A COMPARISON OF ELECTROPHYSIOLOGICALLY GUIDED ANTIARRHYTHMIC DRUG-THERAPY WITH BETA-BLOCKER THERAPY IN PATIENTS WITH SYMPTOMATIC, SUSTAINED VENTRICULAR TACHYARRHYTHMIAS
A COMPARISON OF ELECTROPHYSIOLOGICALLY GUIDED ANTIARRHYTHMIC DRUG-THERAPY WITH BETA-BLOCKER THERAPY IN PATIENTS WITH SYMPTOMATIC, SUSTAINED VENTRICULAR TACHYARRHYTHMIAS
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DOI：
10.1056/nejm199210013271404
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发表时间：
1992-10-01
影响因子：
158.5
通讯作者：
VONLEITNER, ER
中科院分区：
文献类型：
--
作者：
STEINBECK, G;ANDRESEN, D;VONLEITNER, ER
背景。以侵入性电生理测试为指导的抗心律失常药物治疗现已广泛应用于有症状、持续性室性快速心律失常的患者。方法。我们对 170 名患者进行了一项前瞻性随机试验，以调查这种方法是否会改善长期结果。通过程序化电刺激诱发心律失常的患者被分配接受基于系列测试的电生理引导药物治疗（61 名患者）或美托洛尔（54 名患者）治疗。电生理引导治疗包括一系列抗心律失常药物测试，以确定第一种使心律失常不可诱发的药物。 55 名在初始电生理测试期间心律失常为非诱发性的患者也接受了美托洛尔治疗。结果。在平均 (+/-SD) 23+/-17 个月的随访期间，44 名患者出现复发性非致命性心律失常，27 名患者因心脏因素猝死。两年观察后，两组诱发性心律失常的症状性心律失常和猝死的发生率几乎相同（电生理引导治疗与美托洛尔治疗，分别为 46% 和 48%）。基线时患有非诱发性心律失常的患者（75％在两年后没有发生任何不良事件）的结果比接受美托洛尔治疗的诱发性心律失常的患者更有利（通过时序检验，P = 0.009）。 29 名诱发性心律失常在药物治疗期间变为不可诱发性心律失常的患者中，只有 6 名 (21%) 出现复发性心律失常或猝死，而 32 名心律失常继续诱发的患者中，有 21 名 (66%) 出现复发性心律失常或猝死 (P
Background. Antiarrhythmic drug therapy guided by invasive electrophysiologic testing is now widely used in patients with symptomatic, sustained ventricular tachyarrhythmias.Methods. We conducted a prospective, randomized trial in 170 patients to investigate whether this approach would improve long-term outcome. Patients whose arrhythmia was inducible by programmed electrical stimulation were assigned to treatment with electrophysiologically guided drug therapy based on serial testing (61 patients) or with metoprolol (54 patients). Electrophysiologically guided therapy consisted of serial testing of antiarrhythmic agents to identify the first one that rendered the arrhythmia noninducible. The 55 patients whose arrhythmia was noninducible during the initial electrophysiologic test were also treated with metoprolol.Results. During a mean (+/-SD) follow-up period of 23+/-17 months, recurrent, nonfatal arrhythmia occurred in 44 patients and sudden death due to cardiac factors in 27. The incidence of symptomatic arrhythmia and sudden death combined was virtually the same in the two groups with inducible arrhythmia after two years of observation (electrophysiologically guided therapy vs. metoprolol therapy, 46 percent vs. 48 percent). The outcome was more favorable in the patients with noninducible arrhythmia at base line (75 percent had neither adverse event after two years) than in those with inducible arrhythmia who were assigned to metoprolol therapy (P = 0.009 by log-rank test). Only 6 of the 29 patients (21 percent) with inducible arrhythmia that became noninducible during drug therapy had recurrent arrhythmia or sudden death, as compared with 21 of the 32 patients (66 percent) with arrhythmia that continued to be inducible (P