Hummel J D, Strickberger S A, Daoud E, Niebauer M, Bakr O, Man K C, Williamson B D, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Circulation. 1994 Dec;90(6):2827-32. doi: 10.1161/01.cir.90.6.2827.
Conventional programmed ventricular stimulation protocols are inefficient compared with more recently proposed protocols. The purpose of the present study was to determine if additional efficiency could be derived from a 6-step programmed ventricular stimulation protocol that exclusively uses four extrastimuli.
The subjects were 209 consecutive patients with coronary artery disease and documented sustained monomorphic ventricular tachycardia, nonsustained ventricular tachycardia, aborted sudden death, or syncope. These patients underwent 159 electrophysiological tests in the absence of antiarrhythmic drug therapy and 105 electrophysiological tests in the presence of antiarrhythmic therapy. Programmed stimulation was performed with two protocols in random order in each patient. Both protocols used an eight-beat drive train, 4-s intertrain pause, and basic drive cycle lengths of 350, 400, and 600 ms. The 6-step protocol started with coupling intervals of 290, 280, 270, and 260 ms, which were shortened simultaneously in 10-ms steps until S2 was refractory. The 18-step protocol used one, two and three extrastimuli in conventional sequential fashion. The end points were 30 s of sustained monomorphic ventricular tachycardia, two episodes of polymorphic ventricular tachycardia requiring cardioversion, or completion of the protocol at two right ventricular sites. There was no significant difference in the yield of sustained monomorphic ventricular tachycardia using the two protocols, regardless of the clinical presentation or treatment with antiarrhythmic drugs. Polymorphic ventricular tachycardia occurred with the 18-step protocol twice as frequently as with the 6-step protocol (6% versus 3%, P < .001). The duration of the 18-step protocol was significantly longer than that of the 6-step protocol in patients with inducible ventricular tachycardia (5.5 +/- 7 versus 2.3 +/- 2 minutes, P < .001), as well as in patients without inducible ventricular tachycardia (25.4 +/- 7 versus 6.9 +/- 2 minutes, P < .001).
A stimulation protocol that exclusively uses four extrastimuli improves the specificity and efficiency of programmed ventricular stimulation without compromising the yield of monomorphic ventricular tachycardia in patients with coronary artery disease.
与最近提出的方案相比，传统的程控心室刺激方案效率较低。本研究的目的是确定一种仅使用四个期外刺激的六步法程控心室刺激方案是否能提高效率。
研究对象为209例连续的冠心病患者，均记录有持续性单形性室性心动过速、非持续性室性心动过速、心脏骤停或晕厥。这些患者在未使用抗心律失常药物治疗时接受了159次电生理检查，在使用抗心律失常治疗时接受了105次电生理检查。在每位患者中，以随机顺序用两种方案进行程控刺激。两种方案均采用八次驱动刺激序列、4秒的刺激间期以及350、400和600毫秒的基础驱动周期长度。六步法方案起始的联律间期为290、280、270和260毫秒，以10毫秒步长同时缩短，直至S2不应期。十八步法方案以传统的顺序方式使用一个、两个和三个期外刺激。终点为持续30秒的持续性单形性室性心动过速、两阵需要电复律的多形性室性心动过速或在两个右心室部位完成方案。无论临床表现或是否使用抗心律失常药物治疗，使用两种方案诱发持续性单形性室性心动过速的成功率无显著差异。多形性室性心动过速在十八步法方案中的发生率是六步法方案的两倍（6%对3%，P<0.001）。在可诱发室性心动过速的患者中，十八步法方案的持续时间显著长于六步法方案（5.5±7对2.3±2分钟，P<0.001），在不可诱发室性心动过速的患者中也是如此（25.4±7对6.9±2分钟，P<0.001）。
一种仅使用四个期外刺激的刺激方案可提高程控心室刺激的特异性和效率，且不影响冠心病患者单形性室性心动过速的诱发成功率。
