ICD治疗的VT/VF具有更高的预测价值。
