Morady F, Kadish A, de Buitleir M, Kou W H, Calkins H, Schmaltz S, Rosenheck S, Sousa J
Division of Cardiology, University of Michigan Medical Center, Ann Arbor 48109-0022.
Circulation. 1991 Mar;83(3):764-73. doi: 10.1161/01.cir.83.3.764.
This study compared the sensitivity, specificity, and efficiency of a "conventional" and "accelerated" programmed stimulation protocol in 293 patients with coronary artery disease who had a history of sustained or nonsustained monomorphic ventricular tachycardia (VT).
In the conventional protocol, one and two extrastimuli were introduced during sinus rhythm and during basic drive trains at cycle lengths of 600 and 400 msec at the right ventricular apex and then at the outflow tract or septum. In the accelerated protocol, one, two, and then three extrastimuli were introduced at each of three basic drive train cycle lengths (350, 400, and 600 msec) at the right ventricular apex; the procedure was repeated at a second right ventricular site. Six hundred thirty-four electrophysiological tests were performed using one of these two protocols either in the baseline state (293 tests) or during drug testing (341 tests). The yield of sustained, monomorphic VT was 89% with the conventional protocol and 92% with the accelerated protocol during baseline tests in patients who had a history of sustained VT (p = 0.05); 20% and 34%, respectively, during baseline tests in patients with a history of nonsustained VT (p = 0.06); and 70% and 77%, respectively, during drug testing (p = 0.2). To induce sustained, monomorphic VT, 10.1 +/- 5.0 (mean +/- SD) protocol steps and 14.4 +/- 8.7 minutes were required with the conventional protocol, compared with 4.0 +/- 3.7 steps and 5.6 +/- 6.1 minutes with the accelerated protocol (p less than 0.001 for each comparison). Among the tests in which sustained, monomorphic VT was induced, sustained polymorphic VT or ventricular fibrillation was induced more often with the conventional protocol (3.6%) than with the accelerated protocol (0.9%, p = 0.05).
The efficiency of programmed stimulation can be improved by the early use of a basic drive train cycle length of 350 msec and three extrastimuli. Compared with a conventional stimulation protocol, the accelerated protocol used in this study reduces the number of protocol steps and duration of time required to induce monomorphic VT by an average of more than 50% and improves the specificity of programmed stimulation without impairing the yield of monomorphic VT.
本研究比较了“传统”和“加速”程控刺激方案在293例有持续性或非持续性单形性室性心动过速（VT）病史的冠心病患者中的敏感性、特异性和有效性。
在传统方案中，在窦性心律以及右心室心尖部周期长度为600和400毫秒的基础驱动序列期间，然后在流出道或间隔处引入1个和2个期外刺激。在加速方案中，在右心室心尖部的三个基础驱动序列周期长度（350、400和600毫秒）的每一个时分别引入1个、2个然后3个期外刺激；该操作在右心室的第二个部位重复进行。使用这两种方案之一在基线状态（293次测试）或药物测试期间（341次测试）进行了634次电生理检查。在有持续性VT病史的患者的基线测试中，传统方案诱发出持续性单形性VT的成功率为89%，加速方案为92%（p = 0.05）；在有非持续性VT病史的患者的基线测试中，分别为20%和34%（p = 0.06）；在药物测试期间，分别为70%和77%（p = 0.2）。与加速方案相比，传统方案诱发出持续性单形性VT需要10.1±5.0（均值±标准差）个方案步骤和14.4±8.7分钟，而加速方案需要4.0±3.7个步骤和5.6±6.1分钟（每次比较p均小于0.001）。在诱发出持续性单形性VT的测试中，传统方案比加速方案更常诱发出持续性多形性VT或心室颤动（3.6%对0.9%，p = 0.05）。
通过早期使用350毫秒的基础驱动序列周期长度和3个期外刺激可提高程控刺激的有效性。与传统刺激方案相比，本研究中使用的加速方案将诱发出单形性VT所需的方案步骤数和时间平均减少了50%以上，并提高了程控刺激的特异性，同时不影响单形性VT的成功率。
