Gonska B D, Bethge K P, Kreuzer H
Clin Cardiol. 1987 May;10(5):294-304. doi: 10.1002/clc.4960100502.
In order to evaluate the clinical and prognostic significance of programmed ventricular stimulation (PVS), 100 patients were investigated. Twenty-four of 51 patients with coronary artery disease and 22 out of 49 with dilated cardiomyopathy had clinical ventricular tachycardia (VT). The study protocol included 24-h Holter ECG, cardiac catheterization and angiography, and PVS employing 1 and 2 premature extrastimuli and incremental pacing. In patients with coronary artery disease, VT was induced in 67% with prior VT and in 18% without such episodes (p less than 0.01). In dilated cardiomyopathy, however, patients with and without clinical VT did not differ with regard to VT inducibility (18% vs. 15%, NS). The inducibility of monomorphic sustained VT--most frequently induced in VT patients--was significantly higher in patients with coronary artery disease (p less than 0.05). Polymorphic nonsustained VT (in both coronary artery disease and dilated cardiomyopathy) was only initiated in patients without clinical VT. In patients with coronary artery disease, left ventricular ejection fraction could be correlated to clinical arrhythmia (p less than 0.001), while induced VT could only be correlated to depressed left ventricular function in patients with left ventricular aneurysm. Neither clinical nor induced VT could be correlated to left ventricular ejection fraction in patients with dilated cardiomyopathy. During a mean follow-up of 21 months, 7 patients died from sudden cardiac death. Six of them had clinical VT, but in only 1 patient with coronary artery disease was VT initiated. There was no apparent difference in the antiarrhythmic therapy of the patients with sudden death with respect to the surviving population. In conclusion, the response to PVS with the stimulation protocol applied is different in patients with coronary artery disease and dilated cardiomyopathy. The prognostic significance of the results obtained from PVS remains uncertain.
为了评估程控心室刺激（PVS）的临床及预后意义，对100例患者进行了研究。51例冠心病患者中有24例、49例扩张型心肌病患者中有22例有临床室性心动过速（VT）。研究方案包括24小时动态心电图、心脏导管检查及血管造影，以及采用1次和2次早搏刺激及递增起搏的PVS。在冠心病患者中，有既往VT的患者67%可诱发VT，无此类发作的患者中18%可诱发VT（p<0.01）。然而，在扩张型心肌病患者中，有和无临床VT的患者在VT诱发率方面无差异（18%对15%，无显著性差异）。单形性持续性VT（在VT患者中最常诱发）在冠心病患者中的诱发率显著更高（p<0.05）。多形性非持续性VT（在冠心病和扩张型心肌病中均有）仅在无临床VT的患者中诱发。在冠心病患者中，左心室射血分数与临床心律失常相关（p<0.001），而仅在有左心室室壁瘤的患者中，诱发的VT与左心室功能降低相关。在扩张型心肌病患者中，临床及诱发的VT均与左心室射血分数无关。在平均21个月的随访期间，7例患者死于心源性猝死。其中6例有临床VT，但仅1例冠心病患者的VT是诱发的。猝死患者与存活人群在抗心律失常治疗方面无明显差异。总之，冠心病和扩张型心肌病患者对所应用刺激方案的PVS反应不同。PVS所得结果的预后意义仍不确定。
