Scrutinio D, De Toma L, Mangini S G, Lagioia R, Accettura D, Ricci A, Rizzon P
Eur Heart J. 1984 Dec;5(12):1013-22. doi: 10.1093/oxfordjournals.eurheartj.a061603.
Twenty-three patients with variant angina were studied by Holter monitoring both to assess the incidence of serious ventricular arrhythmias (a risk factor of sudden death in variant angina), during ischaemic episodes and to examine the time-relation of the arrhythmias to ST changes. Serious ventricular arrhythmias were observed in 12/23 patients (52%). In the 23 patients, a total of 491 episodes of ST segment elevation were recorded during 954 h of Holter monitoring; serious ventricular arrhythmias were found in only 46 ischaemic episodes (9.4%). Six out of 12 patients showed serious ventricular arrhythmias at the onset of ischaemic episodes or during maximal ST elevation (phase 1), one patient during return or immediately after return of ST to baseline (phase 2) and five patients during both phases. Thirty-three out of 46 ischaemic episodes (76%) showed serious ventricular arrhythmias during phase 1, eight (17%) during phase 2, and five (11%) during both phases. Serious ventricular arrhythmias were neither related to previous myocardial infarction nor to the presence of serious ventricular arrhythmias during inter-crisis periods, whereas a good relationship with severity of ischaemic episodes, as assessed by the magnitude and duration of ST elevation, was found. A modest relationship with anterior ST elevation was also found.
(1) serious ventricular arrhythmias occur in a high percentage of variant angina patients, but in only a small proportion of ischaemic episodes; (2) serious ventricular arrhythmias are related to the severity of ischaemia and occur predominantly at the onset of ischaemic episodes and/or during maximal ST elevation; in only a few cases do they occur during resolution of ischaemic episodes.
对23例变异型心绞痛患者进行动态心电图监测，以评估缺血发作时严重室性心律失常（变异型心绞痛猝死的危险因素）的发生率，并研究心律失常与ST段改变的时间关系。23例患者中有12例（52%）观察到严重室性心律失常。在这23例患者中，动态心电图监测954小时期间共记录到491次ST段抬高发作；仅在46次缺血发作中发现严重室性心律失常（9.4%）。12例患者中有6例在缺血发作开始时或ST段最大抬高时（1期）出现严重室性心律失常，1例在ST段恢复至基线时或恢复后立即出现（2期），5例在两个阶段均出现。46次缺血发作中有33次（76%）在1期出现严重室性心律失常，8次（17%）在2期出现，5次（11%）在两个阶段均出现。严重室性心律失常既与既往心肌梗死无关，也与发作间期严重室性心律失常的存在无关，然而，发现其与缺血发作的严重程度有良好的相关性，缺血发作的严重程度通过ST段抬高的幅度和持续时间来评估。还发现与前壁ST段抬高有一定相关性。
（1）严重室性心律失常在变异型心绞痛患者中发生率较高，但仅在少数缺血发作中出现；（2）严重室性心律失常与缺血严重程度相关，主要发生在缺血发作开始时和/或ST段最大抬高时；仅在少数情况下在缺血发作缓解期出现。
