Kadish A, Schmaltz S, Calkins H, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Pacing Clin Electrophysiol. 1993 May;16(5 Pt 1):1037-50. doi: 10.1111/j.1540-8159.1993.tb04578.x.
Two hundred eighty patients with spontaneous nonsustained ventricular tachycardia were treated based on the results of electrophysiological testing. Seventy-nine patients had no evidence of structural heart disease, 134 had coronary artery disease, 43 had idiopathic dilated cardiomyopathy, and 24 patients had miscellaneous types of heart disease. Sustained monomorphic ventricular tachycardia was induced during electrophysiological testing in the drug free state in 52 of 280 patients (19%). Ventricular tachycardia was induced more frequently in patients with coronary artery disease (32%) than in any of the other groups (P < 0.001). The patients with inducible sustained monomorphic ventricular tachycardia underwent a mean of 1.9 +/- 1.3 drug trials. Twenty-five patients had the induction of ventricular tachycardia suppressed by pharmacological therapy and were treated with the drug judged to be effective during electropharmacological testing. Twenty-seven patients continued to have inducible sustained monomorphic ventricular tachycardia despite antiarrhythmic therapy and were discharged on the drug that made induced ventricular tachycardia best tolerated. Forty-five of 280 patients (16.1%) died during a mean follow-up period of 19.6 +/- 14.4 months. There were 15 sudden cardiac deaths, 21 nonsudden cardiac deaths, 6 noncardiac deaths, and 3 deaths that could not be classified. Sudden cardiac death mortality was lowest in the patients without structural heart disease (0% at 2 years), intermediate in the patients with coronary artery disease and miscellaneous heart disease (4% at 2 years), and highest in the patients with idiopathic dilated cardiomyopathy (13% at 2 years; P < 0.01 for pairwise comparisons). No patient treated with a drug that had suppressed the induction of sustained ventricular tachycardia died suddenly during the follow-up period whereas four of 27 patients who were discharged on "ineffective antiarrhythmic drugs" and 11 of 228 patients without inducible sustained ventricular tachycardia experienced sudden cardiac death during the follow-up period. By multivariate analysis, ejection fraction and inducible ventricular tachycardia during the predischarge electrophysiological test were independent predictors of sudden cardiac death. In conclusion, in patients with spontaneous non-sustained ventricular tachycardia: (1) Arrhythmia inducibility varies depending on the underlying heart disease.(ABSTRACT TRUNCATED AT 400 WORDS)
根据电生理测试结果对280例自发性非持续性室性心动过速患者进行了治疗。79例患者无结构性心脏病证据，134例有冠状动脉疾病，43例有特发性扩张型心肌病，24例有其他类型的心脏病。在280例患者中，有52例（19%）在无药物状态下的电生理测试中诱发出持续性单形性室性心动过速。冠状动脉疾病患者诱发出室性心动过速的频率（32%）高于其他任何组（P<0.001）。诱发出持续性单形性室性心动过速的患者平均进行了1.9±1.3次药物试验。25例患者的室性心动过速诱发被药物治疗抑制，并接受了在电药理学测试中被判定有效的药物治疗。27例患者尽管接受了抗心律失常治疗仍持续有诱发性持续性单形性室性心动过速，并出院时服用了使诱发性室性心动过速耐受性最佳的药物。280例患者中有45例（16.1%）在平均19.6±14.4个月的随访期内死亡。有15例心源性猝死、21例非心源性猝死、6例非心脏性死亡和3例无法分类的死亡。无结构性心脏病患者的心源性猝死死亡率最低（2年时为0%），冠状动脉疾病和其他心脏病患者居中（2年时为4%），特发性扩张型心肌病患者最高（2年时为13%；两两比较P<0.01）。在随访期间，接受抑制持续性室性心动过速诱发药物治疗的患者无1例心源性猝死，而27例出院时服用“无效抗心律失常药物”的患者中有4例以及228例无诱发性持续性室性心动过速的患者中有11例在随访期间发生心源性猝死。多因素分析显示，出院前电生理测试时的射血分数和诱发性室性心动过速是心源性猝死的独立预测因素。总之，对于自发性非持续性室性心动过速患者：（1）心律失常的诱发性因基础心脏病而异。（摘要截断于400字）
