扩张型心肌病室性心律失常的研究

Ventricular arrhythmias in idiopathic dilated cardiomyopathy

对31例扩张型心肌病(DCM)患者进行分析,25例有室性心律失常(VA),2例猝死.≥Lown2级者血浆钾和镁浓度均较<2级者低,EF与VA级别及24小时室早数(VPC/24h)呈负相关(P<O.05),VPC/24h与血浆钾、镁浓度呈负相关(P<0.05);≥2级者对异丙肾上腺素敏感性较<2级者低.2例猝死者生前均有频发室早或室速.提示DCM中VA发生率较高;心功能低下,低钾、低镁及高儿茶酚胺可促使VA发生;高级别VA可能是猝死的原因.

Ventricular premature complex(VPCs) were observed in 25 patients (80. 6%) of 31 patients with dilated cardiomyopathy (DCM). There were almost no arrhythmia-related symptoms during the DCG recordings. The incidence of VA was lower in 9 patients with atrial fibrillation (AF) then patients without AF. The total number of VPCs/24h showed a positve correlation to the number of paired ventricular ectopic beats,number of VT episodes and grade of VA(P<0.05).The patients with VA had a lower ejection fraction (EF), a lower plasma potassium and magnesium than the patients without VA. The EF showed a negative correlation to the grade of VA and to the total number of VPCs/24h (P <0. 05). The negative correlation was also found between the total number of VPCs/24h and plasma potassium and magnesium(P<0. 05). The sensitivity of heart to isoprenaline was lower in patient with VA than that without VA. The 2 patients with subsequent sudden cardiac death showed frequent VPCs or VT in their recordings. The results suggest that incidenc of VA is more highes in patieats with DCM. Decceased heart function,low plasma potassium and magesium and light plasma catocholamine may promote VA in DCM. High grade VA may lead to sudden death.