Treese N, Pop T, Erbel R, Meinertz T, Helmling P, von Olshausen K, Meyer J
Int J Cardiol. 1987 Apr;15(1):19-31. doi: 10.1016/0167-5273(87)90289-0.
The purpose of this study was to assess the arrhythmia profile in survivors of acute myocardial infarction in whom recanalization of the infarct-related vessel was attempted. 127 patients with acute myocardial infarction were randomized to intravenous and intracoronary thrombolysis with or without transluminal coronary angioplasty. 84 of them, aged 54 +/- 9 years, had angiographic control, 24-hour Holter electrocardiographic monitoring and programmed electrical stimulation 4 weeks after infarction. The study protocol of programmed electrical stimulation included single and double extrastimuli at 2 driving cycle lengths. The end point was the induction of ventricular tachycardia with 10 and more beats. During infarction 28 patients had occlusion of the left anterior descending, 12 of the circumflex and 44 of the right coronary artery. Holter monitoring revealed both frequent (greater than 100 ventricular premature complexes per 24 hours) and repetitive (Lown IVA, IVB) ventricular arrhythmias in 23 patients (27%). Inducible ventricular tachycardia (greater than 6 beats) was found in 25 patients (30%), which was sustained in 4 patients. According to the angiographic results two groups of patients could be identified: group A consisted of 64 patients who showed primary recanalization of the infarct-related vessel with persistent patency at control. Group B consisted of 20 patients who showed late reopening (n = 5) or a closed infarct-related vessel (n = 15) due to late reocclusion in 9 of them. Frequent ventricular premature contractions occurred in 18 group A and in 5 group B patients (n.s.). Repetitive ventricular premature contractions were found in 21 group A and in 2 group B patients (P less than 0.05). Inducible ventricular tachycardia was observed in 17 patients of group A (27%) and in 8 patients of group B (40%) (n.s.). The incidence of spontaneous and stimulus-induced ventricular arrhythmias was not influenced by the type of recanalization procedure. Furthermore no relation to the time interval between onset of preinfarct angina and angiographically demonstrated reperfusion of the infarct-related vessel was found. The patients in the two groups did not differ with respect to left ventricular ejection fraction, number of abnormal contracting wall segments or site of infarction. It is concluded that reperfusion infarction does not differ from infarction due to permanent occlusion with respect to inducible ventricular tachycardia but may favor repetitive ectopic activity.
本研究的目的是评估尝试对梗死相关血管进行再通的急性心肌梗死幸存者的心律失常情况。127例急性心肌梗死患者被随机分为接受静脉和冠状动脉内溶栓治疗，同时接受或不接受经皮冠状动脉腔内血管成形术。其中84例年龄为54±9岁的患者在梗死后4周接受了血管造影检查、24小时动态心电图监测以及程控电刺激。程控电刺激的研究方案包括在2个驱动周期长度下进行单和双期外刺激。终点是诱发10次及以上搏动的室性心动过速。梗死期间，28例患者左前降支闭塞，12例回旋支闭塞，44例右冠状动脉闭塞。动态心电图监测显示，23例患者（27%）存在频发（每24小时室性早搏超过100次）和反复性（洛恩IVA、IVB级）室性心律失常。25例患者（30%）诱发出室性心动过速（超过6次搏动），其中4例为持续性室性心动过速。根据血管造影结果，可将患者分为两组：A组由64例患者组成，这些患者梗死相关血管实现了原发性再通，且在对照时保持通畅。B组由20例患者组成，其中5例出现延迟再通，15例梗死相关血管闭塞，9例因延迟再闭塞导致血管闭塞。A组18例患者和B组5例患者出现频发室性早搏（无统计学差异）。A组21例患者和B组2例患者出现反复性室性早搏（P<0.05）。A组17例患者（27%）和B组8例患者（40%）诱发出室性心动过速（无统计学差异）。自发和刺激诱发的室性心律失常的发生率不受再通程序类型的影响。此外，未发现与梗死前心绞痛发作至血管造影显示梗死相关血管再灌注的时间间隔存在关联。两组患者在左心室射血分数、异常收缩壁段数量或梗死部位方面无差异。结论是，再灌注性梗死在可诱发性室性心动过速方面与永久性闭塞性梗死无差异，但可能有利于反复性异位活动。
