Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., E.C., D.V., A. Hochstadt, A. Halkin, O.T-B., O.H., B.B., R.R.).
St Luke's Hospital Mid America Heart Institute, Kansas City, MO (J.K.L.).
Circulation. 2019 May 14;139(20):2304-2314. doi: 10.1161/CIRCULATIONAHA.118.038036.
Polymorphic ventricular tachycardia (VT) without QT prolongation is well described in patients without structural heart disease (mainly idiopathic ventricular fibrillation and Brugada syndrome) and in patients with acute ST-elevation myocardial infarction.
Retrospective study of patients with polymorphic VT related to coronary artery disease, but without evidence of acute myocardial ischemia.
The authors identified 43 patients in whom polymorphic VT developed within days of an otherwise uncomplicated myocardial infarction or coronary revascularization procedure. The polymorphic VT events were invariably triggered by extrasystoles with short (364±36 ms) coupling interval. Arrhythmic storms (4-16 events of polymorphic VT deteriorating to ventricular fibrillation) occurred in 23 (53%) patients. These arrhythmic storms were always refractory to conventional antiarrhythmic therapy, including intravenous amiodarone, but invariably responded to quinidine therapy. In-hospital mortality was 17% for patients with arrhythmic storm. Patients treated with quinidine invariably survived to hospital discharge. During long-term follow-up (of 5.6±6 years; range, 1 month to 18 years), 3 (16%) of patients discharged without quinidine developed recurrent polymorphic VT. There were no recurrent arrhythmias during quinidine therapy Conclusions: Arrhythmic storm with recurrent polymorphic VT in patients with coronary disease responds to quinidine therapy when other antiarrhythmic drugs (including intravenous amiodarone) fail.
无 QT 延长的多形性室性心动过速（VT）在无结构性心脏病患者（主要为特发性室颤和 Brugada 综合征）和急性 ST 段抬高型心肌梗死患者中已有详细描述。
回顾性研究与冠状动脉疾病相关、但无急性心肌缺血证据的多形性 VT 患者。
作者在 43 例患者中发现，多形性 VT 在急性心肌梗死或冠状动脉血运重建后数天内发生。多形性 VT 事件始终由短（364±36ms）偶联间期的早搏触发。心律失常风暴（4-16 次多形性 VT 恶化至室颤）发生在 23 例（53%）患者中。这些心律失常风暴始终对包括静脉胺碘酮在内的传统抗心律失常治疗无效，但对奎尼丁治疗均有反应。有心律失常风暴的患者住院死亡率为 17%。接受奎尼丁治疗的患者均存活至出院。在 5.6±6 年的长期随访（1 个月至 18 年）中，3 例（16%）未服用奎尼丁的出院患者出现复发性多形性 VT。在奎尼丁治疗期间无复发性心律失常。
当其他抗心律失常药物（包括静脉胺碘酮）无效时，冠状动脉疾病患者的心律失常风暴伴复发性多形性 VT 可对奎尼丁治疗有反应。
