State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiovascular Center, PLA Navy General Hospital, Beijing, China.
J Geriatr Cardiol. 2016 Jan;13(1):70-4. doi: 10.11909/j.issn.1671-5411.2016.01.006.
One of the major challenges in arrhythmogenic right ventricular cardiomyopathy (ARVC) ablation is ventricular tachycardia (VT) non-inducibility. The study aimed to assess whether fast rate (≥ 250 beats/min) right ventricular burst stimulation was useful for VT induction in patients with ARVC.
Ninety-one consecutive ARVC patients with clinical sustained VT that underwent electrophysiological study were enrolled. The stimulation protocol was implemented at both right ventricular apex and outflow tract as follows: Step A, up to double extra-stimuli; Step B, incremental stimulation with low rate (< 250 beats/min); Step C, burst stimulation with fast rate (≥ 250 beats/min); Step D, repeated all steps above with intravenous infusion of isoproterenol.
A total of 76 patients had inducible VT (83.5%), among which 49 were induced by Step C, 15 were induced by Step B, 8 and 4 by Step A and D, respectively. Clinical VTs were induced in 60 patients (65.9%). Only two spontaneously ceased ventricular fibrillations were induced by Step C. Multivariate analysis showed that a narrower baseline QRS duration under sinus rhythm was independently associated with VT non-inducibility (OR: 1.1; 95% CI: 1.0-1.1; P = 0.019).
Fast rate (≥ 250 beats/min) right ventricular burst stimulation provides a useful supplemental method for VT induction in ARVC patients.
心律失常性右室心肌病（ARVC）消融术的主要挑战之一是室性心动过速（VT）不能诱发。本研究旨在评估快速（≥250 次/分）右室猝发刺激对 ARVC 患者 VT 诱发的作用。
连续纳入 91 例因临床持续性 VT 而行电生理研究的 ARVC 患者。刺激方案在右室心尖部和流出道实施，包括以下步骤：A 步，最多双额外刺激；B 步，低频率（＜250 次/分）递增刺激；C 步，快频率（≥250 次/分）猝发刺激；D 步，重复以上所有步骤，并静脉注射异丙肾上腺素。
共 76 例患者可诱发 VT（83.5%），其中 49 例由 C 步诱发，15 例由 B 步诱发，8 例和 4 例分别由 A 步和 D 步诱发。60 例患者（65.9%）诱发临床 VT。仅 C 步诱发了 2 例自发终止的心室颤动。多变量分析显示窦性心律下较窄的 QRS 时限与 VT 不能诱发独立相关（OR：1.1；95%CI：1.0-1.1；P = 0.019）。
快速（≥250 次/分）右室猝发刺激为 ARVC 患者 VT 诱发提供了一种有用的补充方法。
