Spirito P, Rapezzi C, Autore C, Bruzzi P, Bellone P, Ortolani P, Fragola P V, Chiarella F, Zoni-Berisso M, Branzi A
Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
Circulation. 1994 Dec;90(6):2743-7. doi: 10.1161/01.cir.90.6.2743.
In the early 1980s, studies performed in highly selected referral patients with hypertrophic cardiomyopathy reported a strong association between the presence of brief episodes of ventricular tachycardia (VT) on ambulatory ECG monitoring and sudden death. These observations led to antiarrhythmic treatment in many patients with hypertrophic cardiomyopathy and brief episodes of VT. In recent years, however, a growing awareness of the potential arrhythmogenic effects of antiarrhythmic medications has raised doubts regarding such a therapeutic approach, particularly in less selected and lower-risk patient populations.
In the present study, we examined the prognostic significance of nonsustained VT in a population of 151 patients with hypertrophic cardiomyopathy who were asymptomatic or had only mild symptoms at the time of their initial ambulatory ECG recording. Of the 151 study patients, 42 had episodes of VT and 109 did not. The runs of VT ranged from 3 to 19 beats, with 35 patients (83%) having < 10 beats. The number of runs of VT ranged from 1 to 12 in 24 hours, with 36 patients (86%) having < or = 5 episodes of VT. Thus, in most patients, the episodes of VT were brief and infrequent. Follow-up averaged 4.8 years. Of the 151 study patients, 6 died suddenly, 3 in the group with VT and 3 in the group without VT. Two other patients, both in the group without VT, died of congestive heart failure. The total cardiac mortality rate was 1.4% per year in the patients with VT (95% CI, 0.4% to 3.5%) and 0.9% in those without VT (95% CI, 0.4% to 2.0%; P = .43). The relative risk of cardiac death for patients with VT was 1.4 compared with patients without VT (95% CI, 0.6 to 6.1). The sudden death rate was 1.4% per year in the patients with VT (95% CI, 0.4% to 3.5%) and 0.6% in those without VT (95% CI, 0.2% to 1.5%; P = .24). The relative risk of sudden death for patients with VT compared with those without VT was 2.4 (95% CI, 0.5 to 11.9). Of the 151 patients included in the study, 88 (58%) remained asymptomatic and were not treated with cardioactive medications during follow-up. Of these 88 patients, 20 were in the group with VT and 68 in the group without VT. None of these patients died.
Our results show that cardiac mortality is low in patients with hypertrophic cardiomyopathy who are asymptomatic or only mildly symptomatic and have brief and infrequent episodes of VT on ambulatory ECG monitoring. Our findings also suggest that brief and infrequent episodes of VT should not be considered, per se, an indication for antiarrhythmic treatment in such patients.
20世纪80年代早期，对高度选择的肥厚型心肌病转诊患者进行的研究报告称，动态心电图监测发现短暂室性心动过速（VT）与猝死之间存在密切关联。这些观察结果导致许多肥厚型心肌病伴短暂VT发作的患者接受了抗心律失常治疗。然而，近年来，人们越来越意识到抗心律失常药物潜在的致心律失常作用，这引发了对这种治疗方法的质疑，特别是在选择标准较低和风险较低的患者群体中。
在本研究中，我们对151例肥厚型心肌病患者进行了研究，这些患者在首次动态心电图记录时无症状或仅有轻微症状，我们研究了非持续性VT的预后意义。151例研究患者中，42例有VT发作，109例没有。VT发作次数为3至19次，35例患者（83%）发作次数少于10次。24小时内VT发作次数为1至12次，36例患者（86%）发作次数≤5次。因此，大多数患者的VT发作短暂且不频繁。平均随访4.8年。151例研究患者中，6例猝死，VT组3例，非VT组3例。另外2例患者，均在非VT组，死于充血性心力衰竭。VT患者的心脏总死亡率为每年1.4%（95%CI，0.4%至3.5%），非VT患者为0.9%（95%CI，0.4%至2.0%；P = 0.43）。与非VT患者相比，VT患者心脏死亡的相对风险为1.4（95%CI，0.6至6.1）。VT患者的猝死率为每年1.4%（95%CI，0.4%至3.5%），非VT患者为0.6%（95%CI，0.2%至1.5%；P = 0.24）。与非VT患者相比，VT患者猝死的相对风险为2.4（95%CI，0.5至11.9）。在纳入研究的151例患者中，88例（58%）在随访期间无症状且未接受抗心律失常药物治疗。在这88例患者中，20例在VT组，68例在非VT组。这些患者均未死亡。
我们的结果表明，无症状或仅有轻微症状且动态心电图监测发现VT发作短暂且不频繁的肥厚型心肌病患者心脏死亡率较低。我们的研究结果还表明，对于此类患者，短暂且不频繁的VT发作本身不应被视为抗心律失常治疗的指征。
