Brembilla-Perrot B, Terrier de la Chaise A, Suty-Selton C, Thiel B, Louis P, Brua J L
CHU Brabois, Nancy-Vandoeuvre.
Arch Mal Coeur Vaiss. 1991 Oct;84(10):1425-30.
The aim of this study was to identify the factors associated with the induction of ventricular tachycardia (TV) by programmed ventricular stimulation in patients with unexplained syncope. Sustained VT was induced in 71 out of 619 patients (11.5%) with syncope. A comparison of subjects with inducible VT and those without inducible VT showed underlying cardiac disease to be more common (89% versus 16%), more Holter abnormalities (Grade IVa ventricular extrasystoles) (60.5% versus 10%) in the first group but that signal-averaged ECG, recorded in 51 cases, was not sufficiently specific to differentiate the two groups (delayed potentials in 57% versus 43%). When syncope occurred in a subject without apparent cardiac disease with a normal Holter recording, inducible VT was rare (1%). On the other hand, when syncope was associated with cardiac disease and/or an abnormal Holter recording, VT could be induced in 45 to 64% of cases. In addition, as inducible VT was associated with severe infrahisian conduction defects in 3 cases, the following strategy is suggested in patients with unexplained syncope: programmed ventricular stimulation should be performed systematically during endocavitary electrophysiological investigation of AV conduction in patients with cardiac disease and if the non-invasive investigations, Holter monitoring or echocardiography, are abnormal.
本研究的目的是确定不明原因晕厥患者经程控心室刺激诱发室性心动过速（VT）的相关因素。619例晕厥患者中有71例（11.5%）诱发出持续性VT。对可诱发出VT的患者与未诱发出VT的患者进行比较，结果显示潜在心脏病在前者中更为常见（89% 对16%），且第一组中有更多的动态心电图异常（IVa级室性期前收缩）（60.5% 对10%），但在51例患者中记录的信号平均心电图不足以特异性地区分两组（延迟电位分别为57% 对43%）。当无明显心脏病且动态心电图记录正常的患者发生晕厥时，诱发出VT的情况很罕见（1%）。另一方面，当晕厥与心脏病和/或动态心电图异常相关时，45%至64%的病例可诱发出VT。此外，由于3例可诱发出VT的患者伴有严重的希氏束下传导缺陷，因此对于不明原因晕厥患者建议采用以下策略：在对心脏病患者进行心腔内电生理检查以评估房室传导时，如果非侵入性检查（动态心电图监测或超声心动图）异常，应系统地进行程控心室刺激。
