使用串联与简单序贯方案的程序性心室刺激。

Programmed ventricular stimulation using tandem versus simple sequential protocols.

作者信息

Fisher J D, Kim S G, Ferrick K J, Roth J A

机构信息

Department of Medicine, Montefiore Medical Center, Bronx, NY 10467.

出版信息

Pacing Clin Electrophysiol. 1994 Mar;17(3 Pt 1):286-94. doi: 10.1111/j.1540-8159.1994.tb01390.x.

DOI:10.1111/j.1540-8159.1994.tb01390.x

PMID:7513853

Abstract

UNLABELLED

The objective was to determine whether two commonly used ventricular stimulation protocols, one more complex than the other, produced concordant results. If such were the case, the simpler protocol would streamline activities in clinical electrophysiology laboratories.

BACKGROUND

Two programmed ventricular stimulation protocols were compared. (1) With the tandem method, the first extrastimulus (S2) is moved stepwise to the effective refractory period and then moved out 50 msec; the second extrastimulus (S3) is then decremented until it fails to capture; S2 and S3 are then decremented in a semialternating (tandem) fashion so that both continue to capture. When S2 reaches the refractory period + 10 msec and S3 fails to capture, S3 is then moved out 50 msec, and S4 is decremented as described for S3. (2) With the simple sequential method, the first extrastimulus (S2) is decremented stepwise to the refractory period, and then moved out 10 msec to assure capture; S3 is then similarly decremented to the refractory period and then moved out 10 msec; and S4 is then similarly decremented.

METHODS

This was a prospective, randomized, crossover, consecutive series study. Both protocols were tested in each patient on the same day in randomized order.

RESULTS

There were 84 matched studies. Fifty-six patients provided data from baseline electrophysiological studies, and 28 of these provided additional data during drug trials. There was a 93% concordance between the two methods, including the primary outcomes of inducibility of clinical arrhythmias, inducibility of nonclinical arrhythmias, and noninducibility (P < 0.001). Discordances were few and evenly distributed between the two protocols (P = NS). Results were similar for baseline studies and drug trials. The simple sequential method required less time to perform (P < or = 0.01).

CONCLUSIONS

Tandem and simple sequential protocols provide concordant results. No advantage could be demonstrated for the more complex tandem method.

摘要

未标注

目的是确定两种常用的心室刺激方案（其中一种比另一种更复杂）是否产生一致的结果。如果是这样，较简单的方案将简化临床电生理实验室的操作。

背景

比较了两种程控心室刺激方案。（1）采用串联法时，第一个额外刺激（S2）逐步移至有效不应期，然后向外移50毫秒；然后第二个额外刺激（S3）递减直至不能夺获；然后S2和S3以半交替（串联）方式递减，以使两者都能继续夺获。当S2达到不应期+10毫秒且S3不能夺获时，将S3向外移50毫秒，然后按S3的描述对S4进行递减。（2）采用简单顺序法时，第一个额外刺激（S2）逐步递减至不应期，然后向外移10毫秒以确保夺获；然后S3以类似方式递减至不应期，然后向外移10毫秒；然后S4以类似方式递减。

方法

这是一项前瞻性、随机、交叉、连续系列研究。两种方案在同一天以随机顺序在每位患者身上进行测试。

结果

有84项匹配研究。56例患者提供了基线电生理研究数据，其中28例在药物试验期间提供了额外数据。两种方法之间的一致性为93%，包括临床心律失常的诱发性、非临床心律失常的诱发性和不能诱发（P<0.001）。两种方案之间的不一致很少且分布均匀（P=无显著性差异）。基线研究和药物试验的结果相似。简单顺序法执行所需时间更少（P≤0.01）。