Böcker D, Block M, Isbruch F, Fastenrath C, Castrucci M, Hammel D, Scheld H H, Borggrefe M, Breithardt G
Department of Cardiology and Angiology, Hospital of the Westfälische Wilhelms-Universität, Münster, Germany.
Br Heart J. 1995 Feb;73(2):158-63. doi: 10.1136/hrt.73.2.158.
The availability of implantable cardioverter-defibrillators (ICD) that are capable of antitachycardia pacing may lead to an increased use of ICDs in patients with haemodynamically tolerated ventricular tachycardia without a history of cardiac arrest. The frequency of potentially life-threatening fast ventricular tachycardias (cycle length < 250 ms) was investigated in patients who had a third generation ICD with endocardial leads implanted because they had haemodynamically tolerated ventricular tachycardia without a history of cardiac arrest.
Between January 1990 and October 1993, 50 patients (age (mean (SD)) 60 (11); ejection fraction 39 (16)%; 82% with coronary artery disease and 8% with dilated cardiomyopathy) with haemodynamically tolerated ventricular tachycardia (cycle length (mean (SD)) 348 (60) ms; range 250-500 ms) and without a history of cardiac arrest were treated with third generation ICDs that were capable of antitachycardia pacing. Fast ventricular tachycardia had been induced in 14 (28%) during baseline electrophysiological study. The benefit of ICD treatment was estimated as the difference between total mortality and the occurrence of fast ventricular tachycardia that would have been fatal if it had not been terminated.
During follow up of 17 (12) months, 33 patients (66%) had a total of 3861 episodes of ventricular tachycardia. 91% of these episodes were terminated by antitachycardia pacing. 11 patients (22%) had episodes of potentially life-threatening fast ventricular tachycardia and 3 of these also had inducible fast ventricular tachycardia. One patient died suddenly 27 months after implantation. The difference between survival without fast ventricular tachycardia and total mortality was 9%, 12%, 27%, and 27% at 6, 12, 18, and 24 months, respectively.
About a fifth of patients who had been given an ICD to treat haemodynamically tolerated ventricular tachycardia and who had no history of cardiac arrest experienced fast ventricular tachycardia during follow up requiring immediate cardioversion. Prospective studies are needed to investigate whether the prognosis of patients with a history of haemodynamically tolerated ventricular tachycardia without cardiac arrest is improved by ICD therapy.
能够进行抗心动过速起搏的植入式心脏复律除颤器（ICD）的出现，可能会导致在无心脏骤停病史但血流动力学耐受的室性心动过速患者中，ICD的使用增加。对因无心脏骤停病史但血流动力学耐受的室性心动过速而植入了第三代心内膜导线ICD的患者，研究了潜在危及生命的快速室性心动过速（周长<250毫秒）的发生频率。
在1990年1月至1993年10月期间，50例（年龄（均值（标准差））60（11）岁；射血分数39（16）%；82%患有冠状动脉疾病，8%患有扩张型心肌病）无心脏骤停病史但血流动力学耐受的室性心动过速（周长（均值（标准差））348（60）毫秒；范围250 - 500毫秒）患者接受了能够进行抗心动过速起搏的第三代ICD治疗。在基线电生理研究期间，14例（28%）诱发了快速室性心动过速。ICD治疗的益处估计为总死亡率与若未终止则会致命的快速室性心动过速发生率之间的差值。
在17（12）个月的随访期间，33例（66%）患者共发生3861次室性心动过速发作。其中91%的发作通过抗心动过速起搏终止。11例（22%）患者发生了潜在危及生命的快速室性心动过速发作，其中3例也可诱发快速室性心动过速。1例患者在植入后27个月突然死亡。无快速室性心动过速存活与总死亡率之间的差值在6、12、18和24个月时分别为9%、12%、27%和27%。
在接受ICD治疗无心脏骤停病史但血流动力学耐受的室性心动过速患者中，约五分之一的患者在随访期间经历了需要立即进行心脏复律的快速室性心动过速。需要进行前瞻性研究以调查ICD治疗是否能改善无心脏骤停病史但血流动力学耐受的室性心动过速患者的预后。
