Hoppe U C, Haverkamp W, Breithardt G, Borggrefe M
Department of Cardiology and Angiology, Westfälische Wilhelms-University, Münster, Germany.
Pacing Clin Electrophysiol. 2000 May;23(5):854-62. doi: 10.1111/j.1540-8159.2000.tb00855.x.
Evidence suggests that infarct related artery (IRA) patency may improve survival after acute myocardial infarction, which is thought to be partially due to a lower incidence of malignant ventricular tachyarrhythmias. However, little is known about the effect of IRA patency on antiarrhythmic drug response and long-term outcome in patients with previous infarction who already experienced sustained ventricular tachyarrhythmias. A total of 152 patients with remote myocardial infarction and documented ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent coronary angiography and programmed ventricular stimulation before and after oral administration of d,l-sotalol (240-640 mg/day). D,l-sotalol suppressed inducibility of VT/VF in 37 (25.2%) patients. The IRA was patent in 38.1% of all patients. There was no significant difference in the frequency of drug response between patients with patent or occluded IRAs (26.8% vs 24.2%, P = 0.87). In patients with a patent IRA, d,l-sotalol tended to be more effective in the absence of a left ventricular aneurysm, although this difference did not reach statistical significance (P = 0.38). Ejection fraction and collateral blood flow had no effect on drug response in the presence or absence of IRA patency. During follow-up (13.0 +/- 19.9 months) of 29 patients discharged on oral d,l-sotalol, 3 patients experienced symptomatic VT and 4 sudden death. Arrhythmia recurrence and death of all cause (n = 6) and cardiac death (n = 4) were independent of IRA patency status. IRA patency had no effect on short-term drug response to d,l-sotalol in patients with remote myocardial infarction and documented VT/VF. Long-term outcome of patients with sustained ventricular tachyarrhythmias is independent of IRA patency status. In contrast to a previous report, outcome of electropharmacological testing was not predicted by the patency of the IRA.
有证据表明，梗死相关动脉（IRA）通畅可能会改善急性心肌梗死后的生存率，这被认为部分归因于恶性室性快速心律失常的发生率较低。然而，对于IRA通畅对既往有梗死且已发生持续性室性快速心律失常患者的抗心律失常药物反应及长期预后的影响，人们了解甚少。共有152例陈旧性心肌梗死且记录有室性心动过速（VT）或室颤（VF）的患者在口服d，l - 索他洛尔（240 - 640mg/天）前后接受了冠状动脉造影及程控心室刺激。d，l - 索他洛尔使37例（25.2%）患者的VT/VF诱发性受到抑制。所有患者中38.1%的IRA通畅。IRA通畅或闭塞的患者之间药物反应频率无显著差异（26.8%对24.2%，P = 0.87）。在IRA通畅的患者中，d，l - 索他洛尔在无左心室室壁瘤时往往更有效，尽管这种差异未达到统计学意义（P = 0.38）。无论IRA是否通畅，射血分数和侧支血流对药物反应均无影响。在29例口服d，l - 索他洛尔出院的患者随访期间（13.0±19.9个月），3例患者发生有症状VT，4例猝死。心律失常复发及全因死亡（n = 6）和心源性死亡（n = 4）均与IRA通畅状态无关。IRA通畅对陈旧性心肌梗死且记录有VT/VF的患者对d，l - 索他洛尔的短期药物反应无影响。持续性室性快速心律失常患者的长期预后与IRA通畅状态无关。与先前的一份报告相反，IRA的通畅情况并不能预测电药理学测试的结果。
