Leenhardt A, Coumel P, Slama R
Clinique Lariboisière, hôpital Lariboisière, Paris.
Arch Mal Coeur Vaiss. 1992 Dec;85 Spec No 4:23-9.
Polymorphic ventricular tachycardia is defined as constant change of the QRS morphology. The diagnosis has important etiological, therapeutic and prognostic implications. This term covers several different entities which may be artificially distinguished by the electrocardiographic appearances during tachycardia, by changes of the resting electrocardiogramme, the mode of onset, the presence or absence of underlying cardiac disease and of intercurrent drug therapy. However, as the resting ECG may not be available in an emergency situation, or difficult to interpret, the clinical context is the key to diagnosis and treatment. Polymorphic ventricular tachycardia is classified according to the absence or presence of underlying cardiac disease respectively as torsades de pointe with long QT, torsades de pointe with a short coupling interval and catecholamine-induced ventricular tachycardia of childhood on the one hand, and, iatrogenic torsades de pointe, ventricular tachycardia in acute or chronic infarction and other cardiac diseases, on the other hand. Finally, the authors discuss the problem of polymorphic ventricular tachycardia induced by programmed ventricular stimulation.
多形性室性心动过速定义为QRS形态持续变化。该诊断具有重要的病因学、治疗学和预后意义。这个术语涵盖了几种不同的实体，它们可能通过心动过速期间的心电图表现、静息心电图的变化、发作方式、是否存在潜在心脏病以及是否正在进行药物治疗而人为区分。然而，由于在紧急情况下可能无法获得静息心电图，或者难以解读，临床背景是诊断和治疗的关键。多形性室性心动过速根据是否存在潜在心脏病分别分类为长QT间期的尖端扭转型室性心动过速、短联律间期的尖端扭转型室性心动过速和儿童期儿茶酚胺诱发的室性心动过速，另一方面为医源性尖端扭转型室性心动过速、急性或慢性梗死及其他心脏病中的室性心动过速。最后，作者讨论了程控心室刺激诱发多形性室性心动过速的问题。
