Brembilla-Perrot B, Jacquemin L, Houplon P, Houriez P, Beurrier D, Berder V, Terrier de la Chaise A, Louis P
Cardiology A, CHU of Brabois, Vandoeuvre les Nancy, France.
Am Heart J. 1998 May;135(5 Pt 1):748-54. doi: 10.1016/s0002-8703(98)70032-8.
Supraventricular tachyarrhythmias (SVTA) may occur in patients with the arrhythmogenic right ventricular dysplasia (ARVD). The purpose of the study was to evaluate the incidence of SVTA in 47 patients with ARVD proved by right ventricular angiography. Thirty-three men and 14 women, aged 21 to 72 years (mean 44 +/- 18) were admitted for nonsustained or sustained ventricular tachycardia. Eight patients had a history of spontaneous SVTA several years before ventricular tachycardia occurrence. Protocol of the study consisted of programmed atrial stimulation with one and two extrastimuli delivered during sinus rhythm and two driven rhythms (600 and 400 msec), programmed ventricular stimulation with up to three extrastimuli and was performed in the control state and after infusion of isoproterenol. The results of programmed atrial stimulation were compared with those obtained in 36 asymptomatic subjects without heart disease and with a mean age of 50 +/- 18 years (control group). Sustained SVTA (> 1 minute) was induced in seven of eight patients with spontaneous SVTA, in 27 (69%) of those with ARVD, who did not have spontaneous SVTA, and in two control subjects (5.5%) (p < 0.001). SVTA was inducible in the control state, but ventricular tachycardia induction required isoproterenol in 11 of 27 patients. Two patients without SVTA history but with inducible SVTA developed later spontaneous SVTA. ARVD was associated with a significantly higher incidence of inducible SVTA than in a control population. Supraventricular tachycardias may precede ventricular tachycardias. This association argues for a diffuse myocardial disorder in ARVD.
室上性快速心律失常（SVTA）可能发生在致心律失常性右室心肌病（ARVD）患者中。本研究的目的是评估47例经右心室血管造影证实为ARVD患者中SVTA的发生率。33例男性和14例女性，年龄21至72岁（平均44±18岁），因非持续性或持续性室性心动过速入院。8例患者在室性心动过速发生前数年有自发SVTA病史。研究方案包括在窦性心律以及两种驱动心律（600和400毫秒）期间给予1个和2个额外刺激进行程控心房刺激，给予最多3个额外刺激进行程控心室刺激，且在对照状态下以及静脉注射异丙肾上腺素后进行。将程控心房刺激的结果与36例平均年龄50±18岁的无症状无心脏病受试者（对照组）获得的结果进行比较。8例有自发SVTA的患者中有7例诱发出持续性SVTA（>1分钟），在无自发SVTA的ARVD患者中有27例（69%）诱发出持续性SVTA，在2例对照受试者中（5.5%）诱发出持续性SVTA（p<0.001）。SVTA在对照状态下可诱发出，但27例患者中有11例诱发出室性心动过速需要异丙肾上腺素。2例无SVTA病史但可诱发出SVTA的患者后来出现了自发SVTA。与对照人群相比，ARVD患者中可诱发性SVTA的发生率显著更高。室上性快速心律失常可能先于室性心动过速出现。这种关联提示ARVD存在弥漫性心肌病变。
