Senges J, Lengfelder W, Jauernig R, Brachmann J, Rizos I, Kübler W
Herz. 1984 Feb;9(1):45-51.
Sudden cardiac death is a leading cause of death in industrially developed countries and accounts for approximately 90 000 deaths yearly in the FRG. While the majority of victims have severe coronary heart disease, sudden cardiac death is infrequently caused by acute myocardial infarction (20%) but is predominantly related to malignant ventricular arrhythmias (i.e., ventricular fibrillation or sustained ventricular tachycardia). Patients with a history of such malignant ventricular arrhythmias are at high risk for sudden death. Spontaneous occurrence of sustained ventricular tachycardia and of ventricular fibrillation is critically related to two factors: 1. trigger-arrhythmias consisting usually of complex ventricular extrasystoles (Lown classification IV to V); 2. increased vulnerability of the myocardium representing the target organ for trigger-arrhythmias. While trigger-arrhythmias can be easily recorded by noninvasive techniques including Holter monitoring or exercise and stress ECG, ventricular vulnerability is more difficult to determine and often requires ventricular stimulation with intracardiac electrocatheters. In patients with documented spontaneous malignant ventricular arrhythmias, two aspects of programmed stimulation must be considered: 1. diagnostic, and more importantly, 2. therapeutic purposes of this method. Diagnostic purposes include determination of the mode of initiation and unequivocal ventricular localization of the tachycardia excluding other arrhythmias with broad QRS complex. In patients with spontaneous sustained ventricular tachycardia, programmed stimulation can reproducibly initiate the clinical arrhythmia in 85% (sensitivity and specificity of the method approximately 90%). In patients with cardiac arrest due to ventricular fibrillation, programmed stimulation is less reliable (50%). However, the main purpose of programmed stimulation in patients with documented clinical malignant arrhythmias is not diagnostic or prognostic evaluation but is serial electrophysiological studies for individual optimization of antiarrhythmic therapy.
心源性猝死是工业发达国家的主要死因，在联邦德国每年约有90000人死于该病。虽然大多数受害者患有严重的冠心病，但心源性猝死很少由急性心肌梗死引起（20%），主要与恶性室性心律失常（即室颤或持续性室速）有关。有此类恶性室性心律失常病史的患者猝死风险很高。持续性室速和室颤的自发发生与两个因素密切相关：1. 触发心律失常，通常由复杂室性早搏组成（洛恩分类IV级至V级）；2. 心肌易损性增加，心肌是触发心律失常的靶器官。虽然触发心律失常可以通过包括动态心电图监测或运动及应激心电图在内的非侵入性技术轻松记录，但心室易损性更难确定，通常需要心内电导管进行心室刺激。在有记录的自发恶性室性心律失常患者中，必须考虑程序刺激的两个方面：1. 诊断方面，更重要的是，2. 该方法的治疗目的。诊断目的包括确定心动过速的起始方式和明确的心室定位，排除其他宽QRS波群心律失常。在自发持续性室速患者中，程序刺激可在85%的患者中重复诱发临床心律失常（该方法的敏感性和特异性约为90%）。在因室颤导致心脏骤停的患者中，程序刺激的可靠性较低（50%）。然而，在有记录的临床恶性心律失常患者中，程序刺激的主要目的不是诊断或预后评估，而是进行系列电生理研究以个体化优化抗心律失常治疗。
