31例致心律失常性右室心肌病的临床研究  

Clinical and ECG features of arrhythmogenic right ventricular cardiomyopathy:a retrospective analysis of 31 cases

作　　者：浦介麟[1] 王洪涛[2] 刘同库[2] 马克娟[3] 李宁[3] 姚焰[3] 楚建民[3] 方丕华[3] 马坚[3] 华伟[3] 张澍[3] 王方正[3] 

机构地区：[1]中国医学科学院 中国协和医科大学 阜外心血管病医院心律失常诊治中心,北京100037 [2]北华大学附属医院心内科 [3]中国医学科学院 中国协和医科大学 阜外心血管病医院 心律失常诊治中心,北京100037

出　　处：《中华心血管病杂志》2007年第1期24-27,共4页Chinese Journal of Cardiology

摘　　要：目的对致心律失常性右室心肌病(ARVC)作回顾性临床分析。方法根据1994年欧洲心脏病协会的诊断标准选择确诊 ARVC 患者31例,分析临床表现、心电学特征及治疗方式,随访疗效。结果 31例中男性27例,女性4例,首次确诊年龄为19～58(34.7±9.4)岁。28例(90.3%)临床症状为心悸、头晕,13例(41.9%)具有晕厥史,3例(9.7%)以晕厥为首发症状,1例有猝死家族史。超声心动图和(或)核磁共振检查,29例表现为右心室扩大,其中2例合并左心室扩大。静息心电图表现为不同程度的 T 波倒置,主要发生在胸前导联;17例(54.8%)可见 epsilon(ε)波;26例(83.9%)平均 QRS 时程≥110 ms,右胸导联 QRS 时程大于左胸导联,平均 QRS 波在 V_(1～3)和 V_(4～5)导联分别为(120.8±13.7)ms和(99.4±13.7)ms(P<0.05);肢体导联低电压和Ⅰ度房室传导阻滞分别为13例(41.9%)和7例(22.6%)。在31例患者中均记录到持续性室性心动过速(VT),其中15例(48.4%)为单形性,16例(51.6%)为多形性。经导管射频消融治疗者14例,即刻成功11例(78.6%),随访(18.3±10.2)个月,6例 VT 复发(54.5%);药物治疗17例,其中7例在置入心脏除颤器情况下用药,随访(35.6±19.0)个月,11例 VT 复发(64.7%),1例猝死。结论 ARVC 青、中年起病,胸前导联T波倒置、s波、V_(1～3)导联平均 QRS 时程≥110 ms 是其特征性心电图表现,经导管射频消融远期复发率高,药物预防远期效果不佳,心脏除颤器是值得选择的防治措施。Objective To retrospectively analyze the clinical and electrocardiographic features of patients with arrythmogenic right ventricular cardiomyopathy （ARVC）. Methods The clinical, electrocardiographic features and the efficacy of various therapies were analyzed in 31 patients （27 males） diagnosed as ARVC according to the criteria estabhshed by European Society of Cardiology. Results The averaged age when the ARVC was first diagnosed was （34. 7 ± 9. 4 ） years （19-58 years ）, palpitation was present in 28 patients （90. 3% ） and syncope in 13 patients （41.9%）, a family history of sudden death was present in 1 patient. Dilatated right ventricle was documented in 29 patients by echocardiography and（or） magnetic resonance imaging （MRI）, 2 of them with dilated left ventricles. ECG changes included： T wave inversion, mostly seen in precordial leads （ 100% ） ; epsilon （e） wave （54. 8% ） ; QRS duration ≥ 110 ms in V1 to V3 （83.9%） ; reduced extremity amplitude （41.9%） ; the first degree of AV block （22.6%） ; sustained VT （100%） including 15 monomorphic VT （48.4%） and 16 polymorphic VT （51.6%）. The mean values of QRS duration in leads of V1-3 [ （ 120. 8± 13.7 ） ms] was significantly longer than that in V4-6 [ （99. 4 ± 13.7） ms, P 〈 0. 05 ]. Fourteen patients underwent radiofrequency catheter ablation （RFCA） with an immediate success rate of 78.6% （11/14）. During follow up （ 18. 3 ± 10. 2） months, VT reoccurred in 6 patients （54. 5% ）. The remaining 17 patients were treated with conventional medications, 7 of them were medicated under implanted cardioverier defibrillator （ICD）. During the follow-up （35.6 ± 19.0 ） months, VT reoccurred in 11 patients （64. 7% ） and one patient died suddenly. Conclusions ARVC patients developed symptoms at mid-30s with significant ECG changes including appearance of an 8 wave, T wave inversion and QRS duration 9110 ms in leads of V1-3. The long term therapy efficacy was not satisfact

关 键 词：心律失常性右心室发育不良 心电描记术 导管消融术 除颤器 植入型 

分 类 号：R542.2[医药卫生—心血管疾病]