Kowey P R, Taylor J E, Marinchak R A, Rials S J
Division of Cardiovascular Diseases, Lankenau Hospital, Wynnewood, PA.
Am Heart J. 1992 Feb;123(2):481-5. doi: 10.1016/0002-8703(92)90664-h.
There has been considerable debate regarding the value of programmed electrical stimulation in patients who present with asymptomatic, or minimally symptomatic, nonsustained VT. Unfortunately, there has never been a sufficiently large study of an untreated group of patients to make any sense of the issue. We culled the literature for reports published between 1986 and 1990 that met certain minimum requirements, the most important of which were adequate patient profiling and outcome data. The survey identified 12 studies of 926 patients, mean age 61 years, with a 5:1 male preponderance. Underlying heart disease was coronary in 818 patients, including 665 who had experienced previous but not recent myocardial infarctions. Of these, 302 (33%) had inducible sustained ventricular arrhythmias (monomorphic VTs in 264). Eighty-three percent of these patients were treated with antiarrhythmic drugs compared to only 13% of the noninducible group (p less than 0.0001). Sudden death or a sustained arrhythmic event occurred in 54 (18%) of the 302 patients in the inducible group compared with 46 (7%) of the 624 in the noninducible group (p less than 0.001). The sensitivity, specificity, and positive and negative predictive accuracies of the test were 54%, 70%, 18%, and 93%, respectively. Thus a patient with an inducible sustained arrhythmia who manifests nonsustained VT is two and a half times as likely to have a major arrhythmic event, but a negative result bodes well for the patient. However, widespread application of the technique cannot be recommended until these results are confirmed in a large, prospective study in which antiarrhythmic therapy is controlled.
对于无症状或症状轻微的非持续性室性心动过速（VT）患者，程控电刺激的价值一直存在大量争议。遗憾的是，从未有过对未经治疗的患者组进行足够大规模的研究，以使这个问题变得清晰明了。我们在文献中筛选了1986年至1990年间发表的符合某些最低要求的报告，其中最重要的是足够的患者资料描述和结果数据。该调查确定了12项针对926例患者的研究，这些患者的平均年龄为61岁，男性占比为5:1。818例患者存在潜在的心脏病，其中665例曾有过心肌梗死，但不是近期发生的。在这些患者中，302例（33%）可诱发出持续性室性心律失常（264例为单形性室性心动过速）。这些患者中有83%接受了抗心律失常药物治疗，相比之下，非诱发性组中只有13%接受了此类治疗（p小于0.0001）。诱发性组的302例患者中有54例（18%）发生了猝死或持续性心律失常事件，而非诱发性组的624例患者中有46例（7%）发生了此类事件（p小于0.001）。该检测的敏感性、特异性、阳性预测准确性和阴性预测准确性分别为54%、70%、18%和93%。因此，表现为非持续性室性心动过速且可诱发出持续性心律失常的患者发生重大心律失常事件的可能性是常人的2.5倍，但检测结果为阴性对患者来说是个好兆头。然而，在一项大规模的前瞻性研究中证实这些结果之前，不建议广泛应用该技术，在该研究中抗心律失常治疗应得到控制。
