Zhu D W, Sun H, Hill R, Roberts R
Baylor College of Medicine, Houston, Texas 77030, USA.
Pacing Clin Electrophysiol. 1998 Jan;21(1 Pt 2):299-302. doi: 10.1111/j.1540-8159.1998.tb01109.x.
Fifty-three consecutive patients with hypertrophic cardiomyopathy (HCM) and no history of sudden death underwent electrophysiology (EP) study. Sustained polymorphic ventricular tachycardia (VT) or ventricular fibrillation (VF) was induced in 19 patients (35%). Patients with prior syncope or near syncope had a higher incidence of VT/VF inducibility. An implantable cardioverter defibrillator (i.c.d.) was placed in 14 of the 19 patients. Of the remaining 5 patients with inducible VT/VF, three refused ICD implantation, while two underwent septal myectomy and VT/VF was no longer inducible after the operation. None of the patients received antiarrhythmic drugs. During a mean follow-up period of 47 +/- 31 (2-117) months, no events occurred in the 34 patients with negative EP study. Three events occurred among the 19 patients with inducible VT/VF. One patient died suddenly, one developed wide complex tachycardia which required resuscitation, and one patient received an appropriate ICD shock. In conclusion, sustained polymorphic VT/VF was inducible in about one-third of patients with HCM. Noninducibility of VT/VF appeared to predict a favorable prognosis. Although the overall event rate was low in patients with inducible VT/VF, prophylactic ICD implantation in patients with multiple risk factors may be appropriate.
53例连续性肥厚型心肌病（HCM）且无猝死病史的患者接受了电生理（EP）检查。19例患者（35%）诱发出持续性多形性室性心动过速（VT）或室颤（VF）。有既往晕厥或接近晕厥病史的患者VT/VF诱发性发生率更高。19例患者中有14例植入了植入式心脏复律除颤器（ICD）。其余5例诱发出VT/VF的患者中，3例拒绝植入ICD，2例行室间隔心肌切除术，术后VT/VF不再能诱发。所有患者均未接受抗心律失常药物治疗。在平均47±31（2 - 117）个月的随访期内，34例EP检查阴性的患者未发生事件。19例诱发出VT/VF的患者中发生了3起事件。1例患者猝死，1例发生宽QRS波心动过速需进行复苏，1例患者接受了ICD恰当电击。总之，约三分之一的HCM患者可诱发出持续性多形性VT/VF。VT/VF不能诱发似乎预示着良好的预后。尽管诱发出VT/VF的患者总体事件发生率较低，但对于有多种危险因素的患者，预防性植入ICD可能是合适的。
