Results of late programmed electrical stimulation and long-term electrophysiologic effects of amiodarone therapy in patients with refractory ventricular tachycardia.
Results of late programmed electrical stimulation and long-term electrophysiologic effects of amiodarone therapy in patients with refractory ventricular tachycardia.
复制标题
难治性室性心动过速患者的晚期程序电刺激和胺碘酮治疗的长期电生理效应的结果。
DOI：
10.1016/0002-9149(85)90379-0
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Griffith,LS
中科院分区：
文献类型：
--
作者：
Veltri,EP;Reid,PR;Platia,EV;Griffith,LS
13例难治性、复发性、危及生命的室性心动过速（VT）患者在长期胺碘酮治疗前后进行了电生理检查。9例（69%）有冠状动脉疾病，3例（23%）有非缺血性心肌病，1例（8%）有二尖瓣脱垂。在对照电生理研究中，程序性电刺激（PES）诱导所有患者VT: 11例持续VT， 2例非持续VT（9和31拍）。口服胺碘酮1200 mg/天，持续14天，然后维持408±20 mg/天（平均值±标准误差），6±1.6个月重复PES显示13例患者中有12例诱发性室速，11例持续室速，1例非持续室速（32次）。诱导型VT仅在1例患者中被抑制。胺碘酮显著增加窦循环长度、PR间期、QRS持续时间和右心室有效不应期。AH、HV和QTc间期无明显增加。24±2个月时，8例（62%）患者（均为PES晚期诱发性VT）无临床心律失常事件（晕厥或猝死），而5例（38%）患者（4例PES晚期诱发性VT）无心律失常事件。有无心律失常事件的PES患者在诱发性室速周期长度、室速周期长度变化、易诱导性及对诱发性室速的血流动力学反应等方面均无显著差异。因此，在长期接受胺碘酮治疗的患者中，晚期PES不能预测临床疗效，诱导性室速向非诱导性室速转化的频率较低，尽管通过晚期PES检测判断室电不稳定，但胺碘酮对高危患者临床有效。
Thirteen patients with refractory, recurrent, life-threatening ventricular tachycardia (VT) underwent electrophysiologic testing before and after long-term amiodarone therapy. Nine patients (69%) had coronary artery disease, 3 (23%) had nonischemic cardiomyopathy and 1 patient (8%) had mitral valve prolapse. At control electrophysiologic study, programmed electrical stimulation (PES) induced VT in all patients: sustained VT in 11 and nonsustained VT in 2 (9 beats and 31 beats). After oral loading with amiodarone, 1200 mg/day for 14 days, followed by maintenance therapy with 408 ± 20 mg/day (mean ± standard error of the mean), repeat PES at 6 ± 1.6 months revealed inducible VT in 12 of 13 patients: sustained VT in 11 and nonsustained VT (32 beats) in 1 patient. Inducible VT was suppressed in only 1 patient. Amiodarone significantly increased sinus cycle length, PR interval, QRS duration and right ventricular effective refractory period. Insignificant increases in AH, HV and QTc intervals were noted. At 24 ± 2 months, 8 patients (62%) (all with inducible VT at late PES) were free of clinical arrhythmic events (syncope or sudden death), compared with 5 patients (38%) (4 with inducible VT at late PES) with events. There were no significant differences in the induced VT cycle length, VT cycle length change, ease of inducibility or hemodynamic response to induced VT at late PES in patients with and without arrhythmic events. Thus, in patients who receive long-term amiodarone treatment, late PES does not predict clinical efficacy, the frequency of conversion from inducible VT to noninducible VT is low, and despite ventricular electrical instability as judged by late PES testing, amiodarone is clinically effective in patients at high risk.