Miller J M, Vassallo J A, Kussmaul W G, Cassidy D M, Hargrove W C, Josephson M E
Clinical Electrophysiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104.
J Am Coll Cardiol. 1988 Aug;12(2):375-82. doi: 10.1016/0735-1097(88)90409-3.
Fifty patients with anteroapical left ventricular aneurysm secondary to prior myocardial infarction underwent aneurysmectomy, at which time endocardial sinus rhythm mapping was performed. Forty patients had a history of recurrent sustained monomorphic ventricular tachycardia, and 10 had an aneurysm but no history of spontaneous sustained tachycardia. A comparison of the clinical, angiographic and sinus rhythm endocardial electrographic characteristics of these two groups revealed that the patients without spontaneous ventricular tachycardia had more severe coronary artery disease (2.6 +/- 0.5 versus 1.9 +/- 0.8 coronary arteries having greater than 70% stenosis; p less than 0.03), underwent surgery earlier after infarction (3 +/- 2 versus 46 +/- 53 months; p less than 0.03) and had less extensive wall motion abnormalities on contrast ventriculography (0 of 8 versus 13 of 35 patients assessed had an abnormally contracting ventriculographic segment length greater than 60%; p less than 0.04). During intraoperative programmed electrical stimulation, all 40 patients with and 4 of 10 without a history of spontaneous ventricular tachycardia had inducible tachycardia. The patients with inducible tachycardia had a larger area of endocardium from which abnormal electrograms (duration greater than 70 ms or amplitude less than 0.7 mV) were recorded (62 +/- 17 versus 45 +/- 20% of electrograms; p less than 0.03) as well as fractionated (duration greater than 90 ms, amplitude less than 0.3 mV) electrograms (20 +/- 14 versus 9 +/- 7% of electrograms; p less than 0.04) than did patients without inducible tachycardia, but there were no angiographic differences between groups.(ABSTRACT TRUNCATED AT 250 WORDS)
50例继发于既往心肌梗死的左心室前尖部动脉瘤患者接受了动脉瘤切除术，术中进行了心内膜窦性心律标测。40例患者有反复持续性单形性室性心动过速病史，10例有动脉瘤但无自发持续性心动过速病史。对这两组患者的临床、血管造影和窦性心律心内膜电图特征进行比较，发现无自发室性心动过速的患者冠状动脉疾病更严重（狭窄大于70%的冠状动脉数量为2.6±0.5支对1.9±0.8支；p<0.03），心肌梗死后更早接受手术（3±2个月对46±53个月；p<0.03），对比心室造影显示的室壁运动异常范围更小（评估的8例患者中有0例对35例患者中有13例收缩期心室造影节段长度异常大于60%；p<0.04）。术中程序电刺激时，40例有自发室性心动过速病史的患者和10例无自发室性心动过速病史患者中的4例均可诱发心动过速。可诱发心动过速的患者记录到异常电图（时限大于70ms或振幅小于0.7mV）的心内膜面积更大（电图的62±17%对45±20%；p<0.03），以及碎裂电图（时限大于90ms，振幅小于0.3mV）（电图的20±14%对9±7%；p<0.04），但两组间血管造影无差异。（摘要截短至250字）
