Horowitz L N
Philadelphia Heart Institute, Presbyterian University of Pennsylvania Medical Center 19104.
Eur Heart J. 1989 Sep;10 Suppl E:53-60. doi: 10.1093/eurheartj/10.suppl_e.53.
Ventricular arrhythmias can be classified into categories based on the risk of sudden death associated with them. Patients with benign ventricular arrhythmias are those with minimal or no heart disease and normal ventricular function. Arrhythmias encountered in this group include ventricular premature complexes and unsustained ventricular tachycardia. In patients with prognostically significant ventricular arrhythmia, the arrhythmias are the same, namely, ventricular premature complexes and/or unsustained ventricular tachycardia. This group differs, however, in that the patients have organic heart disease and the risk of the arrhythmia increases as left ventricular function decreases. Patients with malignant ventricular arrhythmia, sustained ventricular tachycardia and ventricular fibrillation have the highest risk of sudden death. While no conclusive studies are available, some studies do suggest that the suppression of ambient ventricular arrhythmia as documented by Holter monitoring (and possibly exercise testing) identifies antiarrhythmic regimens which are effective in preventing sudden death. Variability in the frequency of ambient ventricular ectopy must be considered in assessing both efficacy and toxicity of antiarrhythmic regimens. Holter monitoring may also be useful in assessing the substrate of malignant ventricular arrhythmias and autonomic tone.
室性心律失常可根据与其相关的猝死风险进行分类。良性室性心律失常患者是那些患有轻度心脏病或无心脏病且心室功能正常的人。该组中遇到的心律失常包括室性早搏复合体和非持续性室性心动过速。在具有预后意义的室性心律失常患者中，心律失常是相同的，即室性早搏复合体和/或非持续性室性心动过速。然而，该组的不同之处在于患者患有器质性心脏病，并且心律失常的风险随着左心室功能的降低而增加。恶性室性心律失常、持续性室性心动过速和心室颤动患者的猝死风险最高。虽然尚无确凿的研究，但一些研究确实表明，动态心电图监测（可能还有运动试验）记录的室性心律失常抑制情况可确定对预防猝死有效的抗心律失常方案。在评估抗心律失常方案的疗效和毒性时，必须考虑室性早搏频率的变异性。动态心电图监测在评估恶性室性心律失常的基质和自主神经张力方面也可能有用。
