Denniss A R, Richards D A, Cody D V, Russell P A, Young A A, Cooper M J, Ross D L, Uther J B
Circulation. 1986 Oct;74(4):731-45. doi: 10.1161/01.cir.74.4.731.
The relative prognostic significance of ventricular tachycardia and ventricular fibrillation inducible at programmed stimulation within 1 month of acute myocardial infarction was compared in a prospective study of 403 clinically well survivors of transmural infarction who were 65 years old or younger. The prognostic significance of delayed potentials on the signal-averaged electrocardiogram was also examined in a subset of 306 patients without bundle branch block. Among the study patients, 20% had inducible ventricular tachycardia, 14% had inducible ventricular fibrillation, and 66% had no inducible arrhythmias. The 2 year probability of remaining free from cardiac death or nonfatal ventricular tachycardia or fibrillation was 0.73 for those with inducible ventricular tachycardia, 0.93 for those with inducible ventricular fibrillation, and 0.92 for those with no inducible arrhythmias. The cycle length of inducible ventricular tachycardia was 230 msec or more in 70% of the patients with inducible tachycardia who died. Of the patients studied by signal-averaged electrocardiography, 26% had delayed potentials. At 2 years, the probability of remaining free from cardiac death or nonfatal ventricular tachycardia or fibrillation was 0.73 for patients with delayed potentials and 0.95 for patients with no delayed potentials. There was a significant correlation (p less than .001) between the presence of delayed potentials and the ability to induce ventricular tachycardia. In conclusion, in survivors of recent infarction who have not had spontaneous ventricular tachycardia or fibrillation, inducible tachycardia (but not inducible fibrillation) at programmed stimulation predicts a significant risk of death or spontaneous tachycardia or fibrillation. A similar risk is found for patients with delayed potentials on the signal-averaged electrocardiogram.
在一项对403名年龄在65岁及以下、临床状况良好的透壁性心肌梗死幸存者进行的前瞻性研究中，比较了急性心肌梗死后1个月内程序刺激可诱发的室性心动过速和室性颤动的相对预后意义。还在306名无束支传导阻滞的患者亚组中检查了信号平均心电图上延迟电位的预后意义。在研究患者中，20%有可诱发的室性心动过速，14%有可诱发的室性颤动，66%没有可诱发的心律失常。对于有可诱发室性心动过速的患者，2年无心脏死亡、非致命性室性心动过速或室性颤动的概率为0.73，对于有可诱发室性颤动的患者为0.93，对于没有可诱发心律失常的患者为0.92。在因可诱发的室性心动过速而死亡的患者中，70%的患者可诱发的室性心动过速的周期长度为230毫秒或更长。在接受信号平均心电图检查的患者中，26%有延迟电位。2年时，有延迟电位的患者无心脏死亡、非致命性室性心动过速或室性颤动的概率为0.73，无延迟电位的患者为0.95。延迟电位的存在与诱发室性心动过速的能力之间存在显著相关性（p小于0.001）。总之，在近期心肌梗死且没有自发室性心动过速或室性颤动的幸存者中，程序刺激时可诱发的心动过速（而非可诱发的颤动）预示着死亡、自发心动过速或颤动的显著风险。信号平均心电图上有延迟电位的患者也有类似风险。
