患有主动脉瓣狭窄、肺动脉瓣狭窄和室间隔缺损患者的心律失常。24小时心电图监测结果。

Arrhythmias in patients with valvar aortic stenosis, valvar pulmonary stenosis, and ventricular septal defect. Results of 24-hour ECG monitoring.

作者信息

Wolfe R R, Driscoll D J, Gersony W M, Hayes C J, Keane J F, Kidd L, O'Fallon W M, Pieroni D R, Weidman W H

出版信息

Circulation. 1993 Feb;87(2 Suppl):I89-101.

PMID:8425327

Abstract

BACKGROUND

Arrhythmias are a significant source of morbidity and mortality in patients with congenital heart defects.

METHODS AND RESULTS

As part of the Second Natural History Study of Congenital Heart Defects (NHS-2), 24-hour ambulatory ECG monitoring was performed for full participants in the study. At least 15.5 hours of monitoring was required for inclusion in the analysis. This was achieved for 755 (90.6%) of the patients. Multiform premature ventricular contractions, ventricular couplets, and ventricular tachycardia were considered "serious arrhythmias." For patients with aortic stenosis, the presence of "serious arrhythmias" was associated with higher left ventricular end-diastolic pressure, presence of aortic regurgitation, male sex, and presence of prior aortic valve replacement. For patients with pulmonary stenosis, only older age on admission to NHS-1 was significantly associated with "serious arrhythmias." For patients with ventricular septal defect, the variables associated with "serious arrhythmias" were different for medically and surgically managed patients. For medically managed patients, higher mean pulmonary artery pressure on admission to NHS-1 and older age on admission to NHS-2 were associated with the presence of serious arrhythmias. For surgically managed patients, higher New York Heart Association functional class and cardiomegaly were associated with serious arrhythmias.

CONCLUSIONS

The prevalence of arrhythmias (especially ventricular arrhythmias) was higher for patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect than for an historical control population. "Serious arrhythmias" were most frequently noted in patients with aortic stenosis who also had a higher incidence of sudden death. The prevalence of "serious arrhythmias" was second highest for patients with ventricular septal defect who had the second highest incidence of sudden death.

摘要

背景

心律失常是先天性心脏缺陷患者发病和死亡的重要原因。

方法与结果

作为先天性心脏缺陷第二次自然史研究（NHS - 2）的一部分，对该研究的所有参与者进行了24小时动态心电图监测。纳入分析要求至少监测15.5小时。755名（90.6%）患者达到了这一要求。多形性室性早搏、室性成对搏动和室性心动过速被视为“严重心律失常”。对于主动脉瓣狭窄患者，“严重心律失常”的存在与较高的左心室舒张末期压力、主动脉瓣反流的存在、男性性别以及既往主动脉瓣置换术的存在相关。对于肺动脉瓣狭窄患者，仅NHS - 1入院时年龄较大与“严重心律失常”显著相关。对于室间隔缺损患者，内科治疗和外科治疗患者中与“严重心律失常”相关的变量不同。对于内科治疗的患者，NHS - 1入院时较高的平均肺动脉压和NHS - 2入院时年龄较大与严重心律失常的存在相关。对于外科治疗的患者，较高的纽约心脏协会功能分级和心脏扩大与严重心律失常相关。