Roelke M, O'Nunain S, Osswald S, Trouton T G, Harthorne J W, Garan H, Ruskin J N
Cardiac Unit, Massachusetts General Hospital, Boston 02114, USA.
Pacing Clin Electrophysiol. 1995 Mar;18(3 Pt 1):486-91. doi: 10.1111/j.1540-8159.1995.tb02551.x.
Appropriately timed noncompetitive ventricular pacing potentially may initiate ventricular tachycardia in patients prone to these arrhythmias. The combination of bradycardia pacing and stored electrograms in a currently available cardioverter defibrillator provides an opportunity to evaluate the occurrence of such pacing induced ventricular tachycardia. During a surveillance period of 18.7 +/- 11.4 months, stored electrograms documented 302 episodes of ventricular tachycardia in 77 patients. Five patients (6.5%) demonstrated 25 episodes (1-16 per patient) of ventricular tachycardia that were immediately preceded by an appropriately paced ventricular beat (8.3% of all episodes of ventricular tachycardia). All five patients had prior myocardial infarctions and a history of monomorphic ventricular tachycardia occurring both spontaneously and in response to programmed electrical stimulation. Antitachycardia pacing terminated pacing induced ventricular tachycardia in 22 episodes; in one episode antitachycardia pacing accelerated ventricular tachycardia. In two cases shock therapy was aborted for nonsustained ventricular tachycardia. We conclude that, in selected nonsustained ventricular tachycardia. We conclude that, in selected postinfarction patients with recurrent sustained monomorphic ventricular tachycardia treated with implantable cardioverter defibrillators, appropriately timed ventricular pacing may induce ventricular tachycardia.
在易于发生此类心律失常的患者中，适时进行的非竞争性心室起搏可能会引发室性心动过速。目前可用的心脏复律除颤器中缓慢性心律失常起搏与存储的心电图表相结合，为评估此类起搏诱发的室性心动过速的发生提供了一个机会。在18.7±11.4个月的监测期内，存储的心电图表记录了77例患者发生的302次室性心动过速发作。5例患者（6.5%）出现了25次室性心动过速发作（每位患者1 - 16次），这些发作之前紧接着一次适时起搏的心室搏动（占所有室性心动过速发作的8.3%）。所有5例患者既往均有心肌梗死病史，且有自发及对程控电刺激发生单形性室性心动过速的病史。抗心动过速起搏在22次发作中终止了起搏诱发的室性心动过速；在1次发作中抗心动过速起搏使室性心动过速加速。在2例患者中，因非持续性室性心动过速而中止了电击治疗。我们得出结论，在选定的非持续性室性心动过速患者中。我们得出结论，在植入式心脏复律除颤器治疗的选定的心肌梗死后复发性持续性单形性室性心动过速患者中，适时的心室起搏可能会诱发室性心动过速。
