Trappe H J, Brugada P, Talajic M, Lezaun R, Wellens H J
Abteilung Kardiologie des Akademischen Krankenhauses Maastricht, Holland.
Z Kardiol. 1988 Nov;77(11):687-95.
To assess the risk of sudden death 79 patients (pts) with sustained monomorphic ventricular tachycardia (SMVT) and 37 patients with ventricular fibrillation (VF) after myocardial infarction (MI) were studied by coronary angiography, ambulatory monitoring, and programmed electrical stimulation. Mean follow-up was 28 +/- 12 months. Total mortality was significantly higher in pts with VF (13/37, 35%) than in pts with SMVT (15/79, 19%) (p less than 0.05), whereas there were no significant differences in the incidence of sudden death between pts with VF (6/37, 16%) and those with SMVT (5/79, 6%) (p = 0.09). Patients with VF had more frequent anterior and multiple MI's (33/37, 89%) than pts with SMVT (42/79, 53%) (p less than 0.05) and more often presented their arrhythmia earlier (within 2 months) after MI (23/37, 62%) than SMVT pts (28/79, 36%) (p less than 0.05). In addition, there were significant differences in mean left-ventricular ejection fraction between pts with VF (30 +/- 8%) and those with SMVT (35 +/- 12%) (p less than 0.05). Our data show that pts with VF after myocardial infarction have more severe left ventricular dysfunction and more extensive coronary disease and a somewhat higher risk of sudden death than pts with SMVT.
为评估猝死风险，我们通过冠状动脉造影、动态监测和程控电刺激对79例心肌梗死（MI）后发生持续性单形性室性心动过速（SMVT）的患者以及37例心肌梗死（MI）后发生心室颤动（VF）的患者进行了研究。平均随访时间为28±12个月。心室颤动（VF）患者的总死亡率（13/37，35%）显著高于持续性单形性室性心动过速（SMVT）患者（15/79，19%）（p<0.05），而心室颤动（VF）患者的猝死发生率（6/37，16%）与持续性单形性室性心动过速（SMVT）患者（5/79，6%）之间无显著差异（p = 0.09）。心室颤动（VF）患者比持续性单形性室性心动过速（SMVT）患者更常发生前壁心肌梗死和多发性心肌梗死（33/37，89%比42/79，53%）（p<0.05），并且心律失常在心肌梗死（MI）后出现得更早（2个月内）的情况也更多见（23/37，62%比28/79，36%）（p<0.05）。此外，心室颤动（VF）患者与持续性单形性室性心动过速（SMVT）患者的平均左心室射血分数存在显著差异（分别为30±8%和35±12%）（p<0.05）。我们的数据表明，心肌梗死（MI）后发生心室颤动（VF）的患者比持续性单形性室性心动过速（SMVT）患者有更严重的左心室功能障碍和更广泛的冠状动脉疾病，猝死风险也略高。
