Leclercq J F, Coumel P, Maison-Blanche P, Cauchemez B, Zimmermann M, Chouty F, Slama R
Arch Mal Coeur Vaiss. 1986 Jun;79(7):1024-33.
A cooperative study involving 23 centres enabled review of 69 cases of sudden death occurring less than one hour after onset of symptoms recorded by the Holter method and not related to recent, clinically documented myocardial infarction or to class IV cardiac failure. The 15 cases of asystole (22 p. cent) were observed in elderly patients (73.3 +/- 2.7 years) whose known ischaemic heart disease (12/15) was confirmed in 10 cases as the direct cause by the preceding acute ST changes. In 2 cases, death resulted from AV block presumed to be iatrogenic. The 13 episodes of torsades de point (19 p. cent) occurred mainly in younger women (58.8 +/- 6 years) without apparent cardiac disease (8 cases) and were provoked by a Group IA antiarrhythmic drug (7 cases) or by hypokalemia (3 cases). Apart from 1 case of congenital long QT syndrome, slowing of the sinus rhythm was observed (78.3 +/- 2.6 to 60.2 +/- 2.7 bpm, p less than 0.001) in the 3 hours preceding these episodes, and ventricular bigeminy with a long coupling interval was recorded in the lasts seconds before the torsades. The 41 (59 p. cent) cases of ventricular fibrillation (VF) were observed in men aged 64.9 +/- 2 years with coronary artery disease (39/41). However signs of acute ischaemia were only found in 5 cases. The VF was primary in 8 cases and secondary to ventricular tachycardia (VT in 33 cases). An acceleration of the cardiac rhythm (83.3 +/- 3.4 to 90 +/- 4.1 bpm, p less than 0.01) was recorded in the hour preceding VF and other arrhythmias were common: atrial tachycardia (4 cases), atrial extrasystoles (4 cases), a new type of ventricular extrasystoles (VES). The VF and VT were preceded by a long cycle in 17 cases. The first complex was different from previous VES in 10 cases and identical to the previous VES in 16 cases; in 4 cases this feature could not be identified and in 11 cases there were no premonitory VES. The coupling interval of the initial VES was shorter than that of the most premature preceding VES (368 +/- 13 ms vs 442 +/- 19 ms, p less than 0.001), especially in primary VF (335 +/- 9 ms, N = 8) compared to polymorphic VT (360 +/- 12 ms, N = 11) or monomorphic VT (384 +/- 18 ms N = 22).(ABSTRACT TRUNCATED AT 250 WORDS)
一项涉及23个中心的合作研究，对69例症状发作后不到1小时即发生猝死的病例进行了回顾，这些病例通过动态心电图记录，且与近期临床记录的心肌梗死或IV级心力衰竭无关。15例心脏停搏（22%）见于老年患者（73.3±2.7岁），其已知的缺血性心脏病（12/15）在10例中被证实为前壁急性ST段改变的直接死因。2例死亡是由推测为医源性的房室传导阻滞导致。13次尖端扭转型室速发作（19%）主要发生在年轻女性（58.8±6岁），她们无明显心脏病（8例），由IA类抗心律失常药物诱发（7例）或低钾血症诱发（3例）。除1例先天性长QT综合征外，在这些发作前3小时观察到窦性心律减慢（从78.3±2.6次/分降至60.2±2.7次/分，p<0.001），且在尖端扭转型室速发作前最后几秒记录到长联律间期的室性早搏。41例（59%）心室颤动（VF）见于64.9±2岁的男性，伴有冠状动脉疾病（39/41）。然而，仅在5例中发现急性缺血迹象。8例VF为原发性，33例继发于室性心动过速（VT）。在VF发作前1小时记录到心律加速（从83.3±3.4次/分升至90±4.1次/分，p<0.01），且其他心律失常常见：房性心动过速（4例）、房性早搏（4例）、一种新型室性早搏（VES）。17例VF和VT发作前有长周期。10例中首个复合波与先前VES不同，16例与先前VES相同；4例无法识别此特征，11例无先兆VES。初始VES的联律间期短于先前最早的VES（368±13毫秒对442±19毫秒，p<0.001），尤其是原发性VF（335±9毫秒，N = 8）与多形性VT（360±12毫秒，N = 11）或单形性VT（384±18毫秒，N = 22）相比。（摘要截短至250字）
