Yonesaka S, Takahashi T, Tomimoto K, Kinjo M, Sunagawa Y, Sato S, Nakada T, Matubara T, Oura H, Koda M, Furukawa H
Department of Pediatrics, Hirosaki University School of Medicine, Japan.
Jpn Circ J. 1996 Aug;60(8):560-6. doi: 10.1253/jcj.60.560.
To determine whether myocardial changes in patients with supraventricular tachycardia (SVT) are primary or secondary to persistent tachycardia, 11 patients with SVT were studied. These patients were divided into 2 groups with respect to the type of SVT. Group I consisted of 5 patients with incessant SVT and one with multifocal atrial tachycardia, while group II consisted of 4 patients with paroxysmal supraventricular tachycardia and one with short-run supraventricular premature contraction. All of the patients underwent electrophysiological study and endomyocardial biopsy from the right ventricle following routine cardiac catheterization. In group II, there were no significant abnormalities in the clinical and hemodynamic parameters. In group I, 3 patients had clinical features of dilated cardiomyopathy including abnormal ECG, chest X-ray and hypokinesis on left ventriculography. Induction and termination of SVT were possible in 2 patients in group I and in 4 of the 5 patients in group II. The only significant histologic difference between group I and group II was fibrosis. A high incidence of histopathological abnormalities, such as hypertrophy, degeneration, interstitial fibrosis and disarray was observed in both groups. The incidence of significant pathology was higher in group I than in group II. Almost all of the patients were given antiarrhythmic drugs. One patient underwent a successful surgical procedure and normal cardiac function returned after resection of the foci of the right atrium. Our present results suggest that patients with SVT who have incessant or recurrent SVT should undergo not only intracardiac electrophysiologic study but also endomyocardial biopsy for the evaluation of myocardial damage, since SVT might be the initial sign of cardiomyopathy.
为了确定室上性心动过速（SVT）患者的心肌改变是原发性的还是持续性心动过速继发的，对11例SVT患者进行了研究。这些患者根据SVT的类型分为两组。第一组包括5例持续性SVT患者和1例多源性房性心动过速患者，而第二组包括4例阵发性室上性心动过速患者和1例短阵室上性早搏患者。所有患者均在常规心导管检查后接受了电生理研究和右心室心内膜活检。在第二组中，临床和血流动力学参数无明显异常。在第一组中，3例患者有扩张型心肌病的临床特征，包括心电图异常、胸部X线检查异常和左心室造影显示运动减弱。第一组中有2例患者以及第二组5例患者中的4例患者的SVT能够被诱发和终止。第一组和第二组之间唯一显著的组织学差异是纤维化。两组均观察到组织病理学异常的高发生率，如肥大、变性、间质纤维化和排列紊乱。第一组中显著病理改变的发生率高于第二组。几乎所有患者都接受了抗心律失常药物治疗。1例患者接受了成功的手术，切除右心房病灶后心脏功能恢复正常。我们目前的结果表明，患有持续性或复发性SVT的SVT患者不仅应接受心内电生理研究，还应进行心内膜活检以评估心肌损伤，因为SVT可能是心肌病的初始征象。
