RESULTS AND EFFICIENCY OF PROGRAMMED VENTRICULAR STIMULATION WITH 4 EXTRASTIMULI COMPARED WITH ONE, 2, AND 3 EXTRASTIMULI
RESULTS AND EFFICIENCY OF PROGRAMMED VENTRICULAR STIMULATION WITH 4 EXTRASTIMULI COMPARED WITH ONE, 2, AND 3 EXTRASTIMULI
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DOI：
10.1161/01.cir.90.6.2827
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发表时间：
1994-12-01
期刊：
影响因子：
37.8
通讯作者：
MORADY, F
中科院分区：
文献类型：
--
作者：
HUMMEL, JD;STRICKBERGER, SA;MORADY, F
背景与最近提出的方案相比，常规的程序化心室刺激方案是低效的。本研究的目的是确定额外的效率是否可以从一个6步程序心室刺激协议，专门使用4 extrastimuli.Methods和结果的主题是209例连续冠状动脉疾病和记录持续单形性室性心动过速，非持续性室性心动过速，流产猝死，或晕厥。这些患者在未接受抗癫痫药物治疗的情况下进行了159项电生理检查，在接受抗癫痫药物治疗的情况下进行了105项电生理检查。在每例患者中以随机顺序使用两种方案进行程控刺激。两种方案都使用8次搏动的驱动链，4秒的链间停顿，以及350、400和600 ms的基本驱动周期长度。6步方案以290、280、270和260 ms的偶联间期开始，以10 ms的步长同时缩短，直到S2不应。18步方案以常规顺序方式使用一次、两次和三次额外刺激。终点为持续性单形性室性心动过速30 s，两次需要心脏复律的多形性室性心动过速发作，或在两个右心室部位完成方案。无论临床表现或抗心律失常药物治疗如何，使用两种方案的持续性单形性室性心动过速发生率无显著差异。多形性室性心动过速的发生率18步方案是6步方案的两倍（6%对3%，P
Background Conventional programmed ventricular stimulation protocols are inefficient compared with more recently proposed protocols. The purpose of the present study was to determine if additional efficiency could be derived from a 6-step programmed ventricular stimulation protocol that exclusively uses four extrastimuli.Methods and Results The subjects were 209 consecutive patients with coronary artery disease and documented sustained monomorphic ventricular tachycardia, nonsustained ventricular tachycardia, aborted sudden death, or syncope. These patients underwent 159 electrophysiological tests in the absence of antiarrhythmic drug therapy and 105 electrophysiological tests in the presence of antiarrhythmic therapy. Programmed stimulation was performed with two protocols in random order in each patient. Both protocols used an eight-beat drive train, 4-s intertrain pause, and basic drive cycle lengths of 350, 400, and 600 ms. The 6-step protocol started with coupling intervals of 290, 280, 270, and 260 ms, which were shortened simultaneously in 10-ms steps until S2 was refractory. The 18-step protocol used one, two and three extrastimuli in conventional sequential fashion. The end points were 30 s of sustained monomorphic ventricular tachycardia, two episodes of polymorphic ventricular tachycardia requiring cardioversion, or completion of the protocol at two right ventricular sites. There was no significant difference in the yield of sustained monomorphic ventricular tachycardia using the two protocols, regardless of the clinical presentation or treatment with antiarrhythmic drugs. Polymorphic ventricular tachycardia occurred with the;18-step protocol twice as frequently as with the 6-step protocol (6% versus 3%, P