Kou W H, de Buitleir M, Kadish A H, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Am J Cardiol. 1989 Nov 15;64(18):1148-51. doi: 10.1016/0002-9149(89)90868-0.
The results of 206 programmed ventricular stimulation studies performed in 130 patients (100 men and 30 women, mean age 62 +/- 12 years, +/- standard deviation) were examined prospectively to determine the sequelae of nonsustained polymorphic ventricular tachycardia (VT) induced during programmed ventricular stimulation. The clinical indication for the electrophysiologic study was either documented monomorphic VT or unexplained syncope. The pacing protocol included 2 right ventricular pacing sites, 2 basic drive cycle lengths and up to 3 extrastimuli. In 111 studies, nonsustained polymorphic VT was induced and with continuation of the programmed stimulation protocol, sustained monomorphic VT was induced in 48 studies (43%) and polymorphic VT was induced in 13 studies (12%). Overall, sustained monomorphic VT was induced in 110 studies and sustained polymorphic VT in 18 studies. The incidence of nonsustained polymorphic VT preceding the induction of sustained polymorphic VT was significantly greater than the incidence of nonsustained polymorphic VT preceding the induction of sustained monomorphic VT (72 vs 44%, p less than 0.05). Nonsustained polymorphic VT is not a useful predictor of the outcome of programmed ventricular stimulation. The use of nonsustained polymorphic VT as an endpoint for stimulation would be likely to improve the specificity of programmed ventricular stimulation by limiting the induction of sustained nonclinical arrhythmias that require countershock, but at the cost of significantly impairing the yield of monomorphic VT.
前瞻性地检查了130例患者（100例男性和30例女性，平均年龄62±12岁，±标准差）进行的206项程控心室刺激研究结果，以确定程控心室刺激期间诱发的非持续性多形性室性心动过速（VT）的后遗症。电生理研究的临床指征为记录到的单形性VT或不明原因的晕厥。起搏方案包括2个右心室起搏部位、2个基础驱动周期长度和最多3个期外刺激。在111项研究中诱发了非持续性多形性VT，随着程控刺激方案的继续，48项研究（43%）诱发了持续性单形性VT，13项研究（12%）诱发了多形性VT。总体而言，110项研究诱发了持续性单形性VT，18项研究诱发了持续性多形性VT。诱发持续性多形性VT之前的非持续性多形性VT发生率显著高于诱发持续性单形性VT之前的非持续性多形性VT发生率（72%对44%，p<0.05）。非持续性多形性VT不是程控心室刺激结果的有用预测指标。将非持续性多形性VT用作刺激终点可能会通过限制需要电击的持续性非临床心律失常的诱发来提高程控心室刺激的特异性，但代价是显著降低单形性VT的诱发率。
