von Olshausen K, Schäfer A, Mehmel H C, Schwarz F, Senges J, Kübler W
Br Heart J. 1984 Feb;51(2):195-201. doi: 10.1136/hrt.51.2.195.
Twenty four hour ambulatory electrocardiograms were recorded in 60 patients with idiopathic dilated cardiomyopathy. The diagnosis was based on clinical, laboratory, and cardiac catheterisation findings. All patients had a left ventricular ejection fraction less than 0.55; in 39 it was less than 0.40. Ventricular extrasystoles were evident in all patients: they were rare in 11 (18%), moderately frequent in 24 (40%), and frequent in 25 (42%). Multiform extrasystoles were recorded in 57 patients (95%), paired ventricular extrasystoles in 47 (78%), and non-sustained ventricular tachycardias consisting of three to 19 beats in 25 (42%) of the 60 patients studied. Eight patients had more than five episodes of ventricular tachycardia a day. Patients with atrial fibrillation had the same frequency and grade of ventricular arrhythmias as those with sinus rhythm. Patients with infrequent and frequent ventricular extrasystoles could not be differentiated on the basis of the clinical or haemodynamic findings. The mean values of NYHA functional class, cardiac index, left ventricular end diastolic pressure, and ejection fraction were, however, significantly different in patients with and without ventricular tachycardia. During follow up of 12 +/- 5 months seven patients died; all seven had an ejection fraction less than 0.40. In four patients who died of congestive heart failure, but in only one of the three patients who died a sudden cardiac death, ventricular tachycardia was recorded during ambulatory monitoring. High grade ventricular arrhythmias are often seen in patients with idiopathic dilated cardiomyopathy; patients with ventricular tachycardia have more impairment of left ventricular function than patients without ventricular tachycardia; and ambulatory monitoring may be of little help in identifying patients at increased risk of sudden cardiac death.
对60例特发性扩张型心肌病患者进行了24小时动态心电图记录。诊断基于临床、实验室及心导管检查结果。所有患者左心室射血分数均小于0.55；其中39例小于0.40。所有患者均有室性期前收缩：11例（18%）少见，24例（40%）中等频率，25例（42%）频繁。57例患者（95%）记录到多形性期前收缩，47例（78%）记录到成对室性期前收缩，60例研究患者中有25例（42%）记录到由3至19次搏动组成的非持续性室性心动过速。8例患者每天有超过5次室性心动过速发作。房颤患者的室性心律失常频率和分级与窦性心律患者相同。室性期前收缩少见和频繁的患者在临床或血流动力学表现上无法区分。然而，有室性心动过速和无室性心动过速的患者在纽约心脏协会（NYHA）心功能分级、心脏指数、左心室舒张末期压力及射血分数方面的平均值有显著差异。在12±5个月的随访期间，7例患者死亡；所有7例射血分数均小于0.40。4例死于充血性心力衰竭，但在3例心源性猝死患者中只有1例在动态监测期间记录到室性心动过速。特发性扩张型心肌病患者常可见到高级别室性心律失常；有室性心动过速的患者左心室功能损害比无室性心动过速的患者更严重；动态监测对识别心源性猝死风险增加的患者可能帮助不大。
