Brembilla-Perrot Beatrice, Zinzius Pierre Yves, Groben Laurent, Freysz Luc, Muresan Lucian, Schwartz Jerome, Martins Raphael P, Jarmouni Soumaya, Nossier Ibrahim, Sadoul Nicolas, Blangy Hugues, De La Chaise Arnaud Terrier, Louis Pierre, Selton Olivier, Beurrier Daniel, Sellal Jean Marc
Department of cardiology, CHU of Brabois, Vandoeuvre, France.
Indian Pacing Electrophysiol J. 2010 Apr 1;10(4):162-72.
The results of programmed ventricular stimulation (PVS) may change after myocardial infarction (MI). The objective was to study the factors that could predict the results of a second PVS.
Left ventricular ejection fraction (LVEF) and QRS duration were determined and PVS performed within 3 to 14 years of one another (mean 7.5+/-5) in 50 patients studied systematically between 1 and 3 months after acute MI.
QRS duration increased from 120+/-23 ms to 132+/-29 (p 0.04). LVEF did not decrease significantly (36+/-12 % vs 37+/-13 %). Ventricular tachycardia with cycle length (CL) > 220ms (VT) was induced in 11 patients at PVS 1, who had inducible VT with a CL > 220 ms (8) or < 220 ms (ventricular flutter, VFl) (3) at PVS 2. VFl or fibrillation (VF) was induced in 14 patients at PVS 1 and remained inducible in 5; 5 patients had inducible VT and 4 had a negative 2nd PVS. 2. 25 patients had initially negative PVS; 7 had secondarily inducible VT, 4 a VFl/VF, 14 a negative PVS. Changes of PVS were related to initially increasing QRS duration and secondarily changes in LVEF and revascularization but not to the number of extrastimuli required to induce VFl.
In patients without induced VT at first study, changes of PVS are possible during the life. Patients with initially long QRS duration and those who developed decreased LVEF are more at risk to have inducible monomorphic VT at 2nd study, than other patients.
心肌梗死（MI）后程序性心室刺激（PVS）的结果可能会改变。目的是研究可预测第二次PVS结果的因素。
在50例急性心肌梗死后1至3个月系统研究的患者中，分别测定左心室射血分数（LVEF）和QRS时限，并在彼此相隔3至14年（平均7.5±5年）内进行PVS。
QRS时限从120±23毫秒增加到132±29毫秒（p<0.04）。LVEF无显著下降（36±12%对37±13%）。在第一次PVS时，11例患者诱发出周期长度（CL）>220毫秒的室性心动过速（VT），其中8例在第二次PVS时仍诱发出CL>220毫秒的VT，3例诱发出CL<220毫秒的室性心动过速（室性扑动，VFl）。14例患者在第一次PVS时诱发出VFl或颤动（VF），其中5例在第二次PVS时仍可诱发；5例患者诱发出VT，4例第二次PVS结果为阴性。2. 25例患者最初PVS结果为阴性；7例随后诱发出VT，4例诱发出VFl/VF，14例第二次PVS结果为阴性。PVS的变化与最初QRS时限增加有关，其次与LVEF变化和血运重建有关，但与诱发出VFl所需的额外刺激数量无关。
在首次研究未诱发出VT的患者中，PVS结果在病程中可能发生改变。与其他患者相比，最初QRS时限长以及LVEF下降的患者在第二次研究时更易诱发出单形性VT。
