LONG-TERM OUTCOME IN PATIENTS WHO SURVIVE OUT OF HOSPITAL VENTRICULAR-FIBRILLATION AND UNDERGO ELECTROPHYSIOLOGIC STUDIES - EVALUATION BY ELECTROPHYSIOLOGIC SUBGROUPS
LONG-TERM OUTCOME IN PATIENTS WHO SURVIVE OUT OF HOSPITAL VENTRICULAR-FIBRILLATION AND UNDERGO ELECTROPHYSIOLOGIC STUDIES - EVALUATION BY ELECTROPHYSIOLOGIC SUBGROUPS
复制标题
DOI：
10.1016/0735-1097(90)90357-u
复制
发表时间：
1990-09-01
影响因子：
24
通讯作者：
GREENE, HL
中科院分区：
文献类型：
--
作者：
POOLE, JE;MATHISEN, TL;GREENE, HL
对接受程序化电刺激的 214 名院外心室颤动幸存者的长期结果进行了评估。根据基线无药物电生理测试诱导的节律对患者进行分类。 39 名患者（16%）（第 1 组）诱发室颤，66 名患者（27%）（第 2 组）诱发持续性室性心动过速，34 名患者（14%）诱发非持续性室性心动过速（第 3 组）； 102 名患者 (42%)（第 4 组）在基线电生理测试中没有诱发心律失常。第2组中92%的患者、第1组中91%的患者和第4组中47%的患者长期服用抗心律失常药物。平均随访时间为30±。 15个月内，39名诱发性室颤患者（第1组）中11名（28％）发生反复心源性猝死或非致命性室颤，66名诱发性持续性室性心动过速（第2组）患者中14名（21％），34名诱发性非持续性室性心动过速（第3组）患者中4名（12％）和16名(16%) 102 名无诱发性心律失常的患者（第 4 组）。精算分析显示，第 2 组患者的 2 年累积无心律失常生存率为 65%，第 1 组患者为 71%，第 3 组患者为 79%，第 4 组患者为 81%（p = 0.02）。通过电生理指导药物治疗抑制诱发性持续性室性心动过速或心室颤动的患者的精算生存率与心律失常未抑制的患者没有显着差异。多变量回归分析显示，只有充血性心力衰竭的存在才是这些患者预后的独立预测因素。心室颤动幸存者基线电生理测试的可诱导性的预后意义取决于其左心室功能状态，并且不能独立预测不良结果。患有可诱发的持续性室性心动过速或心室颤动的患者，随后通过电生理引导的 I 类抗心律失常药物治疗而变得不可诱发，与无法抑制快速性心律失常的患者相比，其生存率并未提高。
The long-term outcome of 214 survivors of out of hospital ventricular fibrillation who underwent programmed electrical stimulation was evaluated. Patients were categorized according to the rhythm induced at baseline drug-free electrophysiologic testing. Ventricular fibrillation was induced in 39 patients (16%) (Group 1), sustained ventricular tachycardia in 66 patients (27%) (Group 2) and nonsustained ventricular tachycardia in 34 patients (14%) (Group 3); 102 patients (42%) (Group 4) did not have an arrhythmia inducible at baseline electrophysiologic testing. Antiarrhythmic drugs were administered over the long term to 92% of patients in Group 2, 91% of patients in Group 1 and 47% of patients in Group 4. At a mean follow-up time of 30 .+-. 15 months, recurrent sudden cardiac death or nonfatal ventricular fibrillation occurred in 11 (28%) of 39 patients with inducible ventricular fibrillation (Group 1), 14 (21%) of 66 patients with inducible sustained ventricular tachycardia (Group 2), 4 (12%) of 34 patients with inducible nonsustained ventricular tachycardia (Group 3) and 16 (16%) of 102 patients without inducible arrhythmias (Group 4). Actuarial analysis revealed a 2 year cumulative arrhythmia-free survival rate of 65% for patients in Group 2, 71% for patients in Group 1, 79% for patients in Group 3 and 81% for patients in Group 4 (p = 0.02). Actuarial survival of patients with inducible sustained ventricular tachycardia or ventricular fibrillation suppressed by electrophysiologically guided drug therapy was not significantly different from that in patients whose arrhythmia was not suppressed. Multivariate regression analysis revealed that only the presence of congestive heart failure was an independent predictor of outcome in these patients. The prognostic significance of inducibility at baseline electrophysiologic testing in survivors of ventricular fibrillation is dependent on the status of their left ventricular function and does not independently predict poor outcome. Patients with inducible sustained ventricular tachycardia or ventricular fibrillation that was subsequently rendered noninducible by electrophysiologically guided drug therapy with class I antiarrhythmic drugs did not have an improved survival rate compared with that of patients whose tachyarrhythmia could not be suppressed.