Lekieffre J
Service de Cardiologie A, Hôpital cardiologique, Lille.
Presse Med. 1987 Sep 12;16(29):1424-9.
Every minute one patient in the world suddenly dies, of heart disease in the vast majority of the cases. Most of these sudden deaths of cardiac origin are due to ventricular tachycardia and/or fibrillation on a background of ischaemic heart disease. It is now recognized that as much as left ventricular dysfunction these ventricular arrhythmias are of sombre prognosis. To prevent sudden death of cardiac origin, therefore, patients with severe ventricular arrhythmia and consequently at high risk must be identified. Among examinations used for this purpose, the Holter monitoring method is of considerable value as it provides qualitative and, mostly, quantitative information on the arrhythmia. Programmed stimulation--a much more invasive method--has a prognostic value which varies from one author to another. On the other hand, late potentials recording is a simple and innocuous procedure, apparently most reliable as indicator of complex ventricular arrhythmias and sudden death. In spite of all these recent technical advances, the prevention of cardiac sudden death remains problematic since no epidemiological study has yet demonstrated that major reduction or even suppression of ventricular arrhythmias by antiarrhythmic drugs can significantly reduce the coronary mortality rate.
世界上每分钟都有一名患者突然死亡，绝大多数情况下是死于心脏病。这些源于心脏的猝死大多是由于缺血性心脏病背景下的室性心动过速和/或心室颤动。现在人们认识到，与左心室功能障碍一样，这些室性心律失常的预后也很严峻。因此，为了预防源于心脏的猝死，必须识别出患有严重室性心律失常且因此处于高风险的患者。在用于此目的的检查中，动态心电图监测方法具有相当大的价值，因为它能提供有关心律失常的定性信息，而且大多是定量信息。程序刺激——一种侵入性大得多的方法——其预后价值因作者而异。另一方面，晚电位记录是一种简单且无害的程序，显然是预测复杂室性心律失常和猝死最可靠的指标。尽管有这些最新的技术进展，但心脏性猝死的预防仍然存在问题，因为尚无流行病学研究表明抗心律失常药物大幅减少甚至抑制室性心律失常能显著降低冠心病死亡率。
