Programmed electrical stimulation in patients with high-grade ventricular ectopy: electrophysiologic findings and prognosis for survival.
Programmed electrical stimulation in patients with high-grade ventricular ectopy: electrophysiologic findings and prognosis for survival.
复制标题
高度心室异位患者的程序化电刺激：电生理学结果和生存预后。
作者：
A. Joseph;Robert I Gomes;Pritpal S Hariman;Nabil Kang;Imtiaz El;Chowdhry;Juliann Lyons;J. A. Gomes
在无持续性室性心动过速(VT)、猝死或晕厥的患者中，室性早搏(VPB)的意义和治疗仍不清楚。我们对73例高度室性早搏患者(年龄60+/-10岁)进行了一项前瞻性的程序性电刺激(最多两次超刺激和突发起搏)研究，这些患者没有持续室速、猝死或晕厥的证据，这些证据是通过48小时的心脏监护病房监测和48小时的动态心电图监测确定的。动脉粥样硬化性心脏病56例(76.7%)，心肌病或瓣膜病10例(13.7%)，无明显心脏病7例(9.6%)。37例(50.7%)为Lown级IVB室间隔，30例(41.1%)为IVA级，6例(8.2%)为Lown级。程序性电刺激分为两组：第一组20例(27%)诱发室性心动过速或室颤，第二组53例(73%)未诱发室性心律失常或仅诱发2~4次重复的室性反应。有动脉粥样硬化性心脏病、陈旧性心肌梗死、射血分数<40%者，第1组与第2组比较差异有统计学意义(P<0.05)，但VPB分级两组间差异无统计学意义。第一组20例患者中有17例接受了抗心律失常治疗(按程序电刺激定义)，而第二组患者被随机分配到预防性抗心律失常治疗中。共对70例患者进行了30+/-15个月的随访。持续性室性心动过速和/或猝死的发生率(31.5%比2%；P<.001)显著高于第二组。
The significance and treatment of ventricular premature beats (VPBs) in patients without sustained ventricular tachycardia (VT), sudden death, or syncope remains unclear. We undertook a prospective study of programmed electrical stimulation (up to two extrastimuli and burst pacing) in 73 patients (age 60 +/- 10 years) with high-grade VPBs who had no evidence of sustained VT, sudden death, or syncope as determined by 48 hr of monitoring in the cardiac care unit and 48 hr Holter monitoring. Fifty-six patients (76.7%) had atherosclerotic heart disease, 10 (13.7%) had cardiomyopathy or valvular heart disease, and seven (9.6%) had no evident heart disease. Thirty-seven patients (50.7%) had Lown grade IVB VPBs, 30 (41.1%) had Lown grade IVA VPBs, and six (8.2%) had Lown grade III VPBs. Programmed electrical stimulation identified two groups of subjects: group 1 comprised 20 patients (27%) in whom VT or ventricular fibrillation was induced, group 2 comprised 53 patients (73%) in whom no ventricular arrhythmia or only two to four repetitive ventricular responses were induced. There was a significant difference between the presence of atherosclerotic heart disease, old myocardial infarction, and ejection fraction of less than 40% in group 1 compared with group 2. However, there was no significant difference in the grade of VPBs between the two groups. Seventeen of 20 patients from group 1 were placed on antiarrhythmic therapy (defined by programmed electrical stimulation), whereas group 2 patients were randomly assigned to prophylactic antiarrhythmic therapy. A total of 70 patients were followed up for 30 +/- 15 months. The incidence of sustained VT and/or sudden death (31.5% vs 2%; p less than .001) was significantly higher in group 1 compared with group 2.(ABSTRACT TRUNCATED AT 250 WORDS)