Ezri M D, Jacobs L G, Denes P
Pacing Clin Electrophysiol. 1985 May;8(3 Pt 1):329-40. doi: 10.1111/j.1540-8159.1985.tb05767.x.
The incidence of multiple, inducible sustained arrhythmias during electrophysiologic studies is unknown. We have identified five patients who had several sustained tachycardias, some of which were not previously recognized clinically. Three patients had documented sustained supraventricular tachycardia (one of these also had nonsustained ventricular tachycardia) and two had documented sustained ventricular tachycardia. The clinically documented tachycardia was successfully reproduced in all cases; however, the three cases of supraventricular tachycardia also had sustained ventricular tachycardia initiated, and the two cases of ventricular tachycardia also had sustained supraventricular tachycardia, which had not previously been seen. The underlying common denominators for all five patients were poor left ventricular function due to ischemic heart disease and a history of syncope. In one case of clinical supraventricular tachycardia, the second sustained tachycardia appeared following drug therapy (procainamide), which seemed to convert nonsustained to sustained ventricular tachycardia. In another patient with clinical ventricular tachycardia, the supraventricular tachycardia was also initiated following drug therapy (indecainide). We conclude that: (1) patients with syncope may have multiple arrhythmic etiologies and (2) complete electrophysiologic evaluation, during control studies as well as serial drug studies, are important in the management of these patients.
在电生理研究期间，多种可诱导的持续性心律失常的发生率尚不清楚。我们已识别出五名患有多种持续性心动过速的患者，其中一些在临床上此前未被识别。三名患者记录有持续性室上性心动过速（其中一名还患有非持续性室性心动过速），两名患者记录有持续性室性心动过速。所有病例中临床上记录的心动过速均成功再现；然而，三例室上性心动过速患者还诱发了持续性室性心动过速，两例室性心动过速患者也出现了此前未见的持续性室上性心动过速。所有五名患者的潜在共同因素是缺血性心脏病导致的左心室功能不佳以及晕厥病史。在一例临床室上性心动过速患者中，第二种持续性心动过速出现在药物治疗（普鲁卡因胺）之后，这似乎将非持续性室性心动过速转变为了持续性室性心动过速。在另一例临床室性心动过速患者中，室上性心动过速也是在药物治疗（茚满丙二胺）之后诱发的。我们得出结论：（1）晕厥患者可能有多种心律失常病因；（2）在对照研究以及系列药物研究期间进行完整的电生理评估对这些患者的管理很重要。
