Frank R, Tonet J L, Rougier I, Fontaine G
Centre de Stimulation cardiaque et de Rythmologie, Hôpital Jean-Rostand, Ivry-sur-Seine.
Ann Cardiol Angeiol (Paris). 1989 Sep 15;38(7):389-93.
53 patients, between the ages of 14 and 76 years, presented a ventricular tachycardia which was treated by the fulguration method. 19 resulted from a complication of an old myocardial infarction, 15 from a right arrhythmogenic ventricular dysplasia, 8 from a dilated myocardiopathy. 10 patients presented idiopathic tachycardias: 3 originated in the infundibulum of the right ventricule and 7 from the left ventricle. One case originated from a surgical scar of the infundibulum. These tachycardias were continuous or occurred daily in half of the cases, or presented monthly recurrences. 1 to 17 shocks were delivered at each session, 143 on the right, 112 on the left and 2 transseptal. Four patients died from haemodynamic deterioration prior to the shock. The other 49 patients are considered as clinical successes. Three died within the first three months of low cardiac output without any recurrence of the tachycardia. 26 did not longer present any recurrent tachycardia and were not given any preventive anti-arrhythmic treatment. 19 developed recurrence or could be triggered off again, but the anti-arrhythmic medications which were ineffective, become effective. One female patient again developed slavos of ventricular tachycardia after a few months. Seven patients died 4 to 18 months after fulguration, and three presented a sudden death. They belong to the group with medically treated recurrences. This technique is a major factor in the therapeutic strategy of ventricular tachycardias, either used alone or associated with a pharmacological treatment.
53例年龄在14至76岁之间的患者出现室性心动过速,采用电灼法进行治疗。其中19例由陈旧性心肌梗死并发症引起,15例由右室致心律失常性心肌病引起,8例由扩张型心肌病引起。10例患者出现特发性心动过速:3例起源于右心室漏斗部,7例起源于左心室。1例起源于漏斗部手术瘢痕。这些心动过速在半数病例中持续存在或每日发作,或每月复发。每次治疗给予1至17次电击,其中143次在右侧,112次在左侧,2次经间隔。4例患者在电击前因血流动力学恶化死亡。其他49例患者视为临床成功。3例在最初三个月内死于低心排血量,未出现心动过速复发。26例不再出现任何复发性心动过速,未接受任何预防性抗心律失常治疗。19例出现复发或可再次诱发,但原本无效的抗心律失常药物变得有效。1例女性患者在几个月后再次出现室性心动过速发作。7例患者在电灼后4至18个月死亡,3例出现猝死。他们属于药物治疗后复发的组。该技术是室性心动过速治疗策略中的一个主要因素,可单独使用或与药物治疗联合使用。