Zehender M, Brugada P, Geibel A, Waldecker B, Stevenson W, Wellens H J
Am J Cardiol. 1987 Mar 1;59(6):578-85. doi: 10.1016/0002-9149(87)91173-8.
The diagnostic accuracy of programmed electrical stimulation was prospectively assessed in 111 patients with myocardial infarction (MI) with or without a history of spontaneous ventricular arrhythmias. In 29 patients neither ventricular tachycardia (VT) nor episodes of 10 premature ventricular depolarizations per hour was documented. Fifty patients had documented nonsustained VT and 32 had sustained monomorphic VT. One and 2 extrastimuli (twice diastolic threshold, 2 ms in duration) were given during sinus rhythm and ventricular pacing at 100, 120 and 140 beats/min in the right ventricular apex (part I). When this protocol failed to induce a sustained monomorphic VT, a third extrastimulus was introduced (part II). Repetitive ventricular responses were induced in all patients, and in 15 (14%) polymorphic ventricular arrhythmias requiring DC shock were induced. Incidence of initiation of sustained monomorphic VT and polymorphic ventricular arrhythmias requiring DC shock was related to the clinical arrhythmia and the stimulation protocol. In patients with documented sustained monomorphic VT, a third extrastimulus only increased the incidence of sustained monomorphic VT (68% to 94%), whereas in patients with documented nonsustained VT and without VT the incidence of both polymorphic and monomorphic arrhythmias increased by 7 to 12%. Sustained monomorphic VTs induced in patients without such a history were faster (p less than 0.01), depended on site of MI (p less than 0.05) and were more often preceded by nonsustained polymorphic VT (p less than 0.01) than in patients with documented sustained monomorphic VT.(ABSTRACT TRUNCATED AT 250 WORDS)
对111例有或无自发性室性心律失常病史的心肌梗死（MI）患者前瞻性评估程序电刺激的诊断准确性。29例患者既未记录到室性心动过速（VT），也未记录到每小时10次室性早搏发作。50例患者记录到非持续性VT，32例患者记录到持续性单形性VT。在窦性心律和右心室心尖部以100、120和140次/分钟进行心室起搏时，给予1个和2个额外刺激（两倍舒张阈值，持续时间2毫秒）（第一部分）。当该方案未能诱发持续性单形性VT时，引入第三个额外刺激（第二部分）。所有患者均诱发了重复性心室反应，15例（14%）诱发了需要直流电休克的多形性室性心律失常。持续性单形性VT和需要直流电休克的多形性室性心律失常的诱发率与临床心律失常及刺激方案有关。在记录到持续性单形性VT的患者中，第三个额外刺激仅增加了持续性单形性VT的诱发率（从68%增至94%），而在记录到非持续性VT且无VT的患者中，多形性和单形性心律失常的诱发率均增加了7%至12%。无此类病史的患者诱发的持续性单形性VT更快（p<0.01），取决于心肌梗死部位（p<0.05），且比记录到持续性单形性VT的患者更常先出现非持续性多形性VT（p<0.01）。（摘要截短于250字）
