维拉帕米敏感性束支内折返性室性心动过速的临床特点

Clinical features of intrafascicular verapamil-sensitive reentrant tachycardia

目的 维拉帕米敏感性束支内折返性室性心动过速（室速）是常见的左心室特发性室速类型,其主要发生机制为左束支浦肯野分支内或邻近区域的折返.本文通过较大样本量的单中心研究对维拉帕米敏感性束支内折返性室速的性别、年龄等临床特点进行分析.方法 在北京阜外心血管病医院住院治疗并经电生理检查证实的维拉帕米敏感性束支内折返性室速患者235例,年龄6～ 79（30.2±11.9）岁.所有患者都接受心内电生理检查和射频消融术治疗.结果 235例患者中,男184例（78.3％）,女51例（21.7％）,男性明显多于女性.出现症状的平均年龄女性为6～60（28.0±15.1）岁,男性为10～79（30.8±14.0）岁（P=0.25）.女性多见于10～ 30岁,男性多见于10～40岁.235例患者中,都有不同程度的心悸,其中有10例患者（4.3％）出现过1次或1次以上的黑矇,9例患者（3.8％）出现过晕厥症状.出现黑嚎和/或晕厥的患者比例为8.1％.235例患者中,111例（47％）患者在入院前,曾经在外院或本院接受过1种或1种以上的抗心律失常药物治疗,但均不能明显改善临床症状或减少室速的发生次数.结论 维拉帕米敏感性束支内折返性室速患者中,存在着显著的性别差异,对这一差异的深入研究,有助于揭示这种心律失常的发生机制和影响因素,并有助于改善患者的诊疗和预后.

Objective Intrafascicular verapamil-sensitive reentrant tachycardia is the most common type of idiopathic left ventricular tachycardia.The purpose of this study was to investigate the gender,age and clinical features of intrafascicular verapamil-sensitive reentrant tachycardias in a large patient population.Methods Two hundreds and thirty-five consecutive patients with symptomatic ventricular tachycardia were included in the study.All of them underwent electrophysiological study（EPS） and radiofrequency catheter ablation （RFCA）,and all of them were confirmed with intrafascicular verapamil-sensitive reentrant tachycardia by clinical examination,EPS and RFCA.Results Of 235 patients,184 patients（78.3%） were male,51 patients（21.7%） were female,male/female ratio is was 3.6.The mean age of 235 patients was 6-79（30.2±11.9）years.The onset of symptom was at the age of（28.0± 15.1）years for female,and （30.8± 14.0） years for male （P =0.25）.Ten of 235 patients（4.3%）and 9 of 235 patients （3.8%）had history of near syncope and syncope respectively.One hundred and eleven of 235 patients （47%） received one or more than one antiarrhythmia durgs before admission.The drug treatment could not prevent patients from tachycardia attacks or relieve the symptoms.Conclusion Intrafascicular verapamil-sensitive reentrant tachycardia occurs more common in male than in female.There is no significant difference at age of the onset of symptom between female and male.