Chiang H T, Lin M
Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan R.O.C.
J Formos Med Assoc. 1994 Jul;93(7):598-604.
Right atrial pacing (RAP) using three pacing stages (I: 100 BPM/5 min; II: 120 BPM/5 min; III: 140 BPM/5 min) was performed for residual myocardial ischemia, hypotensive response and related prognostic significance in 55 uncomplicated acute myocardial infarction (AMI) patients. We aimed to clarify whether early risk stratification and jeopardized myocardium score, calculated using pacing results, could predict disease severity and future major cardiac events during long-term follow-up. During RAP testing, 24 patients displayed negative and 31 patients positive RAP. The positive RAP group had a significantly higher incidence of multivessel disease, higher jeopardized myocardium scores and left ventricular end-diastolic pressure than the negative RAP group. As expected, according to pacing response the disease severity score also showed a significant difference. During the one-year follow-up, there were three recurrent angina attacks, reinfarction and two congestive heart failures in the negative RAP group. In the positive RAP group, four died, six had new or recurrent myocardial infarctions and six developed congestive heart failure. Only six patients in the positive RAP group carried the critical risk, four suffered from recurrent angina, two developed reinfarction, three developed congestive heart failure, and two died. Total major cardiac events in the positive RAP group appeared to significantly increase compared to those in the negative RAP group. Our results show that early RAP with three pacing stages is useful in predicting subsequent major cardiac events after uncomplicated myocardial infarction. We also observed that hypotensive response during positive RAP represents the best predictor of critical risk requiring further invasive studies. We believe that RAP is justified for risk strategy.
对55例无并发症的急性心肌梗死（AMI）患者进行了右心房起搏（RAP），采用三个起搏阶段（I：100次/分钟，持续5分钟；II：120次/分钟，持续5分钟；III：140次/分钟，持续5分钟），以评估残余心肌缺血、低血压反应及相关预后意义。我们旨在明确，根据起搏结果计算出的早期风险分层和心肌损伤评分，能否预测长期随访期间的疾病严重程度和未来主要心脏事件。在RAP测试期间，24例患者表现为RAP阴性，31例患者表现为RAP阳性。与RAP阴性组相比，RAP阳性组多支血管病变的发生率显著更高，心肌损伤评分和左心室舒张末期压力也更高。正如预期的那样，根据起搏反应，疾病严重程度评分也显示出显著差异。在一年的随访期间，RAP阴性组有3例复发性心绞痛发作、再梗死，2例发生充血性心力衰竭。在RAP阳性组，4例死亡，6例发生新的或复发性心肌梗死，6例发生充血性心力衰竭。RAP阳性组中只有6例患者存在重大风险，4例患有复发性心绞痛，2例发生再梗死，3例发生充血性心力衰竭，2例死亡。与RAP阴性组相比，RAP阳性组的主要心脏事件总数似乎显著增加。我们的结果表明，采用三个起搏阶段的早期RAP有助于预测无并发症心肌梗死后的后续主要心脏事件。我们还观察到，RAP阳性期间的低血压反应是需要进一步侵入性研究的重大风险的最佳预测指标。我们认为，RAP对于风险策略是合理的。
