致心律失常性右心室发育不全的临床特点

CLINICAL CHARACTERISTICS OF RIGHT VENTRICULAR DYSDEVELOPMENT THAT LEADS TO CARDICAL ARRHYTHMIA

目的分析一组致心律失常性右心室发育不全患者的临床特点。方法１７例致心律失常性右心室发育不全患者纳入研究对象，对其就诊原因、体表及动态心电图、电生理、心室晚电位、放射性同位素及超声心动图检查作综合性分析。结果１７例患者均因反复发作心悸、胸闷就诊，７例伴有晕厥，查体无阳性体征。体表及动态心电图均可录及室性早搏，室早连发成串或短阵室速，ＱＲＳ形态呈左束支传导阻滞图形，频率７５～１５０次／ｍｉｎ，持续时间最长２ｍｉｎ１５ｓ超声心动图显示１５例右室壁瘤样膨出或变薄。１３例伴室壁收缩活动减弱，６例收缩活动消失，８例行心室晚电位检查多为阳性，５例做核素检查示ＲＶＥＦ值＜８０％。７例８次做电生理检查，测定其窦房结、希氏束电图各值均正常，经右室电刺激可诱发左束支传导阻滞图形室速。结论ＡＲＶＤ病变累及右心室、反复发作室早或（和）室速伴胸闷、心悸伴或不伴晕厥，查体无阳性发现，程序刺激可诱发室速。

Objective To analysis the clinical characteristics of some patients with ARVD. Methods A comprehensive analysis of the cause, surface and trends electronic cardiogram, electronic physiology, ventricular-late electronical potential, radio-nuclear examination, and ultrosonic cardiogram was done on 17 patients with ARVE. Results Physical examination was not positive among the 17 patients who came to the hospital because of recurrent palpitation and chest distress while 7 patents of them came to the hospital because of syncope. Ventricular premature beat, continuous ventricular premature beat, and paroxysmal ventricular tachycardia were recorded by both surface and trends electronic cardiogram. QRS wave, which frequency was 75～100 beats/min and the longest time was 2 minutes and 15 seconds, was like that of left bundle branch block. The ultrosonic cardiogram indicated that there were 15 cases with tumor-like prominent right ventricular wall or thinner wall. Thirteen patients had weaker ventrilular systolic movements while 6 patients had no systolic movements. Patients' ventricular-late electricite was positive. Eight Five patients' RVEF was lower on nuclear-examination (≤50%). In the 7 patients who were given electronic physiology 8 times, the parameters of sinoatrial node and bundles of His were all normal. The gram of left bundle block and ventricular tachycardia was reduced by electronical stimulation through right ventricle. Conclusion ARVD involves right ventricle, which results in recurrent ventricular premature, ventricular tachycardia with chest distress and palpitation with or without syncope. There are no positive signs during physical examination. Program stimulation may reduce ventricular tachycardia.