Ruskin J N
Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston 02114.
Circulation. 1992 Jan;85(1 Suppl):I152-9.
Invasive electrophysiological testing has contributed importantly to the objective evaluation and management of patients at high risk for sudden cardiac death. The clinical application of the technique is based on the hypothesis that the reproducible induction of ventricular arrhythmias by programmed cardiac stimulation constitutes a marker of risk for spontaneous ventricular arrhythmias and sudden death as well as an objective end point to guide the selection of antiarrhythmic therapy. The value of electrophysiological testing is well established in patients with ischemic heart disease and a history of sustained ventricular tachycardia or fibrillation and in some subsets of patients with unexplained syncope. More recently, the technique has been used by some investigators to identify individuals at high risk for sudden death among patients with recent myocardial infarction and those with left ventricular dysfunction and recurrent nonsustained ventricular tachycardia. The predictive value of the technique in patients with nonischemic heart disease is unknown. In addition to its use as an objective end point in the selection of antiarrhythmic drug therapy, invasive electrophysiological testing has advanced our knowledge of the mechanisms of life-threatening ventricular arrhythmias and contributed importantly to the development of new therapies, such as implantable arrhythmia control devices and catheter ablation techniques.
有创电生理检查对心脏性猝死高危患者的客观评估及治疗发挥了重要作用。该技术的临床应用基于这样一种假设，即通过程控心脏刺激可重复性诱发室性心律失常，这构成了自发性室性心律失常和猝死风险的标志物，也是指导抗心律失常治疗选择的客观终点。电生理检查在患有缺血性心脏病且有持续性室性心动过速或颤动病史的患者以及某些不明原因晕厥的患者亚组中，其价值已得到充分确立。最近，一些研究人员已将该技术用于识别近期心肌梗死患者以及左心室功能障碍和复发性非持续性室性心动过速患者中猝死的高危个体。该技术在非缺血性心脏病患者中的预测价值尚不清楚。除了作为抗心律失常药物治疗选择的客观终点外，有创电生理检查还增进了我们对危及生命的室性心律失常机制的了解，并对新疗法的开发，如植入式心律失常控制装置和导管消融技术，做出了重要贡献。
