McComb J M, Gold H K, Leinbach R C, Newell J B, Ruskin J N, Garan H
Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Am J Cardiol. 1988 Aug 1;62(4):186-91. doi: 10.1016/0002-9149(88)90209-3.
Ninety-two patients underwent programmed ventricular stimulation 12 +/- 3 days after acute myocardial infarction (AMI) treated with thrombolytic agents (streptokinase, recombinant tissue plasminogen activator, or both). Cardiac catheterization was performed in all patients on admission to hospital and was repeated in 97% of them 13 +/- 5 days later. Sustained ventricular arrhythmias--either tachycardia (VT) or fibrillation--were induced in 20 (22%) patients, with nonsustained VT induced in another 12 (13%). Multivariate analysis was used to identify predictors of induction of sustained VT, with short right ventricular effective refractory period (p = 0.0061), site of AMI (inferior or posterior, p = 0.008), infarct-related artery (right or circumflex coronary artery, p = 0.018), multivessel coronary artery disease (p = 0.043) and male sex (p = 0.028) being significant predictors of sustained VT. Neither successful reperfusion, time to reperfusion, nor residual stenosis in the infarct-related artery was significant. All patients in whom VT was induced were treated with electrophysiologically guided antiarrhythmic therapy. Cardiac mortality after hospital discharge was 1% over 30 +/- 16 months.
92例患者在接受溶栓药物（链激酶、重组组织型纤溶酶原激活剂或两者皆用）治疗急性心肌梗死（AMI）后12±3天接受了程控心室刺激。所有患者入院时均进行了心导管检查，97%的患者在13±5天后再次进行了检查。20例（22%）患者诱发出持续性室性心律失常——心动过速（VT）或颤动，另有12例（13%）诱发出非持续性VT。采用多因素分析确定持续性VT诱发的预测因素，右心室有效不应期短（p = 0.0061）、AMI部位（下壁或后壁，p = 0.008）、梗死相关动脉（右冠状动脉或回旋支冠状动脉，p = 0.018）、多支冠状动脉疾病（p = 0.043）和男性（p = 0.028）是持续性VT的显著预测因素。成功再灌注、再灌注时间或梗死相关动脉的残余狭窄均无显著意义。所有诱发出VT的患者均接受了电生理指导下的抗心律失常治疗。出院后30±16个月的心脏死亡率为1%。
