Wetstein L, Michelson E L, Simson M B, Moore E N, Harken A H
Surgery. 1982 Aug;92(2):206-11.
Programmed stimulation (PS) is used in the catheterization laboratory and operating room to initiate and study malignant ventricular tachyarrhythmia (VT). The purpose of this study was to evaluate the specificity and sensitivity of PS in short-term studies of 10 normal animals (group A), 10 sham-operated controls (group B), and 10 dogs with chronic myocardial infarction susceptible to inducible VT by an occlusion-reperfusion method (group C). Groups B and C were studied 7 to 14 days after the initial procedure. the pH, PaO2, and PaCO2 were determined and corrected every 30 minutes during the procedure. When bipolar ventricular pacing with three ventricular extrastimuli was used, VT initiation was attempted at 10 normal intramyocardial sites in groups A and B and in close proximity (less than or equal to 1 cm) to areas of infarction in group C. When one ventricular extrastimulus was used during ventricular pacing, VT was induced in dogs with chronic infarctions (3 of 10, 30%, group C). Using two extrastimuli, however, VT was inducible in 4 of 10 (40%) of group A, 6 of 10 60%) of group B, and all 10 (100%) of group C. With three extrastimuli, all 30 dogs had inducible VT. Overall, PS with one extrastimulus was highly specific in 100% but insensitive in 30%. With two extrastimuli the sensitivity increased to 100%, but the specificity fell to 50%. Finally, with three extrastimuli the sensitivity was also 100%, but the specificity decreased to 0%. PS remains an invaluable technique in diagnosing and assessing therapy for patients with VT. The diagnostic implications of this test await more precise pathophysiologic elucidation of arrhythmic mechanisms.
程控刺激（PS）用于导管室和手术室以诱发和研究恶性室性心律失常（VT）。本研究的目的是评估PS在10只正常动物（A组）、10只假手术对照动物（B组）和10只通过闭塞-再灌注方法易诱发VT的慢性心肌梗死犬（C组）短期研究中的特异性和敏感性。B组和C组在初始手术后7至14天进行研究。在操作过程中每30分钟测定并校正pH、动脉血氧分压（PaO₂）和动脉血二氧化碳分压（PaCO₂）。当使用双极心室起搏加三个心室期外刺激时，在A组和B组的10个正常心肌内部位以及C组梗死区域附近（小于或等于1厘米）尝试诱发VT。当心室起搏时使用一个心室期外刺激，慢性梗死犬可诱发VT（10只中的3只，30%，C组）。然而，使用两个期外刺激时，A组10只中有4只（40%）、B组10只中有6只（60%）以及C组全部10只（100%）可诱发VT。使用三个期外刺激时，所有30只犬均可诱发VT。总体而言，一个期外刺激的PS特异性为100%但敏感性为30%。两个期外刺激时敏感性增至100%，但特异性降至50%。最后，三个期外刺激时敏感性也为100%，但特异性降至0%。PS仍然是诊断和评估VT患者治疗的一项宝贵技术。该试验的诊断意义有待心律失常机制更精确的病理生理学阐明。
