致心律失常性右室心肌病的临床分析

目的探讨致心律失常性右室心肌病(ARVC)的临床特点。方法回顾分析符合欧洲心脏病协会ARVC诊断标准的15例患者的临床表现、心电图、超声心动图、MRI及电生理检查等,评价ARVC的检查手段及治疗方法。结果 15例患者均有心悸,其中13例有晕厥,有右室扩大及明确右室心力衰竭临床表现者7例。5例静息心电图出现Epsilon波,10例表现为平均QRS时程延长(≥110 ms),13例记录到室性心动过速。15例患者超声心动图均提示右室受累。治疗上以药物治疗为主,经导管射频消融治疗者2例,1例患者植入ICD。结论 ARVC临床表现隐匿,典型者常以反复发作性室性心动过速、晕厥、猝死为首发症状,部分呈家族遗传倾向。Epsilon波、右胸导联QRS波时限≥110 ms及T波倒置是其特征性心电图表现。经导管射频消融治疗室性心动过速成功率低,药物治疗效果不佳,埋藏式心脏转复除颤器治疗较为可行。

Clinical analysis of arrhythmogenic right ventricular cardiomyopathy

Objective To study the clinical feature of arrhythmogenic right ventricular cardiomyopathy （ARVC）. Methods Fifteen pa- tients with ARVC were involved in our study according to the diagnosis criteria published by European Society of Cardiology. The clinical data including the clinical manifestations, ECG, echocardiogram, MRI and electrophysiology study was investigated retrospectively. Re- suits All the patients experienced palpitation attack and syncope in 13 patients, dilated right ventricle and heart failure in 7 patients. Seen from the ECG we can find the Epsilon waves in 5 patients, a QRS duration I〉 110 ms in right precordial leads in 10 patients, ventric- ular tachycardia in 13 patients. The echocardiogram showed right ventricle involved in 15 patients. Drug therapy was the main treatment, 2 patients underwent radiofrequence catheter ablation, 1 patient implanted ICD. Conclusion The clinical manifestations of ARVC are delitescence. The common symptoms include recurrent ventricular tachycardia, syncope and sudden death. There is a familial hereditary tendency. The main characteristics in ECG includ Epsilon waves, QRS duration≥110 ms and T-wave inversions in right precordial leads, which are significant ECG changes. The successful rate of radiofrequency ablation in ARVC is relatively low, and the therapy efficacy of medication is not satisfactory. ICD implantation has shown the superiority.