Stevenson W G, Wiener I, Weiss J N
Circulation. 1986 Apr;73(4):693-700. doi: 10.1161/01.cir.73.4.693.
To determine if anodal excitation during bipolar stimulation facilitates the initiation of sustained monomorphic ventricular tachycardia, nonsustained polymorphic ventricular tachycardia, or repetitive ventricular responses, both bipolar and cathodal unipolar programmed ventricular stimulation with one to three extrastimuli delivered during ventricular pacing at two rates from the right ventricular apex were performed in 28 patients evaluated for spontaneous sustained ventricular tachycardia or ventricular fibrillation (11 patients), nonsustained tachycardia (eight patients), or syncope (nine patients). In 25 patients a hexapolar pacing catheter was used to record local endocardial activation times adjacent to the cathode and anode and ventricular excitation during bipolar stimulation was defined as predominantly anodal, cathodal, or simultaneous at both anode and cathode. When bipolar and unipolar stimulation were compared there was no difference in the incidence of initiating sustained monomorphic ventricular tachycardia (57% vs 57%), nonsustained polymorphic ventricular tachycardia (14% vs 14%), or repetitive ventricular responses (21% vs 21%), although the response to bipolar vs unipolar stimulation was not concordant in every patient. Evidence of anodal excitation was observed in 11 (44%) patients but did not indicate increased risk of initiation of any ventricular arrhythmia, despite the fact that it was associated with shortening of the ventricular effective refractory period by 5.2 +/- 8.7 msec (p less than .05) during bipolar as opposed to unipolar stimulation. We conclude that unipolar and bipolar stimulation produce a similar incidence of initiation of arrhythmia, despite the frequent occurrence of anodal excitation during bipolar stimulation. Thus, the risk of initiation of nonspecific ventricular arrhythmias during programmed stimulation is unlikely to be reduced by the use of unipolar stimulation.
为了确定双极刺激期间的阳极激动是否会促进持续性单形性室性心动过速、非持续性多形性室性心动过速或重复性室性反应的起始，我们对28例因自发性持续性室性心动过速或室颤（11例）、非持续性心动过速（8例）或晕厥（9例）而接受评估的患者，在右心室心尖以两种频率进行心室起搏时，分别采用双极和阴极单极程控心室刺激，并给予1至3个额外刺激。在25例患者中，使用六极起搏导管记录阴极和阳极附近的局部心内膜激动时间，双极刺激期间的心室激动被定义为主要为阳极、阴极或阳极和阴极同时激动。当比较双极刺激和单极刺激时，持续性单形性室性心动过速（57%对57%）、非持续性多形性室性心动过速（14%对14%）或重复性室性反应（21%对21%）的起始发生率没有差异，尽管并非每个患者对双极刺激和单极刺激的反应都一致。在11例（44%）患者中观察到阳极激动的证据，但这并未表明任何室性心律失常起始风险增加，尽管与单极刺激相比，双极刺激期间它与心室有效不应期缩短5.2±8.7毫秒有关（P<0.05）。我们得出结论，尽管双极刺激期间经常发生阳极激动，但单极和双极刺激产生心律失常起始的发生率相似。因此，在程控刺激期间使用单极刺激不太可能降低非特异性室性心律失常起始的风险。
