Davis L M, Cooper M J, Sadick N, Byth K, Uther J B, Richards D A, Ross D L
Cardiology Unit, Westmead Hospital, N.S.W., Australia.
Int J Cardiol. 1994 Jun 1;45(1):53-68. doi: 10.1016/0167-5273(94)90054-x.
Sustained ventricular tachyarrhythmias unrelated to coronary artery disease are uncommon. Currently there are no clear guidelines to aid selection of the most appropriate treatment strategy. Therefore, factors potentially predictive of arrhythmia recurrence and death and the ability of the electrophysiologic study to predict treatment outcome in patients with spontaneous sustained ventricular tachyarrhythmias unrelated to coronary artery disease were examined in 41 medically treated patients followed for a median of 25 (range 1-76) months. Examined factors were: syncope associated with the spontaneous arrhythmia, the morphology and cycle length of the presenting arrhythmia, underlying ventricular function, cardiac pathology, and the results of drug assessment at electrophysiologic study. Random variability in the ease of arrhythmia induction at electrophysiologic study was measured for the group as a whole and was allowed for in prediction of an effective drug response. The 95% confidence intervals for variability in the ease of repeat arrhythmia induction at the same study were < or = 1 extrastimulus and for variability in the ease of repeat arrhythmia inductions at different studies were < or = 2 extrastimuli. Poisson regression models were used for data analysis. Arrhythmia recurrence was most likely in: (1) patients on treatment not predicted to be anti-arrhythmic at electrophysiologic study; (2) patients whose treatment was not assessable at electrophysiologic study because the arrhythmia was not reliably inducible; (3) patients with impaired ventricular function; and (4) re-entered patients whose arrhythmia had recurred on previously allocated therapy. The risk of arrhythmia recurrence decreased with time from hospital assessment. All five deaths occurred in patients with impaired ventricular function.
drug efficacy should be tested at electrophysiologic study in patients with reproducibly inducible clinical arrhythmias. Treatment not proven to be anti-arrhythmic at electrophysiologic study is usually ineffective. Patients with ventricular dysfunction are at highest risk of death from arrhythmia recurrence and should be considered for an implantable defibrillator, arrhythmia surgery, or heart transplantation if drug treatment is not predicted to be effective or is not assessable at electrophysiologic study.
与冠状动脉疾病无关的持续性室性心律失常并不常见。目前尚无明确的指南来帮助选择最合适的治疗策略。因此，在41例接受药物治疗的患者中，对可能预测心律失常复发和死亡的因素以及电生理研究预测与冠状动脉疾病无关的自发性持续性室性心律失常患者治疗结果的能力进行了研究，这些患者的中位随访时间为25（范围1 - 76）个月。研究的因素包括：与自发性心律失常相关的晕厥、出现的心律失常的形态和周期长度、潜在的心室功能、心脏病理学以及电生理研究中的药物评估结果。对整个组测量了电生理研究中诱发心律失常难易程度的随机变异性，并在预测有效药物反应时予以考虑。同一研究中重复诱发心律失常难易程度的变异性的95%置信区间≤1个额外刺激，不同研究中重复诱发心律失常难易程度的变异性的95%置信区间≤2个额外刺激。使用泊松回归模型进行数据分析。心律失常复发最可能发生在：（1）在电生理研究中预测无抗心律失常作用的治疗患者；（2）由于心律失常不可靠诱发而在电生理研究中无法评估治疗效果的患者；（3）心室功能受损的患者；（4）重新纳入研究且其心律失常在先前分配的治疗中复发的患者。心律失常复发的风险随距医院评估时间的延长而降低。所有5例死亡均发生在心室功能受损的患者中。
对于临床心律失常可重复性诱发的患者，应在电生理研究中测试药物疗效。在电生理研究中未被证明有抗心律失常作用的治疗通常无效。心室功能障碍的患者因心律失常复发而死亡的风险最高，如果药物治疗在电生理研究中预测无效或无法评估，应考虑植入式除颤器、心律失常手术或心脏移植。
