Greene H L, Reid P R, Schaeffer A H
N Engl J Med. 1978 Oct 5;299(14):729-34. doi: 10.1056/NEJM197810052991401.
We examined the value of cardiac pacing for assessing ventricular electrical instability and for predicting ventricular tachycardia and sudden death in 50 patients with refractory symptomatic ventricular tachycardia, 12 normal patients, and 48 survivors of a recent myocardial infarction. The repetitive ventricular response (two or more ventricular premature beats produced by a single ventricular pacing stimulus during control of heart rate with atrial pacing) was absent in all 12 normal patients but was present in 44 of the 50 patients (88 per cent) with recurrent ventricular tachycardia (P less than 0.001). Of the 48 survivors of myocardial infarction, 19 had repetitive ventricular responses. During the next 12 months 15 of these patients (79 per cent) had symptomatic ventricular tachycardia or sudden death, or both, as compared with four of 29 patients (14 per cent) who did not have repetitive ventricular responses (P less than 0.001). The repetitive ventricular response identifies patients with life-threatening ventricular instability, but it is still an investigational technic that should be used only with due precautions.
我们研究了心脏起搏对于评估50例难治性有症状室性心动过速患者、12例正常患者以及48例近期心肌梗死幸存者的心室电不稳定性、预测室性心动过速和猝死的价值。在所有12例正常患者中均未出现重复性心室反应（在心房起搏控制心率期间，单个心室起搏刺激产生两个或更多室性早搏），但在50例复发性室性心动过速患者中有44例（88%）出现了重复性心室反应（P<0.001）。在48例心肌梗死幸存者中，19例有重复性心室反应。在接下来的12个月中，这些患者中有15例（79%）出现了有症状的室性心动过速或猝死，或两者皆有，相比之下，在29例没有重复性心室反应的患者中有4例（14%）出现上述情况（P<0.001）。重复性心室反应可识别有危及生命的心室不稳定性的患者，但它仍是一种研究性技术，使用时应谨慎。
