Gorgels A P, Vos M A, Letsch I S, Verschuuren E A, Bär F W, Janssen J H, Wellens H J
Department of Cardiology, Academic Hospital, Maastricht, The Netherlands.
Am J Cardiol. 1988 Feb 1;61(4):231-5. doi: 10.1016/0002-9149(88)90921-6.
The value of the accelerated idioventricular rhythm (AIVR) as a marker for myocardial necrosis and/or reperfusion was prospectively studied in 87 patients admitted with persistent ischemic chest pain. All patients received streptokinase. Necrosis was diagnosed by new Q waves and an increase in plasma enzymes. Reperfusion was documented angiographically. Myocardial necrosis occurred in 72 patients and reperfusion in 70 patients, 58 of whom had myocardial necrosis. Of 27 patients with AIVR, 26 had both necrosis and reperfusion (p less than 0.001). AIVR started after a long coupling interval to the preceding sinus rhythm and was regular. Configuration depended on the reperfused infarct vessel. Reperfusion of the left anterior descending branch showed most configurations of AIVR and with the least QRS width. Reperfusion of the circumflex branch never had a left bundle branch block-like configuration. AIVR from reperfusion of the right coronary artery never had an inferior axis. AIVR occurring during persistent ischemic chest pain is a marker for both myocardial necrosis and reperfusion of the infarct vessel. AIVR starts with a long coupling interval and is regular. The QRS configuration may be useful for the noninvasive identification of the infarct vessel.
对87例持续性缺血性胸痛入院患者前瞻性研究了加速性室性自主心律（AIVR）作为心肌坏死和/或再灌注标志物的价值。所有患者均接受链激酶治疗。通过新出现的Q波和血浆酶升高诊断坏死。通过血管造影记录再灌注情况。72例患者发生心肌坏死，70例患者发生再灌注，其中58例同时有心肌坏死。27例有AIVR的患者中，26例既有坏死又有再灌注（p<0.001）。AIVR在前一个窦性心律的长联律间期后开始，且规则。形态取决于再灌注的梗死血管。左前降支再灌注显示AIVR的形态最多，且QRS波宽度最窄。回旋支再灌注从未有左束支阻滞样形态。右冠状动脉再灌注引起的AIVR从未有下轴。持续性缺血性胸痛期间出现的AIVR是心肌坏死和梗死血管再灌注的标志物。AIVR以长联律间期开始且规则。QRS波形态可能有助于无创识别梗死血管。
