Raitt M H, Renfroe E G, Epstein A E, McAnulty J H, Mounsey P, Steinberg J S, Lancaster S E, Jadonath R L, Hallstrom A P
Portland VA Medical Center, Portland, Ore., USA.
Circulation. 2001 Jan 16;103(2):244-52. doi: 10.1161/01.cir.103.2.244.
Sustained ventricular tachycardia (VT) can be unstable, can be associated with serious symptoms, or can be stable and relatively free of symptoms. Patients with unstable VT are at high risk for sudden death and are best treated with an implantable defibrillator. The prognosis of patients with stable VT is controversial, and it is unknown whether implantable cardioverter-defibrillator therapy is beneficial.
Screening for the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial identified patients with both stable and unstable VT. Both groups were included in a registry, and their clinical characteristics and discharge treatments were recorded. Mortality data were obtained through the National Death Index. The mortality in 440 patients with stable VT tended to be greater than that observed in 1029 patients presenting with unstable VT (33.6% versus 27.6% at 3 years; relative risk [RR]=1.22; P:=0.07). After adjustment for baseline and treatment differences, the RR was little changed (RR=1.25, P:=0.06).
Sustained VT without serious symptoms or hemodynamic compromise is associated with a high mortality rate and may be a marker for a substrate capable of producing a more malignant arrhythmia. Implantable cardioverter-defibrillator therapy may be indicated in patients presenting with stable VT.
持续性室性心动过速（VT）可能不稳定，可伴有严重症状，也可能稳定且相对无症状。不稳定VT患者猝死风险高，最佳治疗方法是植入式除颤器。稳定VT患者的预后存在争议，植入式心脏复律除颤器治疗是否有益尚不清楚。
抗心律失常药物与植入式除颤器（AVID）试验筛选出稳定和不稳定VT患者。两组均纳入登记系统，记录其临床特征和出院治疗情况。通过国家死亡指数获取死亡率数据。440例稳定VT患者的死亡率倾向于高于1029例不稳定VT患者（3年时分别为33.6%和27.6%；相对风险[RR]=1.22；P=0.07）。在对基线和治疗差异进行校正后，RR变化不大（RR=1.25，P=0.06）。
无严重症状或血流动力学损害的持续性VT与高死亡率相关，可能是能够产生更恶性心律失常的基质的标志。对于稳定VT患者，可能需要植入式心脏复律除颤器治疗。
