Lacombe P, Metge M, Cointe R, Bru P, Lévy S
Clinique cardiologique, Centre Cardiovasculaire J. Cantini, Marseille.
Arch Mal Coeur Vaiss. 1987 Aug;80(9):1365-8.
The mode of termination by programmed electrical stimulation of sustained ventricular tachycardia (VT) (more than 30 seconds) and induced by stimulation was investigated in 33 patients. In 27 patients (82%) programmed stimulation was possible because VT did not require an immediate electric shock or did not terminate spontaneously, but constant reduction of VT was obtained with one extrasystole in only 1 patient (3%), with two extrasystoles in 5 patients (15%) and by overdrive stimulation in 12 patients (36%). The remaining 15 patients (45%) required an external electric shock either because VT was poorly tolerated clinically, or because stimulation had failed. In 8 of the 27 cases in whom stimulation was attempted (30%), acceleration of VT was observed. A significant correlation was found between the need for electrical shock and the VT cycle length. It is concluded that reduction of VT by programmed electrical stimulation can only be successful in a limited number of patients and carries a significant risk of acceleration. These data must be taken into account when temporary treatment of VT by stimulation is contemplated. They should incite to considerable caution in the use of implantable pacemakers for tachycardia termination.
对33例患者进行了研究，探讨通过程控电刺激终止持续时间超过30秒的持续性室性心动过速（VT）以及刺激诱发VT的方式。在27例患者（82%）中，由于VT不需要立即电击或未自发终止，因此可以进行程控刺激，但仅1例患者（3%）通过一次期前收缩、5例患者（15%）通过两次期前收缩以及12例患者（36%）通过超速驱动刺激使VT持续减慢。其余15例患者（45%）因临床对VT耐受性差或刺激失败而需要进行体外电击。在尝试刺激的27例患者中的8例（30%）观察到VT加速。发现电击需求与VT周期长度之间存在显著相关性。结论是，通过程控电刺激减少VT仅在少数患者中能够成功，并且存在显著的加速风险。在考虑通过刺激对VT进行临时治疗时，必须考虑这些数据。它们应促使在使用植入式起搏器终止心动过速时相当谨慎。
