A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic-drug efficacy for ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators.
A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic-drug efficacy for ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators.
复制标题
电生理测试与动态心电图监测的比较，以预测室性快速心律失常的抗心律失常药物疗效。
DOI：
10.1056/nejm199308123290701
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Mason,JW
中科院分区：
文献类型：
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作者：
Mason,JW
背景有创电生理检查和无创霍尔特监测（结合运动试验）已被用于评价抗心律失常药物对持续性室性心动过速患者和心脏骤停幸存者的疗效。我们直接比较这两种方法来预测药物efficacy.MethodsA共486例记录室性快速性心律失常，诱导在电生理研究和10个或更多的室性早搏每小时在霍尔特监测期间被随机分配到进行一系列测试的抗心律失常药物的疗效，通过电生理研究或霍尔特监测。患者随机接受多达6种药物，直到其中一种药物被预测有效抑制诱导性心律失常（在电生理研究组）或抑制室性早搏复合波（在动态心电图监测组）。结果在电生理研究组，108 242例（45%）收到了疗效预测，与188 244例（77%）在动态心电图监测组（P<0.001）。在六年的随访期内，在296名接受预期有效药物治疗的患者中，有150名心律失常复发，46名死亡。其中34例死亡是由于药物原因，8例是由于心脏原因。在这些事件的精算概率方面，两个研究组之间没有显著差异。接受索他洛尔治疗的患者心律失常复发的风险显著低于接受其他抗心律失常药物治疗的患者，而那些以前未对抗心律失常药物反应失败的患者的风险低于那些曾对抗心律失常药物反应失败的患者。两种方法选择的药物治疗成功率无显著差异。
BackgroundInvasive electrophysiologic study and noninvasive Holter monitoring (in conjunction with exercise testing) have both been used to evaluate the efficacy of antiarrhythmic drugs in patients with sustained ventricular tachycardia and in survivors of cardiac arrest. We directly compared these two approaches to the prediction of drug efficacy.MethodsA total of 486 patients who had documented ventricular tachyarrhythmias that were inducible during electrophysiologic study and 10 or more premature ventricular complexes per hour during Holter monitoring were randomly assigned to undergo serial testing of antiarrhythmic-drug efficacy by electrophysiologic study or Holter monitoring. The patients received up to six drugs in random order until one was predicted to be effective either in suppressing inducible arrhythmia (in the electrophysiologic-study group) or in suppressing premature ventricular complexes (in the Holter-monitoring group). The patients were then followed for recurrences of arrhythmia or death.ResultsIn the electrophysiologic-study group, 108 of 242 patients (45 percent) received a prediction of efficacy, as compared with 188 of 244 patients (77 percent) in the Holter-monitoring group (P<0.001). Over a six-year follow-up period, there were 150 recurrences of arrhythmia and 46 deaths among the 296 patients receiving drugs predicted to be effective. Thirty-four of the deaths were from arrhythmic causes, and eight were from cardiac causes. There was no significant difference between the two study groups in the actuarial probabilities of these events. The risk of a recurrence of arrhythmia was significantly lower in patients who received sotalol than in those who received other antiarrhythmic drugs, and the risk was lower in those who had not previously failed to respond to antiarrhythmic drugs than in those who had.ConclusionsAlthough Holter monitoring led to predictions of antiarrhythmic-drug efficacy more often than did electrophysiologic study in patients with sustained ventricular tachyarrhythmias, there was no significant difference in the success of drug therapy as selected by the two methods.