Cripps T R, Camm A J
National Heart Hospital, London, England.
Clin Cardiol. 1989 Nov;12(11):661-5. doi: 10.1002/clc.4960121109.
The value of techniques used to predict arrhythmic events (sudden cardiac death not preceded by reinfarction and spontaneous sustained ventricular tachycardia) after acute myocardial infarction is reviewed. A full clinical assessment allows the detection of patients with major infarction, present in the majority of those suffering arrhythmic events during follow-up. More sophisticated noninvasive tests, including Holter monitoring, and the high gain, signal averaged ECG, add prognostic accuracy to clinical assessment in patients with major infarction but are by themselves nonspecific. Noninvasive assessment of autonomic function from baroreceptor sensitivity analysis and heart rate variability measurement may also provide useful prognostic information. The results of programmed ventricular stimulation studies in patients with recent acute infarction have been contradictory, though many of the disagreements can be explained by methodological differences. At best this technique is highly invasive, and probably adds little to what can be discovered from a thorough noninvasive assessment. The treatment to be adopted in those judged to be at high risk remains to be established, and this may include nonpharmacological modalities such as the implantable defibrillator and surgical ablation as alternatives to drug therapy.
本文综述了用于预测急性心肌梗死后心律失常事件（无再梗死及自发性持续性室性心动过速的心脏性猝死）的技术价值。全面的临床评估能够发现大面积梗死患者，这类患者在随访期间发生心律失常事件的比例较高。更为复杂的无创检查，包括动态心电图监测和高增益信号平均心电图，可提高大面积梗死患者临床评估的预后准确性，但这些检查本身缺乏特异性。通过压力感受器敏感性分析和心率变异性测量对自主神经功能进行无创评估，也可能提供有用的预后信息。近期急性梗死患者的程控心室刺激研究结果存在矛盾，不过许多分歧可以用方法学差异来解释。这项技术至多具有高度侵入性，且对通过全面无创评估所能发现的内容可能增益不大。对于被判定为高危的患者应采用何种治疗方法仍有待确定，这可能包括植入式除颤器和手术消融等非药物治疗方式，作为药物治疗的替代方案。
