Viskin Sami, Ish-Shalom Maya, Koifman Edward, Rozovski Uri, Zeltser David, Glick Aharon, Finkelstein Ariel, Halkin Amir, Fish Roman, Belhassen Bernard
Department of Cardiology, Tel Aviv-Sourasky Medical Center, Sackler-School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel.
J Cardiovasc Electrophysiol. 2003 Sep;14(9):913-9. doi: 10.1046/j.1540-8167.2003.03082.x.
Induction of ventricular flutter during electrophysiologic (EP) studies (similar to that of ventricular fibrillation [VF]) often is viewed as a nonspecific response with limited prognostic significance. However, data supporting this dogma originate from patients without previously documented ventricular tachyarrhythmias. We examined the significance of ventricular flutter in patients with and without spontaneous ventricular arrhythmias.
We conducted a cohort study of all patients with myocardial infarction (MI) undergoing EP studies at our institution. Of 344 consecutive patients, 181 had previously documented spontaneous sustained ventricular arrhythmias, 61 had suspected ventricular arrhythmias, and 102 had neither. Ventricular flutter was induced in 65 (19%) of the patients. Left ventricular ejection fraction was highest among patients with inducible VF (35 +/- 13), lowest for patients with inducible sustained monomorphic ventricular tachycardia (SMVT; 27 +/- 9), and intermediate for patients with inducible ventricular flutter (30 +/- 10). Similarly, the coupling intervals needed to induce the arrhythmia were shortest for VF (200 +/- 28 msec), intermediate for ventricular flutter (209 +/- 27 msec), and longest for SMVT (230 +/- 35 msec). During 5 +/- 8 years of follow-up, the risk for ventricular tachycardia/VF was high for patients with SMVT and ventricular flutter and low for patients with inducible VF and noninducible patients (46%, 34%, 17%, and 14%, P < 0.005).
Patients with inducible ventricular flutter appear to be "intermediate" between patients with inducible VF and patients with SMVT in terms of clinical and electrophysiologic correlates. However, the prognostic value of inducible ventricular flutter is comparable to that of SMVT.
在电生理（EP）研究期间诱发室性扑动（类似于室颤[VF]）通常被视为一种非特异性反应，预后意义有限。然而，支持这一教条的数据来源于既往无室性快速性心律失常记录的患者。我们研究了有和无自发性室性心律失常患者中室性扑动的意义。
我们对在本机构接受EP研究的所有心肌梗死（MI）患者进行了一项队列研究。在连续的344例患者中，181例既往有自发性持续性室性心律失常记录，61例怀疑有室性心律失常，102例两者均无。65例（19%）患者诱发出室性扑动。左心室射血分数在可诱发性VF患者中最高（35±13），在可诱发性持续性单形性室性心动过速（SMVT）患者中最低（27±9），在可诱发性室性扑动患者中居中（30±10）。同样，诱发心律失常所需的联律间期在VF中最短（200±28毫秒），在室性扑动中居中（209±27毫秒），在SMVT中最长（230±35毫秒）。在5±8年的随访期间，SMVT和室性扑动患者发生室性心动过速/VF的风险较高，可诱发性VF和不可诱发性患者的风险较低（46%、34%、17%和14%，P<0.005）。
就临床和电生理相关性而言，可诱发性室性扑动患者似乎介于可诱发性VF患者和SMVT患者之间。然而，可诱发性室性扑动的预后价值与SMVT相当。
