Cua M, Veltri E P
Department of Medicine, Sinai Hospital, Baltimore, Maryland 21215.
Pacing Clin Electrophysiol. 1993 Mar;16(3 Pt 1):382-6. doi: 10.1111/j.1540-8159.1993.tb01598.x.
In patients undergoing implantation and testing of the implantable cardioverter defibrillator (ICD), alternating current (AC) may be used to induce ventricular tachyarrhythmias in a prompt, safe, and efficient manner. These arrhythmias have been previously reported to be similar to those induced during programmed electrical stimulation (PES). We compared the ventricular tachyarrhythmias induced by both methods in 14 patients: 8 male, 6 female; mean age 61 years; coronary disease in 10, cardiomyopathy in 4; mean ejection fraction 31%. The presenting arrhythmia was nonsustained ventricular tachycardia (VT) in four, sustained monomorphic ventricular tachycardia (SMVT) in five, ventricular fibrillation (VF) in four, and unknown in one patient with syncope. PES (single, double, triple extrastimuli; burst pacing) and AC (1-2 sec application) stimulation via right ventricular endocardial electrode catheter was performed off antiarrhythmic drugs in the nonsedated state. PES induced SMVT in nine, polymorphic VT in two, and VF in three. AC induced VF in all patients. Although AC can reliably induce ventricular tachyarrhythmias during defibrillation threshold and ICD testing, there is poor correlation to PES induced tachyarrhythmias.
在接受植入式心脏复律除颤器（ICD）植入和测试的患者中，交流电（AC）可用于快速、安全且有效地诱发室性快速心律失常。此前已有报道称，这些心律失常与程控电刺激（PES）期间诱发的心律失常相似。我们比较了14例患者中两种方法诱发的室性快速心律失常：男性8例，女性6例；平均年龄61岁；10例患有冠心病，4例患有心肌病；平均射血分数为31%。表现出的心律失常中，4例为非持续性室性心动过速（VT），5例为持续性单形性室性心动过速（SMVT），4例为心室颤动（VF），1例晕厥患者情况不明。在未使用抗心律失常药物且未镇静的状态下，通过右心室心内膜电极导管进行PES（单、双、三联额外刺激；短阵快速起搏）和AC（应用1 - 2秒）刺激。PES诱发9例SMVT、2例多形性VT和3例VF。AC在所有患者中均诱发VF。尽管在除颤阈值和ICD测试期间AC能可靠地诱发室性快速心律失常，但与PES诱发的快速心律失常相关性较差。
