Senges Julia C, Becker Ruediger, Schreiner Kirsten D, Bauer Alexander, Weretka Slawomir, Siegler Karl, Kuebler Wolfgang, Schoels Wolfgang
Department of Medicine, University of Heidelberg, Germany.
Pacing Clin Electrophysiol. 2002 Feb;25(2):183-90. doi: 10.1046/j.1460-9592.2002.00183.x.
In the MADIT study, a selected group of postinfarction patients with asymptomatic nonsustained ventricular tachycardia (NSVT) has been shown to benefit from prophylactic ICD treatment. The present study analyzed the variability of NSVT in a patient population fulfilling the non-invasive MADIT criteria. Three consecutive Holter ECGs were performed in weekly intervals in 68 postinfarction patients with an LVEF < or = 0.35. Patients with NSVT underwent programmed ventricular stimulation (PVS); patients were implanted with an ICD if sustained VT or VF was inducible. If NSVT was found in at least two recordings, the arrhythmia was defined as reproducible. In 28 (41%) of the 68 patients, NSVT was found in at least one recording. Seventeen patients revealed NSVT in the first, the remaining 11 in the second registration; no patient had NSVT only in the third Holter. Of the patients with NSVT, 50% had only one, 39% had two, and 11% had three positive recordings. Thus, reproducible NSVT was found in only 50% of the patients with NSVT. Predictors for reproducibility were LVEF > 0.27, NYHA Class I, absence of digitalis therapy, and > 2 NSVT per 24-hour period. Reproducible NSVT was not associated with risk factors such as elevated mean heart rate, reduced heart rate variability, late potentials, or inducibility of sustained VT during PVS. During 17 +/- 9 months of follow-up, seven (10%) patients experienced arrhythmic events: two without and five with previously documented NSVT. In the latter patients, first occurrence of NSVT was consistently in the first Holter; only two of them had reproducible NSVT. In postinfarction patients, the risk factor NSVT exhibits marked spontaneous variability, especially in those with a low number of NSVT per 24-hour period, LVEF < 0.27 or NYHA III, which limits its clinical value as a selection criterion for PVS. Reproducibility of NSVT itself does not seem to be an independent risk factor.
在MADIT研究中，一组选定的心肌梗死后无症状非持续性室性心动过速（NSVT）患者已被证明可从预防性植入式心脏复律除颤器（ICD）治疗中获益。本研究分析了符合非侵入性MADIT标准的患者群体中NSVT的变异性。对68例左心室射血分数（LVEF）≤0.35的心肌梗死后患者每隔一周进行连续三次动态心电图（Holter）检查。发生NSVT的患者接受程控心室刺激（PVS）；如果能诱发出持续性室性心动过速（VT）或心室颤动（VF），则为患者植入ICD。如果在至少两份记录中发现NSVT，则将该心律失常定义为可再现性的。68例患者中有28例（41%）在至少一份记录中发现了NSVT。17例患者在第一次记录中出现NSVT，其余11例在第二次记录中出现；没有患者仅在第三次Holter检查时出现NSVT。在出现NSVT的患者中，50%仅有一次、39%有两次、11%有三次阳性记录。因此，仅50%的NSVT患者存在可再现性NSVT。可再现性的预测因素为LVEF＞0.27、纽约心脏协会（NYHA）I级、未使用洋地黄治疗以及每24小时NSVT发作＞2次。可再现性NSVT与平均心率升高、心率变异性降低、晚电位或PVS期间持续性VT的可诱发性等危险因素无关。在17±9个月的随访期间，7例（10%）患者发生心律失常事件：2例在发生心律失常事件前未记录到NSVT，5例曾记录到NSVT。在后一组患者中，NSVT首次出现均在第一次Holter检查时；其中只有2例存在可再现性NSVT。在心肌梗死后患者中，危险因素NSVT表现出明显的自发变异性，尤其是在那些每24小时NSVT发作次数较少、LVEF＜0.27或NYHA III级的患者中，这限制了其作为PVS选择标准的临床价值。NSVT本身的可再现性似乎并非一个独立的危险因素。
