Somberg J C, Butler B, Torres V, Tepper D, Keren G, Siegel L, Jentzer J, Miura D S
Angiology. 1985 Mar;36(3):181-90. doi: 10.1177/000331978503600307.
Non-sustained ventricular tachycardia (VT) in the late post myocardial infarction (MI) period (7-21 days) has been reported to be a predictor of sudden death. We suspected that patients with 3 beat VT on Holter monitoring in the late infarction period would demonstrate electrical instability at electrophysiologic studies. Forty-seven patients were identified as having at least 3 beat VT on Holter monitoring. Eighteen patients refused electrophysiologic studies or were not referred by their attending physician. The mean ejection fraction of this group was 43 +/- 16%. Eight patients have died, 3 sudden deaths in 13 +/- 5 months, a 17% incidence of sudden death. Twenty-nine patients underwent invasive electrophysiologic studies. Their mean ejection fraction was 37 +/- 7%, and 28 had inducible, 18 sustained ventricular tachycardia and 10 non-sustained VT. No complications were noted with electrophysiological testing in the post infarction patients. Using programmed electrical stimulation studies an effective antiarrhythmic agent preventing VT induction (usually experimental) could be found for each patient. After a mean follow-up of 12.5 +/- 4 months, the patient without inducible VT is alive and 26 of the 28 "inducible" patients are alive and well. Two patients died, one of stroke and one due to pump failure following a second MI. No sudden deaths were observed in this group. Two patients had breakthrough arrhythmias and were treated by alternative antiarrhythmic therapy that was also effective at the initial electrophysiologic studies. Thus, PES studies post MI are safe and may be an effective way to assess therapy for patients in the early post MI period, identified at high risk for sudden death.
据报道，心肌梗死（MI）后期（7 - 21天）出现的非持续性室性心动过速（VT）是猝死的一个预测指标。我们怀疑，在梗死后期动态心电图监测发现有3次心跳的室性心动过速的患者，在电生理研究中会表现出电不稳定。47例患者经动态心电图监测确定至少有3次心跳的室性心动过速。18例患者拒绝电生理检查或未被其主治医师转诊。该组患者的平均射血分数为43±16%。8例患者死亡，13±5个月内有3例猝死，猝死发生率为17%。29例患者接受了有创电生理检查。他们的平均射血分数为37±7%，其中28例可诱发室性心动过速，18例为持续性室性心动过速，10例为非持续性室性心动过速。梗死后期患者进行电生理检查未发现并发症。通过程序电刺激研究，可以为每位患者找到一种有效的抗心律失常药物来预防室性心动过速的诱发（通常是实验性的）。平均随访12.5±4个月后，未诱发室性心动过速的患者存活，28例“可诱发”患者中有26例存活且情况良好。2例患者死亡，1例死于中风，1例在第二次心肌梗死后因泵衰竭死亡。该组未观察到猝死病例。2例患者出现心律失常复发，接受了在初始电生理研究中也有效的替代抗心律失常治疗。因此，心肌梗死后的程序电刺激研究是安全的，可能是评估心肌梗死后早期猝死高危患者治疗效果的有效方法。
