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院外心脏骤停幸存者的外科冠状动脉血运重建:其对诱发性室性心律失常和长期生存的影响。

Surgical coronary revascularization in survivors of prehospital cardiac arrest: its effect on inducible ventricular arrhythmias and long-term survival.

作者信息

Kelly P, Ruskin J N, Vlahakes G J, Buckley M J, Freeman C S, Garan H

机构信息

Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.

出版信息

J Am Coll Cardiol. 1990 Feb;15(2):267-73. doi: 10.1016/s0735-1097(10)80046-4.

DOI:10.1016/s0735-1097(10)80046-4
PMID:2299065
Abstract

In a selected subgroup of 50 survivors of cardiac arrest, the impact of surgical myocardial revascularization on inducible arrhythmias, arrhythmia recurrence and long-term survival was examined. The effects of several clinical, angiographic and electrophysiologic variables on arrhythmia recurrence and survival were also analyzed. All patients had a prehospital cardiac arrest and severe operable coronary artery disease and underwent myocardial revascularization. Preoperative electrophysiologic study was performed in 41 patients; 33 (80%) had inducible ventricular arrhythmias. Of 42 patients studied off antiarrhythmic drugs postoperatively, 19 (45%) had inducible ventricular arrhythmias. Thirty patients with inducible arrhythmias preoperatively underwent postoperative testing off antiarrhythmic drugs; arrhythmia induction was suppressed in 14 (47%). By multivariate analysis, the induction of ventricular fibrillation at the preoperative electrophysiologic study was the only significant predictor of induced ventricular arrhythmia suppression by coronary surgery (p less than 0.001). Inducible ventricular fibrillation was not present postoperatively in any of the 11 patients who manifested this arrhythmia preoperatively. In contrast, inducible ventricular tachycardia persisted in 80% of patients in whom preoperative testing induced this arrhythmia. Patients were followed up for 39 +/- 29 months. There were four arrhythmia recurrences; one was fatal. There were three nonsudden cardiac deaths and three noncardiac deaths. By life-table analysis, 5 year survival, cardiac survival and arrhythmia-free survival rates were 88%, 98%, and 88%, respectively. Depressed left ventricular ejection fraction and advanced age were predictive of death (p = 0.015 and 0.026, respectively) and cardiac death (p = 0.037 and 0.05, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

在选定的50名心脏骤停幸存者亚组中,研究了外科心肌血运重建对可诱导性心律失常、心律失常复发和长期生存的影响。还分析了几个临床、血管造影和电生理变量对心律失常复发和生存的影响。所有患者均有院外心脏骤停和严重的可手术治疗的冠状动脉疾病,并接受了心肌血运重建。41例患者进行了术前电生理研究;33例(80%)有可诱导性室性心律失常。42例术后停用抗心律失常药物的患者中,19例(45%)有可诱导性室性心律失常。30例术前有可诱导性心律失常的患者术后停用抗心律失常药物进行检测;14例(47%)心律失常诱导被抑制。通过多变量分析,术前电生理研究中室颤的诱导是冠状动脉手术抑制诱导性室性心律失常的唯一显著预测因素(p<0.001)。术前表现出这种心律失常的11例患者术后均未出现可诱导性室颤。相比之下,术前检测诱发这种心律失常的患者中,80%的患者可诱导性室性心动过速持续存在。患者随访39±29个月。有4例心律失常复发;1例死亡。有3例非猝死性心脏死亡和3例非心脏死亡。通过生命表分析,5年生存率、心脏生存率和无心律失常生存率分别为88%、98%和88%。左心室射血分数降低和高龄是死亡(分别为p = 0.015和0.026)和心脏死亡(分别为p = 0.037和0.05)的预测因素。(摘要截断于250字)

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