Babuty D, Cosnay P, Breuillac J C, Charniot J C, Delhomme C, Fauchier L, Fauchier J P
Service de Cardiologie B, Hôpital Trousseau, Tours, France.
Pacing Clin Electrophysiol. 1994 Jun;17(6):1090-9. doi: 10.1111/j.1540-8159.1994.tb01466.x.
To assess the prevalence of ventricular arrhythmias and late potentials (LPs) in mitral valve prolapse (MVP) and to identify clinical, ECG, and echocardiographic markers of spontaneous ventricular arrhythmias, we studied 58 consecutive patients (mean age 46.6 +/- 17.8 years; 29 males, 29 females) with MVP diagnosed by echocardiography. Patients underwent ambulatory ECG recording (n = 58), exercise stress test (n = 56), signal-averaged ECG (n = 58), and programmed ventricular stimulation (n = 52). Ten patients (17.2%) had spontaneous nonsustained ventricular tachycardia (NSVT), 26 patients (44.8%) had premature ventricular contractions (PVCs), Lown grade > or = 3 during 24-hour ECG, and 19 had Lown grade > or = 3 PVCs during exercise stress test; 13 patients had LPs (22.4%). We provoked sustained VT in one case and NSVT in ten cases. Patients with complex ventricular arrhythmias during 24-hour ECG and exercise stress test were older and more often had mitral regurgitation. There was a statistical correlation between the presence of LPs and spontaneous VT (46.1% vs 8.9%; P < 0.005) and induced ventricular arrhythmias (50% vs 12.8%; P < 0.005). No correlation was found between spontaneous ventricular arrhythmias and thickness or posterior displacement of the mitral valve. In conclusion, complex ventricular arrhythmia (especially VT) and LPs are frequent in MVP. Patient age and mitral regurgitation seem to be determinant factors of complex ventricular arrhythmias in MVP. On signal-averaged ECG, absence of LPs seems to be a good additional marker to identify MVP patients without spontaneous VT. On the other hand, programmed ventricular stimulation does not appear valuable in determining a MVP subgroup with a high risk of ventricular arrhythmias.
为评估二尖瓣脱垂（MVP）患者室性心律失常和晚电位（LPs）的患病率，并确定自发性室性心律失常的临床、心电图和超声心动图标志物，我们研究了58例经超声心动图诊断为MVP的连续患者（平均年龄46.6±17.8岁；男性29例，女性29例）。患者接受了动态心电图记录（n = 58）、运动负荷试验（n = 56）、信号平均心电图（n = 58）和程控心室刺激（n = 52）。10例患者（17.2%）有自发性非持续性室性心动过速（NSVT），26例患者（44.8%）有室性早搏（PVCs），24小时心电图期间Lown分级≥3级，19例患者在运动负荷试验期间有Lown分级≥3级的PVCs；13例患者有LPs（22.4%）。我们诱发出1例持续性室速和10例非持续性室速。24小时心电图和运动负荷试验期间有复杂室性心律失常的患者年龄较大，且更常伴有二尖瓣反流。LPs的存在与自发性室速（46.1%对8.9%；P < 0.005）和诱发性室性心律失常（50%对12.8%；P < 0.005）之间存在统计学相关性。未发现自发性室性心律失常与二尖瓣厚度或后移之间存在相关性。总之，复杂室性心律失常（尤其是室速）和LPs在MVP中很常见。患者年龄和二尖瓣反流似乎是MVP中复杂室性心律失常的决定性因素。在信号平均心电图上，无LPs似乎是识别无自发性室速的MVP患者的一个很好的附加标志物。另一方面，程控心室刺激在确定有室性心律失常高风险的MVP亚组方面似乎没有价值。
