Incidence and determinants of multiple morphologically distinct sustained ventricular tachycardias.
Incidence and determinants of multiple morphologically distinct sustained ventricular tachycardias.
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多种形态不同的持续性室性心动过速的发生率和决定因素。
DOI：
10.1016/s0735-1097(87)80201-2
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发表时间：
1987
影响因子：
24
通讯作者：
Garan,H
中科院分区：
文献类型：
--
作者：
Wilber,DJ;Davis,MJ;Rosenbaum,M;Ruskin,JN;Garan,H
前瞻性地研究了71例连续患者中多个形态不同的室性心动过速的发生率和决定因素，这些患者至少记录了一次持续性单形性室性心动过速的自发发作。本文根据190例自发性心动过速和352例诱发心动过速的12导联心电图，测定了QRS波的平均额轴和水平轴。在44例至少有两次记录的自发性发作的患者中，19例(43%)观察到两次或两次以上形态上不同的自发性心动过速。在71例患者中，有43例(61%)由程序性室性刺激引起多个不同形态的心动过速。总体而言，71名患者中有57名(80%)至少有两种不同的心动过速。从临床和血管造影变量中通过多变量分析选择了多种心动过速的预测因素，对自发性和诱发性室性心动过速的预测结果相似：既往有多次心肌梗死(p=0.032自发，p=0.005诱发)，以及在此期间记录到室性心动过速的不同抗心律失常药物治疗的次数(p=0.0089自发，p<；0.0001诱发)。这些数据表明，大多数持续性单形性室性心动过速患者在不同的抗心律失常药物治疗期间获得充分的多个发作的心电图记录时，显示出不止一种不同的QRS构型。对于个别患者，在将临床意义归因于单一独特的QRS构型时应谨慎。
The incidence and determinants of multiple morphologically distinct ventricular tachycardias were examined prospectively in 71 consecutive patients with at least one documented spontaneous episode of sustained monomorphic ventricular tachycardia. Mean frontal and horizontal QRS axes were determined from the 12 lead electrocardiograms (ECGs) of 190 spontaneous and 352 induced tachycardias. Two or more morphologically distinct spontaneous tachycardias were observed in 19 (43%) of 44 patients who had at least two documented spontaneous episodes. In 43 (61 %) of the 71 patients, multiple morphologically distinct tachycardias were induced by programmed ventricular stimulation. Overall, 57 (80%) of the 71 patients had at least two morphologically distinct tachycardias.Predictors of multiple tachycardia configurations were selected by multivariate analysis from clinical and angiographic variables and were similar for both spontaneous and induced ventricular tachycardia: presence of multiple previous myocardial infarctions (p = 0.032 spontaneous, p = 0.005 induced) and number of different antiarrhythmic drug treatments during which ventricular tachycardia was documented (p = 0.0089 spontaneous, p < 0.0001 induced). These data demonstrate that a large majority of patients with sustained monomorphic ventricular tachycardia exhibit more than one distinct QRS configuration when adequate ECG documentation of multiple episodes is obtained during different antiarrhythmic drug treatments. In individual patients, caution should be used in attributing clinical significance to a single unique QRS configuration.
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