Maron B J, Savage D D, Wolfson J K, Epstein S E
Am J Cardiol. 1981 Aug;48(2):252-7. doi: 10.1016/0002-9149(81)90604-4.
The prevalence and prognostic significance of ventricular arrhythmias identified on 24 hour ambulatory electrocardiographic monitoring was prospectively assessed in 99 patients with hypertrophic cardiomyopathy. In the absence of antiarrhythmic therapy, high grade ventricular arrhythmias (grade 3 and above) were common; that is they were identified in 66 percent of the patients, including 19 percent with episodes of asymptomatic ventricular tachycardia. Clinical outcome was assessed 3 years after the initial 24 hour ambulatory electrocardiogram. Of the 84 patients who did not undergo ventricular septal myotomy-myectomy, 6 died suddenly or experienced cardiac arrest, 1 died of progressive congestive heart failure and the other 77 have survived without a cardiac catastrophe. The prevalence rate of sudden death or cardiac arrest during the follow-up period was the same (3 percent) in patients with high grade arrhythmias other than ventricular tachycardia (1 of 37) as in those with no or low grade arrhythmias (1 of 29). However, the occurrence of a sudden cardiac catastrophe was significantly more common in patients with asymptomatic ventricular tachycardia of brief duration on 24 hour electrocardiography (4 [24 percent] of 17) than in patients without ventricular tachycardia (2 [3 percent] of 66) (p less than 0.02). In summary, (1) high grade ventricular arrhythmias are commonly found on continuous 24 hour electrocardiography monitoring in patients with hypertrophic cardiomyopathy; and (2) although sudden death is relatively uncommon in patients with high grade ventricular arrhythmias other than ventricular tachycardia (annual mortality rate 1 percent), the finding of ventricular tachycardia on 24 hour electrocardiography identifies a subgroup of patients at high risk for sudden death (annual mortality rate 8.6 percent). Although no conclusions can be drawn regarding the impact of therapy, our findings suggest that 24 hour electrocardiographic monitoring should be performed in patients with hypertrophic cardiomyopathy and that it may be reasonable to initiate antiarrhythmic therapy if ventricular tachycardia is identified.
对99例肥厚型心肌病患者进行前瞻性评估，以确定24小时动态心电图监测发现的室性心律失常的患病率及其预后意义。在未接受抗心律失常治疗的情况下，高级别室性心律失常（3级及以上）很常见；也就是说，66%的患者存在此类心律失常，其中19%有无症状性室性心动过速发作。在首次进行24小时动态心电图检查3年后评估临床结局。在84例未接受室间隔心肌切开术-心肌切除术的患者中，6例突然死亡或发生心脏骤停，1例死于进行性充血性心力衰竭，其余77例存活且未发生心脏灾难。在随访期间，除室性心动过速外的高级别心律失常患者（37例中的1例）与无心律失常或低级别心律失常患者（29例中的1例）的猝死或心脏骤停患病率相同（均为3%）。然而，24小时心电图显示为短暂无症状性室性心动过速的患者（17例中的4例[24%]）发生心脏突发事件的情况明显多于无室性心动过速的患者（66例中的2例[3%]）（p<0.02）。总之，（1）肥厚型心肌病患者在连续24小时心电图监测中常发现高级别室性心律失常；（2）虽然除室性心动过速外的高级别室性心律失常患者猝死相对少见（年死亡率1%），但24小时心电图发现室性心动过速可确定一组猝死高危患者（年死亡率8.6%）。尽管无法就治疗的影响得出结论，但我们的研究结果表明，肥厚型心肌病患者应进行24小时心电图监测，如果发现室性心动过速，启动抗心律失常治疗可能是合理的。
