Finkler Bruno Schaaf, Sant'Anna Roberto, Pinos Javier, Zanotta Danilo Barros, Moreira Thiago Camargo, de Jesus Felipe Della Barba, Batista Pedro Dutra, da Rocha Helena Guedes, de Lima Barbara Adelmann, Saffi Marco Aurélio Lumertz, de Lima Gustavo Glotz, Kruse Marcelo, Leiria Tiago Luiz Luz
Instituto de Cardiologia do Rio Grande, do Sul, Fundação Universitária de Cardiologia Porto Alegre RS Brazil.
Universidade Federal de Ciências da Saúde de Porto Alegre Porto Alegre RS Brazil.
J Arrhythm. 2023 Nov 15;40(1):124-130. doi: 10.1002/joa3.12953. eCollection 2024 Feb.
Programmed ventricular stimulation (PVS) during electrophysiological study (EPS), is a globally accepted tool for risk stratification of sudden cardiac death (SCD) in some specific clinical situations. The aim of this study was to evaluate the prognosis of ventricular arrhythmia induction in a cohort of patients with syncope of undetermined origin (SUO).
This is a historical cohort study in a population of patients with SUO referred for EPS between the years 2008-2021. In this interval, 575 patients underwent the procedure.
Patients with induced ventricular arrhythmias had a higher occurrence of structural heart disease (36.7% vs. 76.5%), ischemic heart disease (28.2 vs. 57.1%), heart failure (15.5% vs. 34.4%), and lower left ventricular ejection fraction (59.16% vs. 47.51%), when compared to the outcome with a negative study. PVS triggered ventricular arrhythmias in 98 patients, 62 monomorphic and 36 polymorphic. During a median follow-up of 37.6 months, 100 deaths occurred. Only the induction of sustained ventricular arrhythmias showed a significant association with the primary outcome (all-cause mortality) with a value <.001. After the performance of EPS, 142 patients underwent cardioverter-defibrillator (ICD) implantation. At study follow-up, 30 patients had therapies by the device. Only the induction of sustained monomorphic ventricular arrhythmia showed statistically significant association with appropriate therapies by the device ( = .012).
In patients with SUO, the induction of sustained monomorphic ventricular arrhythmia after programmed ventricular pacing is related to a worse prognosis, with a higher incidence of mortality and appropriate therapies by the ICD.
在电生理研究（EPS）期间进行程控心室刺激（PVS），是在某些特定临床情况下对心脏性猝死（SCD）进行危险分层的全球公认工具。本研究的目的是评估不明原因晕厥（SUO）患者队列中心室心律失常诱发的预后。
这是一项对2008年至2021年间因EPS转诊的SUO患者群体进行的历史性队列研究。在此期间，575例患者接受了该手术。
与检查结果为阴性的患者相比，诱发室性心律失常的患者结构性心脏病发生率更高（36.7%对76.5%）、缺血性心脏病发生率更高（28.2对57.1%）、心力衰竭发生率更高（15.5%对34.4%），左心室射血分数更低（59.16%对47.51%）。PVS诱发室性心律失常98例，其中单形性62例，多形性36例。在中位随访37.6个月期间，发生100例死亡。只有持续性室性心律失常的诱发与主要结局（全因死亡率）显著相关，P值<0.001。在进行EPS后，142例患者接受了植入式心脏复律除颤器（ICD）植入。在研究随访时，30例患者接受了该设备的治疗。只有持续性单形性室性心律失常的诱发与该设备的适当治疗在统计学上显著相关（P = 0.012）。
在SUO患者中，程控心室起搏后诱发持续性单形性室性心律失常与更差的预后相关，死亡率和ICD适当治疗的发生率更高。
