Kim S G, Seiden S W, Felder S D, Waspe L E, Fisher J D
N Engl J Med. 1986 Aug 7;315(6):356-62. doi: 10.1056/NEJM198608073150604.
We studied the value of programmed stimulation in assessing the efficacy of antiarrhythmic agents in 52 patients with sustained ventricular tachycardia. All patients in this nonrandomized study had ventricular tachycardia inducible by programmed stimulation and also had frequent ventricular premature complexes (greater than or equal to 30 per hour) on Holter-monitor recordings before therapy. The efficacy of antiarrhythmic agents was assessed by both programmed stimulation and Holter recordings during serial drug testing. A regimen was deemed effective according to the programmed-stimulation criteria in 25 patients (Group 1). Twenty-seven patients in whom tachycardia could still be induced during programmed stimulation despite extensive drug trials were discharged on a regimen that caused a marked reduction of ventricular premature complexes according to Holter monitoring (Group 2). In 23 patients no effective drug regimen was identified by either set of efficacy criteria, and these patients were excluded from the present analysis. Follow-up lasted 18.6 +/- 13.9 months. Rates of arrhythmia-free survival at 12 and 24 months were 88 percent and 72 percent, respectively, in Group 1 and 84 percent and 75 percent in Group 2 (P = 0.637). We conclude that demonstration of antiarrhythmic efficacy by programmed stimulation predicts a good clinical outcome, that inefficacy as shown by the programmed-stimulation protocol used in this study may not preclude a good outcome if there is a marked reduction of spontaneous ventricular premature complexes on Holter monitoring, and that randomized trials should be conducted to validate the results of this observational study.
我们研究了程序刺激在评估抗心律失常药物对52例持续性室性心动过速患者疗效中的价值。在这项非随机研究中，所有患者的室性心动过速均可通过程序刺激诱发，且在治疗前动态心电图记录上有频发室性早搏（每小时大于或等于30次）。在系列药物测试期间，通过程序刺激和动态心电图记录评估抗心律失常药物的疗效。根据程序刺激标准，25例患者（第1组）的治疗方案被认为有效。尽管进行了广泛的药物试验，但在程序刺激期间仍可诱发心动过速的27例患者，根据动态心电图监测，采用能使室性早搏明显减少的治疗方案出院（第2组）。在23例患者中，两组疗效标准均未确定有效的药物治疗方案，这些患者被排除在本分析之外。随访持续18.6±13.9个月。第1组12个月和24个月无心律失常生存率分别为88%和72%，第2组为84%和75%（P = 0.637）。我们得出结论，通过程序刺激证明抗心律失常疗效可预测良好的临床结果；如果动态心电图监测显示自发性室性早搏明显减少，本研究中使用的程序刺激方案显示无效可能并不排除良好的结果；并且应该进行随机试验以验证这项观察性研究的结果。
