Arrhythmias in Patients with Mitral Valve Prolapse

僧帽瓣脫垂與不整脈之關係

許勝雄(Sheng-Hsiung Sheu) ； 林慶正(Ching-Cheng Lin) ； 張志賢(Jyh-Shyan Chang)

《The Kaohsiung Journal of Medical Sciences》 4卷2期 (1988/02) Pp. 81-90

https://doi.org/10.6452/KJMS.198802.0081

摘要

對僧帽瓣脫垂病人51位及具有相似症狀的正常對照組病人54位，實施靜態12誘導心電圖，霍特24小時連續心電圖及踏車運動心電圖檢查。在24小時連續性心電圖檢查中，僧帽瓣脫垂病人發生心室早期收縮的有71%，心房早期收縮的有69%，慢速心律(包恬嚴重性竇性心搏遲緩、竇房傳導阻滯和Mobitz I型第二度房室傳導阻滯)的有10%。對照組病人發生心室早期收縮的有59%，心房早期收縮的有65%，慢速心律的有4%，其發生率在兩群病人之間並無有意義的差別。但是，多竈性心室早期收縮及複雜性心室早期收縮之發生率，僧帽瓣脫垂病人高於對照組，而且具有統計學上之意義。(分別是25%對6%，p＜0.01;33%對11%，p＜0.02)。
在僧帽瓣脫垂病人中，運動心電圖可以記錄到心室早期收縮者29%，心房早期收縮者4%，無記錄到有慢速心律者。靜態12誘導心電圖可以記錄到心室早期收縮者14%，無記錄到有心房早期收縮或慢速心律者。所以霍特24小時連續心電圖檢查是測知病人是否有不整脈的最敏感檢查方法。但是有兩個病人踏車運動試驗可以誘發複雜性心室早期收縮。僧帽瓣脫垂病人在睡眠時，其心室早期收縮、複雜性心室早期收縮及心房早期收縮之發生率分別是47%、4%和37%，這比病人清醒時之發生率65%、31%和55%，在統計學上為有意義的減少(p值分別為＜0.05，＜0.01及＜0.05)。
結論：僧帽瓣脫垂病人和具有相似症狀的正常對照組病人比較，其心室早期收縮、心房早期收縮和慢速心律之發生率在兩群病人並無差別，但是僧帽瓣脫垂病人之複雜性心室早期收縮之發生率比對照組病人有意義的增高。從本篇研究結果，建議僧帽瓣脫垂病人必須施行霍特24小時連續心電圖檢查及運動心電圖檢查以測知病人是否有可能導致危險的複雜性不整脈的發生。

並列摘要

Resting ECGs, 24 hour ambulatory ECGs and treadmill exercise tests were performed in 51 symptomatic patients with mitral valve prolapse (MVP) and in 54 similarly symptomatic control subjects. During 24 hour ambulatory monitoring, the incidences of ventricular premature contractions (VPCs), atrial premature contractions (APCs) and bradyarrhythmias (including severe sinus bradycardia, sinoatrial block and Mobitz type I atrioventricular block) were observed in 71%, 69% and 10% of the patients with MVP and in 59%, 65% and 4% of the control group. The differences were not statistically significant. However, the patients with MVP had significantly greater incidences of multiform VPCs and complex VPCs than the control group. (Which were 25% vs 6%, p＜0.01; 33% vs 11%, p＜0.02, respectively).
In patients with MVP, prevalence of VPCs, APCs and bradyarrhythmias on treadmill exercise tests were 29%, 4% and 0% respectively, and on resting 12 lead ECGs were 14%, 0% and 0% respectively; therefore, 24 hour ambulatory monitoring was the most sensitive method for arrhythmia detection. However, exercise induced the appearance of complex VPSc in 2 patients. The incidences of VPCs, complex VPCs and APCs during sleep in patients with MVP were 47%, 4% and 37% respectively, these were significantly less than those during the awake period, which were 65%, 31% and 55% respectively. (p＜0.05, p＜0.01 and p＜0.05 respectively).
In conclusion, there were no significant differences in the incidences of VPCs, APCs and bradyarrhythmias in patients with MVP and similarly symptomatic control group. However, there was significantly more complex VPCs in patients with MVP. The findings of this study suggest that 24 hour ambulatory ECG and treadmill exercise ECG should be performed in patients with MVP for detecton of this probable risk ventricular arrhythmia.

並列關鍵字

mitral valve prolapse ； ambulatory electrocardiographic monitoring ； treadmill exercise test