Doherty J U, Kienzle M G, Buxton A E, Marchlinski F E, Waxman H L, Josephson M E
Am J Cardiol. 1984 Aug 1;54(3):336-42. doi: 10.1016/0002-9149(84)90193-0.
Programmed ventricular stimulation (PVS) was prospectively performed in 56 consecutive patients from both the right ventricular (RV) apex and the RV outflow tract. Thirty-seven patients had documented clinical sustained ventricular tachycardia (VT) and 19 patients had no sustained spontaneous VT in the absence of antiarrhythmic drugs. The sensitivity of VT induction was 65% from the RV apex, 76% from the RV outflow tract and was 89% with combined stimulation at both RV sites. The specificity from the RV apex, the RV outflow tract and both sites combined was 100%. When sustained VT was induced from both sites (51%), it was usually of the same morphologic characteristics, axis and cycle length. When sustained VT was induced at 1 site and nonsustained VT at the second site, the morphologic characteristics or axis usually differed. Of patients who had VT induced at both RV sites during the baseline study 37% had VT rendered noninducible during treatment with conventional antiarrhythmic agents. No patients whose VT was induced at only 1 RV site responded to conventional drugs. We conclude that programmed ventricular stimulation at a second RV site is frequently helpful in the evaluation of VT. Inducibility at only 1 of 2 RV sites predicts a poor response to conventional antiarrhythmic drugs.
对56例连续患者前瞻性地进行了右心室（RV）心尖部和RV流出道的程控心室刺激（PVS）。37例患者记录有临床持续性室性心动过速（VT），19例患者在未使用抗心律失常药物时无持续性自发性VT。RV心尖部VT诱发的敏感性为65%，RV流出道为76%，两个RV部位联合刺激时为89%。RV心尖部、RV流出道及两者联合的特异性均为100%。当两个部位均诱发出持续性VT时（51%），其形态特征、电轴和周长通常相同。当在一个部位诱发出持续性VT而在另一个部位诱发出非持续性VT时，形态特征或电轴通常不同。在基线研究期间两个RV部位均诱发出VT的患者中，37%在使用传统抗心律失常药物治疗期间VT变为不能诱发。仅在一个RV部位诱发出VT的患者对传统药物均无反应。我们得出结论，在第二个RV部位进行程控心室刺激对VT的评估通常很有帮助。仅在两个RV部位中的一个部位可诱发提示对传统抗心律失常药物反应不佳。
