Mitchell L Brent
Department of Cardiac Science, Calgary Health Region, Foothills Hospital, Calgary, Alberta, Canada.
Card Electrophysiol Rev. 2002 Dec;6(4):458-62. doi: 10.1023/a:1021152812529.
The transvenous-catheter electrophysiologic (EP) study has occupied a central position in the investigation and management of patients with ischemic heart disease and a propensity to ventricular tachycardia (VT) or ventricular fibrillation (VF) for more than 25 years. However, demonstration of the superiority of the implantable cardioverter defibrillator (ICD) compared to other approaches to the management of VT/VF has resulted in a decrease in the frequency of use of the EP study in these patients. Nevertheless, the EP study remains a value-added procedure for many patients in this setting. These advantages include demonstration that the clinical arrhythmia is VT/VF when the diagnosis is uncertain, identification of those patients whose VT/VF is actually the result of a supraventricular tachyarrhythmia, identification of VT mechanisms readily amenable to catheter ablation, assessment of the response of a patient's VT to attempts at pace-termination, evaluation of candidacy for ablative VT therapy, prediction of the efficacy of approaches to prevention of VT/VF episodes, risk stratification of patients who have not yet experienced a sustained episode of VT/VF, and continued enhancement of our understanding of the mechanisms and therapeutics of VT/VF. The purpose of this review is to outline our present understanding of the techniques and indications for an EP study in patients with ischemic heart disease.
在25年多的时间里，经静脉导管电生理（EP）研究在缺血性心脏病以及有室性心动过速（VT）或心室颤动（VF）倾向患者的调查和管理中占据核心地位。然而，与其他VT/VF管理方法相比，植入式心脏复律除颤器（ICD）的优越性已导致这些患者中EP研究的使用频率下降。尽管如此，对于许多处于这种情况的患者，EP研究仍然是一项增值程序。这些优势包括：在诊断不确定时证明临床心律失常为VT/VF；识别那些VT/VF实际上是室上性快速心律失常所致的患者；识别易于通过导管消融治疗的VT机制；评估患者的VT对起搏终止尝试的反应；评估VT消融治疗的候选资格；预测预防VT/VF发作方法的疗效；对尚未经历过持续性VT/VF发作的患者进行风险分层；以及不断加深我们对VT/VF机制和治疗方法的理解。本综述的目的是概述我们目前对缺血性心脏病患者进行EP研究的技术和适应症的理解。
