Hays L J, Lerman B B, DiMarco J P
Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
Am Heart J. 1989 Jul;118(1):53-7. doi: 10.1016/0002-8703(89)90071-9.
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the most common arrhythmias documented at the time of resuscitation in survivors of out-of-hospital cardiac arrest unassociated with an acute myocardial infarction. However, 20% and 40% of these patients will not manifest inducible ventricular arrhythmias during subsequent electrophysiologic studies. The optimal management of these patients has been controversial. In a consecutive series of 100 survivors of out-of-hospital cardiac arrest with documented VF, six were identified by either clinical or electrophysiologic data as having a nonventricular arrhythmia as the immediate precursor of VF. Two of these patients had rapid, hypotensive supraventricular arrhythmias induced with programmed cardiac stimulation. In four patients, bradyarrhythmias (sinus arrest two; atrioventricular block two) preceded and caused the episode of VF. Therapy directed at these nonventricular arrhythmias prevented recurrence of cardiac arrest in all patients. In survivors of out-of-hospital cardiac arrest, nonventricular arrhythmias represent a treatable potential etiology that may be overlooked during the patient's evaluation.
室性心动过速（VT）和心室颤动（VF）是院外心脏骤停幸存者复苏时记录到的最常见心律失常，且这些心脏骤停与急性心肌梗死无关。然而，这些患者中有20%至40%在随后的电生理研究中不会表现出可诱发的室性心律失常。这些患者的最佳治疗方法一直存在争议。在连续的100例记录到VF的院外心脏骤停幸存者系列中，根据临床或电生理数据确定有6例患者的非室性心律失常是VF的直接先兆。其中2例患者通过程控心脏刺激诱发了快速、低血压性室上性心律失常。在4例患者中，缓慢性心律失常（窦性停搏2例；房室传导阻滞2例）先于VF发作并导致VF发作。针对这些非室性心律失常的治疗可防止所有患者心脏骤停复发。在院外心脏骤停幸存者中，非室性心律失常是一种可治疗的潜在病因，在患者评估过程中可能被忽视。
