[Risk of stress-induced ventricular arrhythmias in hypertrophic cardiomyopathy].
200 exercise tests in 106 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 45 exercise tests in 30 patients with hypertrophic non-obstructive cardiomyopathy (HNCM), primarily performed to assess the hemodynamic impairment during stepwise increased maximal exercise, were analysed with respect to incidence and severeness of ventricular arrhythmias by evaluating the continuously recorded ECG. The exercise tests were subdivided in 4 phases: 1. introduction of a Swan-Ganz pulmonary wedge catheter; 2. resting phase until constant hemodynamic basal values were reached; duration 5 to 51, mean 18 +/- 8 min; 3. exercise phase; bicycle ergometer exercise in supine position; increase in work load by steps of 25 Watts to the maximum which was defined by onset of angina pectoris, dyspnea or exhaustion; total duration 6 to 41, mean 18 +/- 6 min; 4. resting phase after exercise, duration 1 to 30, mean 5 +/- 3 min. Ventricular arrhythmias were classified in a modified Lown classification: 1. no ventricular ectopic beats (VEB); 2. single VEB, less than 0.5/min; 3. single VEB, more than 0.5/min; 4. ventricular pairs; 5. ventricular salvos or tachycardias (3 or more QRS complexes). In the total series of 200 exercise tests in patients with HOCM, the highest incidence of ventricular arrhythmias was found during insertion of the pulmonary wedge catheter, i.e., in 75% of the cases. In nearly 20% of the cases, ventricular pairs or tachycardias were observed. The longest tachycardia consisted of 17 QRS complexes. All tachycardias terminated spontaneously. During the following resting phase, ventricular arrhythmias were documented in 52% of the cases, with ventricular pairs, however, in only 11 (5.5%) and ventricular tachycardias in only 5 (2.5%) tests.(ABSTRACT TRUNCATED AT 250 WORDS)
D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D011183:Postoperative Complications / Q000503:physiopathology; D011433:Propranolol / Q000627:therapeutic use; D012306:Risk; D014700:Verapamil / Q000627:therapeutic use
D011433:Propranolol; D014700:Verapamil
Das Risiko belastungsinduzierter ventrikulärer Arrhythmien bei hypertrophischen Kardiomyopathien.