Pleskot M, Parízek P, Hodac M, Haman L, Stásek J, Cervinka P, Tauchman M
II. interní klinika FN, Hradec Králové.
Vnitr Lek. 2000 Feb;46(2):80-6.
The objective of the work was to describe in subjects with spontaneous ventricular fibrillation, after elimination of acute cardiac disease, the strategy of antiarrhythmic treatment and to evaluate, based on prospective follow-up, the effectiveness of this treatment. The authors included in the group 36 patients (30 men and 6 women) within the range from 34 to 78 years (mean age 58 +/- 11 years) with spontaneous ventricular fibrillation. They divided the group into a subgroup (15 subjects) without revascularization of the heart muscle, into a subgroup (17 subjects) with revascularization of the myocardium (coronary angioplasty and bypasses) and a subgroup (4 subjects) where ischaemic heart disease was ruled out (mostly cardiomyopathies). In all subgroups they used programmed ventricular stimulation (apparatuses of Quinton Co. USA, Biotronik Co. GFR), in the subgroup with revascularization within 3 months. During the diagnostic procedure of ventricular stimulation they tested antiarrhythmic drugs most frequently amiodarone per os (for 4 weeks). An implantable cardioverter--defibrillator was implanted in 17 patients (8 subjects without revascularization, 6 subjects with revascularization, 3 subjects without ischaemic heart disease). All patients were followed up till death, maximum 24 months. The authors evaluated the rate of cardiac deaths (death on cardiac grounds, incl. sudden arrhythmic death) and sudden arrhythmic deaths (within one hour after the onset of symptoms or the first malignant ventricular tachyarrhythmia recorded after implantation of the defibrillator). In the subgroup without revascularization with electric instability of the ventricles according to programmed stimulation 66.7% they described seven cardiac deaths (46.7%) and 6 sudden "arrhythmic" deaths (40%) incl. 5 subjects with ineffective testing of antiarrhythmic drugs. Conversely in the subgroup with revascularization and with diagnostic programmed stimulation in 47.1% they found 3 cardiac deaths (17.7%), one sudden "arrhythmic" death (5.9%)--a subject with ineffective testing. In the subgroup without ischaemic heart disease they recorded cardiac and sudden "arrhythmic" deaths in half the subjects, in all instances in subjects without inducible ventricular tachyarrhythmia. The authors found in the course of a two-year investigation a relapse of cardiac arrest in 25% of subjects after spontaneous ventricular fibrillation. A third of these subjects (all without a cardioverter-defibrillator) died. They confirm the benefit of implantation of a defibrillator for all subjects regardless of the basic diagnosis and revascularization of the heart muscle.
这项工作的目的是描述在排除急性心脏疾病后，患有自发性心室颤动的患者的抗心律失常治疗策略，并基于前瞻性随访评估该治疗的有效性。作者纳入了36例年龄在34至78岁（平均年龄58±11岁）的自发性心室颤动患者（30名男性和6名女性）。他们将该组患者分为一个未进行心肌血运重建的亚组（15名受试者）、一个进行了心肌血运重建（冠状动脉血管成形术和搭桥术）的亚组（17名受试者）以及一个排除了缺血性心脏病的亚组（4名受试者，主要为心肌病患者）。在所有亚组中，他们使用了程控心室刺激（美国Quinton公司、德国百多力公司的仪器），在进行血运重建的亚组中于3个月内进行。在心室刺激的诊断过程中，他们最常口服抗心律失常药物胺碘酮（持续4周）。17例患者植入了植入式心脏复律除颤器（8例未进行血运重建的受试者、6例进行了血运重建的受试者、3例无缺血性心脏病的受试者）。所有患者均随访至死亡，最长随访24个月。作者评估了心源性死亡（因心脏原因导致的死亡，包括猝死性心律失常死亡）和猝死性心律失常死亡（症状发作后1小时内或植入除颤器后记录到的首次恶性室性快速心律失常后）的发生率。在未进行血运重建且根据程控刺激显示心室电不稳定的亚组中，他们描述了7例心源性死亡（46.7%）和6例猝死性“心律失常”死亡（40%），其中包括5例抗心律失常药物测试无效的受试者。相反，在进行了血运重建且进行了诊断性程控刺激的亚组中，他们发现47.1%的患者中有3例心源性死亡（17.7%）、1例猝死性“心律失常”死亡（5.9%）——1例抗心律失常药物测试无效的受试者。在无缺血性心脏病的亚组中，他们记录到半数受试者有心源性和猝死性“心律失常”死亡，所有病例均为无诱发性室性快速心律失常的受试者。作者在为期两年的调查过程中发现，25%的自发性心室颤动患者出现了心脏骤停复发。其中三分之一的受试者（均未植入心脏复律除颤器）死亡。他们证实，无论基本诊断和心肌血运重建情况如何，为所有受试者植入除颤器都是有益的。
