Cardiovascular Department, "Azienda Sanitaria Universitaria Giuliano-Isontina", Trieste, Italy.
Cardiovascular Department, "Azienda Sanitaria Universitaria Giuliano-Isontina", Trieste, Italy; Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK.
Am J Cardiol. 2021 Nov 15;159:72-78. doi: 10.1016/j.amjcard.2021.08.026.
There is limited evidence on characterization and natural history of supraventricular tachycardia (SVT)-induced left ventricular (LV) dysfunction. The aim of this work was to characterize clinical features and long-term evolution of SVT-induced LV dysfunction. Patients consecutively admitted with sustained SVT and heart rate >100 bpm as the only known cause of a new onset LV systolic dysfunction (i.e., LV ejection fraction [EF] <50%) were analyzed. Patients were then revaluated periodically. Recovered LVEF (i.e., ≥50%) and a composite of death, heart transplant or first episode of major ventricular arrhythmias were evaluated as study end-points. We enrolled 83 patients. After SVT therapy, 56 (67%) showed a recovered LVEF at the last follow-up of median 54 (interquartile range 36 to 87) months. Seventeen (30%) of those patients had a temporary new drop in LVEF during follow-up associated to high-rate SVT relapse. At presentation, patients with recovered LVEF were younger (52 vs 67 years respectively, p <0.001) and had higher LVEF (34% vs 27% respectively, p = 0.005) compared to non-recovered LVEF patients. Finally, 4% of recovered LVEF patients vs 26% of nonrecovered LVEF patients experienced death/heart transplant/major ventricular arrhythmias during follow-up (p = 0.004). In conclusion, after almost 5 years of follow-up, two-thirds of patients with high-rate SVT causing a newly diagnosed LV systolic dysfunction recovered and maintained normal LV function after SVT control, with a subsequent benign outcome. Long term individual surveillance is required in those patients, as arrhythmic recurrences and new drops in LVEF are common in the long term.
关于室上性心动过速（SVT）引起的左心室（LV）功能障碍的特征和自然病史的证据有限。本研究旨在描述 SVT 引起的 LV 功能障碍的临床特征和长期演变。连续入组因持续性 SVT 伴心率>100 bpm 而导致新发 LV 收缩功能障碍（即 LV 射血分数 [EF] <50%）的患者。随后定期对患者进行评估。恢复的 LVEF（即≥50%）和死亡、心脏移植或首次出现主要室性心律失常的复合终点作为研究终点。我们共纳入 83 例患者。在 SVT 治疗后，56 例（67%）患者在中位随访 54 个月（四分位距 36 至 87）时 LVEF 恢复。其中 17 例（30%）患者在随访期间因 SVT 复发出现一过性 LVEF 新降低。在就诊时，与未恢复 LVEF 患者相比，恢复 LVEF 患者更年轻（分别为 52 岁和 67 岁，p<0.001）且 LVEF 更高（分别为 34%和 27%，p=0.005）。最后，在随访期间，恢复 LVEF 的患者中有 4%（4/104）发生死亡/心脏移植/主要室性心律失常，而非恢复 LVEF 的患者中有 26%（27/104）（p=0.004）。总之，在近 5 年的随访后，三分之二因高心率 SVT 导致新发 LV 收缩功能障碍的患者在控制 SVT 后恢复并维持正常 LV 功能，随后结果良好。需要对这些患者进行长期个体监测，因为心律失常复发和 LVEF 新降低在长期随访中很常见。
