Sudden arrhythmic cardiac death--mechanisms, resuscitation and classification: the Seattle perspective.
Sudden arrhythmic cardiac death--mechanisms, resuscitation and classification: the Seattle perspective.
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心律失常性心源性猝死——机制、复苏和分类：西雅图观点。
DOI：
10.1016/0002-9149(90)91285-e
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Greene,HL
中科院分区：
文献类型：
--
作者：
Greene,HL
心室颤动（VF）是75%的心血管性猝死患者的第一个心律失常。持续性室性心动过速（VT）很少（1%）单独引起虚脱和意识丧失。是否所有的室颤都以室性心动过速开始尚不清楚，早期应用心肺复苏和快速除颤是确保患者存活和满意的神经功能恢复的关键。在西雅图的过去2年中，VF的初始复苏率为447例患者中的269例（60%），447例患者中的114例（26%）长期存活。VF的幸存者具有较高的VF复发的总体风险，确定了许多单变量风险因素：左心室功能不良的证据（充血性心力衰竭史、既往心肌梗死[MI]或射血分数低）、广泛冠状动脉疾病、无新发MI（Q波或非Q波）伴VF、男性、高龄、霍尔特记录显示复杂或高频心室异位、电生理检查诱导，运动诱发的心绞痛或低血压和吸烟。心脏性死亡分类为心脏病性或非心脏病性在解释治疗反应方面很重要。然而，由于许多患者有Chrome症状，因此很难确定新事件发生的时间。此外，事件的准确时间并不能保证正确的分类。猝死不一定是猝死，也不是所有猝死都是突然的。总心脏死亡率可能是衡量抗心律失常治疗总体效果的更简单且更相关的终点。
Ventricular fibrillation (VF) is the first recorded arrhythmia in 75% of patients who have a sudden cardiovascular collapse. Rarely (1%) does sustained ventricular tachycardia (VT) alone cause collapse and unconsciousness. Whether all VF begins as VT is unknown.Early application of cardiopulmonary resuscitation and rapid defibrillation are essential to ensure survival and satisfactory neurologic recovery. During the last 2 years in Seattle, the initial resuscitation rate for VF was 269 of 447 patients (60%), with 114 of 447 patients (26%) surviving long-term. Survivors of VF have a high overall risk of recurrent VF, with many univariate risk factors identified: evidence of poor left ventricular function (history of congestive heart failure, prior myocardial infarction [MI] or low ejection fraction), extensive coronary artery disease, absence of a new MI (either Q wave or non-Q wave) with VF, male gender, advanced age, complex or high-frequency ventricular ectopy on Holter recording, inducibility at electrophysiologic study, exercise-induced angina or hypotension, and smoking.Classification of cardiac deaths as arrhythmic or nonarrhythmic is important in interpreting the therapeutic response. However, because many patients have chrome symptoms, timing of the onset of a new event is difficult. Furthermore, accurate timing of an event does not guarantee correct classification. Sudden death is not necessarily arrhythmic, nor is all arrhythmic death sudden. Total cardiac mortality may be a simpler and more relevant end point to measure the overall effect of antiarrhythmic therapy.