Brooks R, Burgess J H
Department of Medicine, Montreal General Hospital, Quebec, Canada.
Medicine (Baltimore). 1988 Sep;67(5):271-94. doi: 10.1097/00005792-198809000-00001.
Idiopathic or unexplained VT occurs in a small but important subset of patients without clinically evident heart disease. The majority of these patients appear to have a structurally normal heart. The cause of the arrhythmias in these individuals is unclear and may never be recognized. Other patients with this condition may have minor abnormalities not sufficient to impair overall cardiac function. The significance of these abnormalities to the genesis of the arrhythmia is uncertain. Whether patients with minor abnormalities are more likely to harbor covert heart disease such as myocarditis or a focal defect is not known, nor is it resolved whether such patients warrant a more aggressive search for a structural cause. The question that remains in any patient not subjected to surgical or pathological exploration is whether undetermined heart disease is responsible for the arrhythmia. Continued correlation between functional (electrophysiological) and structural (pathological) data will provide meaningful information concerning the pathophysiology (substrate) of these arrhythmias. Because of the preservation of normal cardiac function, these arrhythmias are generally well-tolerated. Although the condition is usually associated with a favorable prognosis, the occasional deaths reported in patients with apparently idiopathic ventricular arrhythmias may not permit calling this condition benign. It would be important to know the extent to which unrecognized abnormalities play a role in the genesis of these tachycardias, and whether such patients are more predisposed to fatal arrhythmias or have a different natural history. If cases involving undetermined or covert heart disease were excluded from consideration, then a relatively homogeneous disease-free group may be identified with a truly benign condition and a uniformly favorable prognosis. In these cases, a primary electrical abnormality may prove to be the basis for the arrhythmia. These issues remain to be elucidated in future studies.
特发性或不明原因的室性心动过速（VT）发生在一小部分但很重要的无临床明显心脏病的患者中。这些患者中的大多数心脏结构似乎正常。这些个体心律失常的原因尚不清楚，可能永远无法明确。其他患有这种情况的患者可能有轻微异常，但不足以损害整体心脏功能。这些异常对心律失常发生的意义尚不确定。有轻微异常的患者是否更有可能隐匿有诸如心肌炎或局灶性缺陷等隐匿性心脏病尚不清楚，对于这类患者是否需要更积极地寻找结构性病因也未得到解决。在任何未接受手术或病理检查的患者中，仍然存在的问题是未确定的心脏病是否是心律失常的原因。功能（电生理）和结构（病理）数据之间的持续关联将为这些心律失常的病理生理学（基质）提供有意义的信息。由于心脏功能正常得以保留，这些心律失常通常耐受性良好。尽管这种情况通常预后良好，但在明显特发性室性心律失常患者中报告的偶发死亡可能不允许将这种情况称为良性。了解未被识别的异常在这些心动过速发生中所起的作用程度，以及这类患者是否更容易发生致命性心律失常或有不同的自然病史，将是很重要的。如果将涉及未确定或隐匿性心脏病的病例排除在外，那么可能会确定一个相对同质的无病组，其病情真正良性且预后一致良好。在这些病例中，原发性电异常可能被证明是心律失常的基础。这些问题仍有待未来的研究阐明。
