[植入式除颤器治疗的陈旧性心肌梗死患者心律失常复发：根据初始临床表现进行的分析]

[Arrhythmia recurrence in patients with an old myocardial infarct treated by implantable defibrillator: an analysis according to the initial clinical presentation].

作者信息

Vacca M, Mont L, Valentino M, Sambola A, Madariaga R, Matas M, Brugada J

机构信息

Unitat d'Arítmies, Hospital Clínic, Universitat de Barcelona.

出版信息

Rev Esp Cardiol. 1999 Dec;52(12):1066-74.

PMID:10659653

Abstract

INTRODUCTION AND OBJECTIVES

The importance of the clinical presentation in the frequency and type of recurrences of ventricular arrhythmias in patients that received an automatic implantable defibrillator is not well known. The purpose of this study was to analyze the frequency and type of recurrences in patients with an old myocardial infarction that received an automatic implantable defibrillator with electrogram recording.

METHODS AND RESULTS

We analyzed 100 patients classified in 3 groups according to their clinical presentation: Sustained Monomorphic Ventricular Tachycardia (VT Group n = 65), Cardiac Arrest (CA Group = 19), and Syncope (Syncope Group n = 16). There were no significant differences in the clinical variables among the different groups, nor in the inducibility of arrhythmia at the electrophysiologic study. In a follow-up 27 +/- 14 months, 54% of patients presented at last one episode of sustained ventricular arrhythmia. All recurrences except one were as sustained monomorphic ventricular tachycardia (776 episodes). 81% of episodes of sustained monomorphic ventricular tachycardia (630) were treated with antitachycardia pacing with an effectiveness of 89%. There were no differences in the probability of arrhythmic recurrence among groups but death probability was higher in the ventricular fibrillation group at 36 follow-up months (38% vs 7% and 12% in the sustained monomorphic ventricular tachycardia and syncope groups respectively, p = 0.0113).

CONCLUSIONS

In the patients with an old myocardial infarction and malignant ventricular arrhythmias, most of recurrences are due to sustained monomorphic ventricular tachycardia independently of the clinical presentation. The antitachycardia pacing is not only effective in patients with documented sustained monomorphic ventricular tachycardia but also in those that are presented as cardiac arrest or syncope.

摘要

引言与目的

在接受植入式自动除颤器的患者中，临床表现对室性心律失常复发频率和类型的重要性尚不明确。本研究旨在分析接受带有心电图记录功能的植入式自动除颤器的陈旧性心肌梗死患者的复发频率和类型。

方法与结果

我们根据临床表现将100例患者分为3组：持续性单形性室性心动过速（室速组，n = 65）、心脏骤停（心脏骤停组，n = 19）和晕厥（晕厥组，n = 16）。不同组间的临床变量以及电生理研究中诱发心律失常的情况均无显著差异。在27±14个月的随访中，54%的患者至少出现过一次持续性室性心律失常发作。除1例复发外，所有复发均为持续性单形性室性心动过速（776次发作）。81%的持续性单形性室性心动过速发作（630次）接受了抗心动过速起搏治疗，有效率为89%。各组间心律失常复发概率无差异，但在随访36个月时，心室颤动组的死亡概率更高（分别为38%，而持续性单形性室性心动过速组和晕厥组为7%和12%，p = 0.0113）。