Marchetti Matteo, Pascale Patrizio, Muller Olivier, Lu Henri
Service de médecine interne, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, 1011 Lausanne, Suisse.
Service de cardiologie, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, 1011 Lausanne, Suisse.
Ann Cardiol Angeiol (Paris). 2022 Oct;71(4):223-227. doi: 10.1016/j.ancard.2022.08.006. Epub 2022 Sep 9.
Arrhythmogenic right ventricular cardiomyopathy is a hereditary myocardial condition in most cases that affects the right ventricle, but also the left ventricle with variable degree. It predisposes patients to ventricular arrhythmia, heart failure and sudden death. Its diagnosis remains challenging and is mostly based on reference task-force criteria. The latter, divided between major and minor criteria, include structural abnormalities (visualized on echocardiography or cardiac magnetic resonance), electrocardiographic anomalies, ventricular arrythmia documentation, histological proof of fibro-fatty infiltrates within myocardial tissue and family history. Following a correct diagnosis, patient-tailored care is essential. First, implantation of an implantable cardioverter-defibrillator is recommended in case of history of sudden death, sustained ventricular tachycardia or advanced right/left ventricular dysfunction. It should be considered in case of cardiac syncope or non-sustained ventricular tachycardia. Secondly, eviction of high intensity physical activity is mandatory. Finally, beta-blockers are recommended for all patients with clinically manifest arrhythmogenic right ventricular cardiomyopathy.
致心律失常性右室心肌病在大多数情况下是一种遗传性心肌疾病,主要影响右心室,但也会不同程度地累及左心室。它使患者易患室性心律失常、心力衰竭和猝死。其诊断仍然具有挑战性,主要基于参考工作组标准。该标准分为主要标准和次要标准,包括结构异常(通过超声心动图或心脏磁共振成像显示)、心电图异常、室性心律失常记录、心肌组织内纤维脂肪浸润的组织学证据以及家族史。正确诊断后,针对患者的个体化治疗至关重要。首先,对于有猝死史、持续性室性心动过速或严重右/左心室功能障碍的患者,建议植入植入式心脏复律除颤器。对于心脏性晕厥或非持续性室性心动过速的情况也应考虑。其次,必须避免高强度体育活动。最后,对于所有临床表现为致心律失常性右室心肌病的患者,推荐使用β受体阻滞剂。