Robertson J F, Cain M E, Horowitz L N, Spielman S R, Greenspan A M, Waxman H L, Josephson M E
Am J Cardiol. 1981 Aug;48(2):263-8. doi: 10.1016/0002-9149(81)90606-8.
In 108 patients with reproducible initiation of ventricular tachycardia by programmed ventricular stimulation, the ventricular tachycardia was initiated only by left ventricular stimulation in 12 (11 percent). Programmed ventricular stimulation included single and double extrastimuli extrastimuli at three cycle lengths and bursts of rapid pacing to cycle lengths of 250 ms. Clinical, electrocardiographic, angiographic, hemodynamic and electrophysiologic data were available in 74 of 96 patients with ventricular tachycardia initiated by right ventricular stimulation (Group A) and in all 12 patients with ventricular tachycardia initiated only by left ventricular stimulation (Group B). there were no significant differences between Groups A and B in clinical characteristics, hemodynamics or presence and site of infarction or aneurysm. Comparison of electrophysiologic variables revealed no significant differences between Groups A and B mean A-H interval (92 +/- 22 versus 89 +/- 15 ms, respectively), H-V interval (59 +/- 15 versus 59 +/- 15 ms) or right ventricular (241 +/- 38 versus 260 +/- 40 ms) or left ventricular (232 +/- 28 versus 251 +/- 42 ms) effective refractory period. Ventricular tachycardia with right bundle branch block and superior axis was more prevalent in Group B (92 percent versus 31 percent, p less than 0.001) but was observed in 32 patients in Group A. It is concluded that 11 percent of patients with clinically documented sustained ventricular tachycardia will require left ventricular programmed stimulation to reproducibly initiate the tachycardia. No clinical, anatomic, electrocardiographic or electrophysiologic features can predict whether left ventricular programmed stimulation will be required. Because initiation of ventricular tachycardia by programmed ventricular stimulation has important prognostic and therapeutic implications in such patients, stimulation should be performed from the left ventricle when the tachycardia is not initiated by stimulation from the right ventricle.
在108例通过程控心室刺激可重复性诱发室性心动过速的患者中，仅12例（11%）的室性心动过速由左心室刺激诱发。程控心室刺激包括在三个周期长度下发放单和双期外刺激，以及发放快速起搏至周期长度为250毫秒的猝发刺激。96例由右心室刺激诱发室性心动过速的患者中的74例（A组）以及所有12例仅由左心室刺激诱发室性心动过速的患者（B组）可获得临床、心电图、血管造影、血流动力学和电生理数据。A组和B组在临床特征、血流动力学、梗死或动脉瘤的存在及部位方面无显著差异。电生理变量比较显示，A组和B组之间平均A-H间期（分别为92±22毫秒和89±15毫秒）、H-V间期（59±15毫秒和59±15毫秒）或右心室（241±38毫秒和260±40毫秒）或左心室（232±28毫秒和251±42毫秒）有效不应期无显著差异。B组中伴有右束支阻滞和上轴的室性心动过速更为常见（92%对31%，p<0.001），但A组中32例患者也观察到这种情况。结论是，11%有临床记录的持续性室性心动过速患者需要进行左心室程控刺激才能可重复性诱发心动过速。没有临床、解剖、心电图或电生理特征能够预测是否需要进行左心室程控刺激。由于通过程控心室刺激诱发室性心动过速对此类患者具有重要的预后和治疗意义，当心动过速不能由右心室刺激诱发时，应从左心室进行刺激。
