Jazayeri M R, Van Wyhe G, Avitall B, McKinnie J, Tchou P, Akhtar M
Natalie and Norman Soref and Family Electrophysiology Laboratory, University of Wisconsin-Milwaukee Clinical Campus, Mount Sinai Medical Center.
J Am Coll Cardiol. 1989 Sep;14(3):705-11; discussion 712-4. doi: 10.1016/0735-1097(89)90114-9.
Seventeen patients (16 men and 1 woman) were challenged with isoproterenol after their initially inducible sustained ventricular tachyarrhythmia (monomorphic tachycardia in 14 patients and fibrillation in 3) was completely suppressed by class I antiarrhythmic drugs. Coronary artery disease was documented in 11 patients, dilated cardiomyopathy in 2 and no structural heart disease in the remaining 4 patients. The initial presentation was aborted sudden cardiac death (five patients), syncope (eight patients) and symptomatic nonsustained ventricular tachycardia (four patients). The antiarrhythmic drug that rendered the initial ventricular tachyarrhythmias noninducible was class IA in 11 cases, class IC in 5 and combined class IA and IB in 1. The original ventricular tachyarrhythmia became reinducible in 10 patients (group A) and remained noninducible in 7 patients (group B) after isoproterenol infusion at a rate necessary to achieve a 20% increase in heart rate. Despite the results of isoproterenol challenge, all patients were maintained on their electrophysiologically guided antiarrhythmic regimen. During a mean follow-up period of 13 +/- 9 months, 3 of the 10 patients in group A experienced clinical recurrence of tachyarrhythmia; no recurrence was noted in group B. In conclusion, reinducibility of ventricular tachyarrhythmia after beta-adrenergic stimulation seems to identify a subgroup of patients at high risk of subsequent arrhythmic events. Beta-adrenergic blockade or surgical therapy may be indicated in some patients with a positive isoproterenol challenge.
17例患者（16例男性，1例女性）在最初可诱发的持续性室性心律失常（14例为单形性心动过速，3例为颤动）被I类抗心律失常药物完全抑制后，接受了异丙肾上腺素激发试验。11例患者有冠状动脉疾病记录，2例为扩张型心肌病，其余4例无结构性心脏病。初始表现为心脏性猝死（5例）、晕厥（8例）和有症状的非持续性室性心动过速（4例）。使初始室性心律失常不可诱发的抗心律失常药物，11例为IA类，5例为IC类，1例为IA类和IB类联合使用。在以能使心率增加20%的速率输注异丙肾上腺素后，10例患者（A组）的原有室性心律失常再次变得可诱发，7例患者（B组）仍不可诱发。尽管有异丙肾上腺素激发试验的结果，但所有患者仍维持在电生理指导下的抗心律失常治疗方案。在平均13±9个月的随访期内，A组10例患者中有3例出现心律失常的临床复发；B组未观察到复发。总之，β肾上腺素能刺激后室性心律失常的可再诱发性似乎可识别出随后发生心律失常事件风险较高的患者亚组。对于异丙肾上腺素激发试验阳性的一些患者，可能需要使用β肾上腺素能阻滞剂或进行手术治疗。
